Kathleen Louden

November 23, 2015

CHICAGO — Physicians must do more to help reduce the rate of gun-related injuries and deaths, according to an impassioned panel of experts discussing gun violence and the impact on children here at the American Public Health Association (APHA) 2015 Annual Meeting.

"One in five deaths in young people ages 15 to 29 are from firearms — a stunning number," said panel member Eric Fleegler, MD, MPH, a pediatric emergency medicine physician from Boston Children's Hospital.

"If these were deaths due to cancer, we would find this outrageous," he pointed out.

On average, every day in the United States there are 31 homicides, 55 suicides, and two unintentional shooting deaths that involve guns, and children and teenagers are often the ones who are shot, according to statistics published on the Brady Campaign to Prevent Gun Violence website.

In nearly half of households with a child and a gun, the firearm is stored improperly, Dr Fleegler reported.

He called for "a more concentrated approach across the country" to decrease the rate of firearm-related injury, which drew applause from the audience.

"Physicians are not going to solve the problem of firearm violence, but we can be part of trying to solve it," he told Medscape Medical News.

What Physicians Can Do

Clinicians could play a major role in reducing children's access to guns, said Dr Fleegler.

"Pediatric offices often give out infant and child car seats. We could do this with gun lockboxes and trigger locks," he explained.

Patient counseling could also help improve gun-storage practices. One study showed that patients who received in-office counseling on firearm storage from a family medicine physician were more likely to make a safe change in gun storage than those who received no intervention (64% vs 33%) (J Am Board Fam Pract. 2003;16:40-46).

Dr Fleegler proposed a five-pronged public health approach to reducing firearm-related injuries.

A Five-Pronged Public Health Approach

First, he recommended that providers ask about gun ownership when taking a health history.

His other recommendations focused on legislation, regulation, and research. He called for better firearm-related legislation, which includes laws on safe storage, trigger locks, and criminal background checks for all firearm purchases; for firearms to be regulated as a consumer product, which would encompass consumer safety; for the robust collection of data on gun-related fatalities and firearm sales, which could be used for research; and for research on the reduction and prevention of firearm-related injuries and deaths to be funded at a rate commensurate with the scope of the problem.

Dr Fleegler was involved in a study that demonstrated that states with a higher number of gun control laws had a lower rate of firearm-related fatalities (JAMA Intern Med. 2013;173:732-740), as reported by Medscape Medical News. However, cause and effect could not be established, he said.

Despite this finding, since the December 2012 shootings at Sandy Hook Elementary School in Newtown, Connecticut, most state firearm laws have loosened gun control, Dr Fleegler reported, which elicited murmurs of disbelief from the audience.

I don't think we need to change the Constitution, we just need to change how we use guns.

One audience member expressed a desire to see a change to the Second Amendment in the United States Constitution.

"I don't think we need to change the Constitution, we just need to change how we use guns," said Dr Fleegler. "We want to make them safe."

He is adamant that guns need to be regulated for safety, as are other consumer products in the United States.

"It's insane that firearms are not regulated, considering the number of people who are maimed and killed by guns," he told Medscape Medical News. "Teddy bears are regulated," he pointed out.

Regional and cultural views on gun ownership and the durability of guns already sold are among the challenges related to reducing gun violence, Dr Fleegler explained.

Community-Based Strategies

The discussion covered community and school-based prevention strategies against gun violence, and none of the panelists presented any views opposing those of Dr Fleegler.

People who use guns do not listen to scientists or public health professionals, said one conference delegate. "We need to get the word out, not just on the internet, but also to politicians, the faith community, and other community leaders who might have stronger influences," she said after the discussion.

"The community needs to be involved," said session moderator Jacob Kopp, MD, who is a member of the APHA Injury Control and Emergency Health Services Section.

"I think a comprehensive public health approach is the best way to fight gun violence," he said.

Most pediatricians support the idea of asking patients during a visit if guns are in the home and how they are stored, said Denise Dowd, MD, lead author of the American Academy of Pediatrics (AAP) 2012 position statement on firearms and a member of the AAP Council on Injury, Violence, and Poison Prevention (Pediatrics. 2012;130:e1416- e1423).

Dr Dowd, who did not attend the APHA panel session, said she is unaware of any objective evidence on how many pediatricians are having this conversation with patients' families.

Gun control is an unnecessarily politicized issue, she said.

"We're not saying, 'You shouldn't have a gun'," she told Medscape Medical News. "We're saying, 'If you own a gun, you have a responsibility to keep your gun unloaded and locked away from your kids'."

However, the AAP, in its firearms position statement, affirms that the absence of guns in homes and communities is "the most effective measure to prevent suicide, homicide, and unintentional firearm-related injuries."

Earlier this year, the AAP and APHA joined six other health professional organizations to reiterate their support for a public health approach to reduce the rate of firearm injuries and deaths in the United States. Similar approaches have succeeded in reducing tobacco use and in decreasing motor vehicle deaths by requiring seat belts (Ann Intern Med. 2015;162:513-516).

However, Dr Dowd said she does not think the call to action is working.

"But we'll keep raising our voices over and over. We're not giving up," she said. "It's about keeping kids safe."

Dr Fleegler, Dr Kopp, and Dr Dowd have disclosed no relevant financial relationships.

American Public Health Association (APHA) 2015 Annual Meeting: Abstract 327079. Presented November 4, 2015.


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