Incorporating Gun Safety into Routine Pediatric Wellness Visits
A Complete Approach to Public Health
The mission of the Stamford Pediatric Gun Safety Project is to collect and analyze empirical evidence of the barriers that Stamford pediatricians face while providing anticipatory guidance on firearm safety.
Introduction Aligned with the American Association of Pediatric's recommendations on gun safety, the purpose of the Stamford Pediatric Gun Safety Project is to support local pediatricians with the tools and encouragement to provide families with advice on firearms in the home. The Project encourages pediatricians to engage with parents and guardians to regularly incorporate gun safety into routine wellness visits, and aims to address barriers to preventing youth suicide, gun injury, and unintentional death.
The Stamford Pediatric Gun Safety Project intends to avert tragedy by implementing a quantitative survey of primary care pediatricians to collect data to ascertain the barriers in doctors’ communications with patients in discussing gun safety. The Project will follow up by addressing any barriers discovered and employing possible solutions.
Whole Safety Care for Children, Adolescents, and Teens A pediatrician will ask a variety of age-appropriate questions that focus on developmental milestones, nutrition, family medical history, safety, the child and family's emotional well-being, and more. Doctors take special care to learn about their patient and the family.
"Do you own a car seat?" "Do you have a smoke detector installed in the home?" "Do you own a firearm?" How many pediatricians ask all three of these routine safety questions during regular wellness checkups?
A 2005 study on adult firearm storage practices in U.S. homes found that over 1.69 million children and youth under age 18 are living in homes with loaded and unlocked firearms. But it also found that the practices of keeping firearms locked, unloaded, and storing ammunition in a locked location separate from firearms serve as a protective measure to reduce youth suicide and unintentional injury in homes with children and teenagers where guns are stored.
According to the Gun Violence Archive, as of March 27, 2017, there have been in the U.S. 493 unintentional shootings, 140 children (age 0-11) shot or killed, and 713 teenagers (age 12-17) shot or killed, this year alone.
The American Association of Pediatrics recommends that pediatricians incorporate questions about guns into their patient history taking and urge parents who possess guns to remove them, especially handguns, from the home. Scientific studies have found overwhelming evidence that a gun in the home is a risk factor for completed suicide and that gun accidents are most likely to occur in homes with guns. The Stamford Pediatric Gun Safety Project recognizes that guns in the home is a health and safety issue, and that gun violence is a matter of public health. Therefore, gun safety should be incorporated into the pediatrician’s regular roster of safety checks for each patient.
While we may know anecdotally that many doctors do have this conversation with their patients and parents, we do not know if all Stamford pediatricians discuss gun safety, and if those who do not - or are apprehensive about initiating the subject - we do not know the reasons. It is the intention of this Project to identify and address barriers to discussing gun safety during wellness visits.
The Project seeks a researcher to help to design a survey, identify variables to be examined, to help advise in writing an abstract outlining objectives, methods, results, and conclusions, and offer the Project director general guidance.
In addition, the Project also seeks guidance from a pediatrician who can advise the Project director in seeking out potential survey respondents.
Coordinating the Project will be director Shira Tarantino. She will oversee all operations, and will implement survey administration and follow-up.
A timeline will be established by both the Project researcher and Project coordinator.
Pediatricians routinely discuss gun safety with parents.
Pediatricians are aware of the American Association of Pediatric’s recommendations of incorporating safe gun storage into basic safety conversations.
The gun safety discussion is framed by the pediatrician as a public health issue.
Parents are receptive to counseling about firearm safety within the context of locking up other items that should also be unavailable to children, such as prescription drugs and cleaning products.
Pediatricians recommend parents to ask other parents prior to play dates if there are guns in the home.
Pediatricians recommend parents to ask relatives prior to visits if there are guns in the home.
Pediatricians regularly and proactively offer supplemental materials about gun safety for parents to take home and read.
Gun safety materials are available in the office and/or waiting room to take home and are also posted on display in plain view at the office.
The gender of the pediatrician and/or the gender of the parent plays a role in the discussion of gun safety.
Race of the pediatrician and/or the race of the parent plays a role in the discussion of gun safety. [Gather respondent estimates of socioeconomic characteristics of families seen in their practices.]
Language barriers prevent pediatricians from discussing gun safety with a parent.
The pediatrician finds it difficult to discuss gun safety with parents.
Does the pediatrician find it harder to discuss gun safety with some parents than others? If yes, then why?
Pediatricians work in a supportive environment whereby co-workers accept the gun safety query to patients' families as acceptable.
Doctor stats to be collected:
Office zip code
Medical Doctor or Nurse Practitioner? (If the pediatric group offers NPs as an alternative to pediatricians to perform wellness visits, they should be filling out this survey.)
What percentage of patients at pediatrician’s practice live in Stamford?
Pediatricians surveyed must have a Stamford-based practice to qualify as a respondent.
Stamford stats to be collected:
How many pediatricians are in Stamford? (and how many pediatric practices are there in Stamford?)
How many children under the age of 18 live in Stamford? (US Census)
How many non-Stamford residents see Stamford-based pediatricians?
How many Stamford children see doctors not based in Stamford?
Ideally, surveys will be anonymously collected and quantified. However, if possible, non-responding pediatricians may be asked why they did not respond to the survey (response choices may be, for example, not enough time, not that important of an issue, not an issue that is relevant to public/children’s health and safety, etc.), which could help lead to more determinations.
The Project will be designed to be a replicable survey template to share with other cities across Connecticut.
Empirical data gathered from Project queries could help us prevent the toddler from finding a parent's gun and shooting a sibling. It could prevent the depressed teen from having access to their parent's pistol when they try to solve a temporary problem with a very permanent solution. The outcomes of the Stamford Pediatric Gun Safety Project are prevention-driven, and therefore aim to hasten the number of children and adolescents who are hurt or who die each year from gun-related injuries.
Pediatricians inherently have a chance to educate families. Discussion with a trusted pediatrician of the statistically-proven dangers that a firearm can impose on a family may inspire families to think twice about keeping a gun in the home or even purchasing a firearm.
In collecting local data specific to gun safety and the barriers to administering gun safety information, we can create measurable outcomes that will support the prevention of gun injury, including unintentional injury and death, homicide, and suicide in children and youth in Stamford.
Projected Impact This project has the potential to impact all children whose families see Stamford-based pediatricians. According to the U.S. Census of the state of Connecticut, with 5.1% population growth from 2010 to 2015 factored, there are an estimated 27,840 children under the age of 18 in the City of Stamford, 30% of whom are under age five. Potentially, thousands of children in Stamford may be impacted by the Stamford Pediatric Gun Safety Project.
What Happens Afterward?
Study findings will be analyzed in order for the project to make certain recommendations in support of gun safety and wellness for families with children. Findings may be shared with survey respondents, other area pediatricians, Stamford residents, the American Association of Pediatrics, and anyone who has a stake in children's health. Findings may be publicized in a manner that aligns with and supports the mission and purpose of the Project.
The results of this project are intended to support the health and well-being of children in the City of Stamford, bolster home and community safety, and keep Stamford a great place to live, work, and raise a family.
Thank you in advance for considering this initiative as a viable community project with the potential to avert tragedy and make a difference in the lives of children.