Firearm Safety Strategies for Pediatric Primary Care
Ann MillerChild Safety, Health & Wellness

December 12, 2024
• Research Highlight

Addressing firearm injuries and fatalities among youth is an urgent public health issue that demands immediate attention. Despite the well-documented benefits of secure firearm storage practices, alarming statistics reveal that fewer than 30% of households with children report that their firearms are stored in a locked and unloaded manner . In an effort to bridge this critical gap, a recent study funded by the National Institute of Mental Health explored the efficacy of two scalable strategies aimed at enhancing safe firearm storage practices during routine well-child visits.

Understanding the Importance of Secure Firearm Storage Programs

Multiple esteemed medical associations, alongside the Office of the U.S. Surgeon General , recognize the vital role of clinicians in disseminating guidance on firearm safety. Pediatric healthcare providers are seen as trusted authorities who routinely engage in safety discussions with parents and guardians. Both parties agree that incorporating conversations about firearm storage safety into these discussions is not only appropriate but essential . By educating parents on safe firearm storage, we can significantly reduce the risk of accidental injuries and fatalities, as research indicates that discussions led by clinicians can effectively improve home storage practices.


In response to this pressing issue, a dedicated team of researchers and healthcare professionals collaborated with firearm safety experts and caregivers to create a comprehensive secure firearm storage initiative known as the S.A.F.E. (Suicide and Accident prevention through Family Education) Firearm program .

A yellow cable lock with a key inserted and safety instructions attached.
Credit: SolidMaks.

Pediatric clinicians introduce this program during well-child visits by initiating a brief yet impactful conversation with parents regarding the critical importance of secure firearm storage. They also provide a complimentary cable lock to facilitate safe storage practices. This initiative is designed for easy implementation, requiring less than one minute of discussion during these routine visits. Previous clinical trials have demonstrated that parents exposed to the original S.A.F.E. Firearm program were twice as likely to adopt safe firearm storage practices at home. Despite its proven benefits, the program’s widespread implementation remains limited, prompting this study to find ways to enhance its adoption.

Exploring the Research Methodology Behind the Study

The research, spearheaded by Rinad Beidas, Ph.D. , at Northwestern University Feinberg School of Medicine, involved testing two distinct approaches to integrating the S.A.F.E. Firearm program into pediatric primary care practices.

Throughout the study, clinicians conducted well-child visits for over 47,300 children aged 5 to 17 years across 30 pediatric clinics that are part of two expansive and diverse healthcare systems located in Michigan and Colorado. The clinics participated in the Mental Health Research Network , a consortium of research facilities focused on enhancing mental health outcomes for patients.

To assess the effectiveness of the secure firearm storage program delivery, the researchers randomly assigned clinics to one of two supportive strategies:

  • Nudge: Clinicians received automatic reminders embedded in patients’ electronic health records to encourage program delivery.
  • Nudge+: In addition to the reminders, clinicians benefited from a year of facilitation support, including guidance on parent interactions, assistance with overcoming implementation challenges, and performance feedback.

Key Findings and Implications of the Study

Before this study commenced, only about 2% of pediatric clinicians reported providing safe storage counseling and distributing cable locks during well-child visits. Following the implementation of either the Nudge or Nudge+ strategies, there was a remarkable increase in clinician engagement in these essential safety behaviors.

Results graph showing Reach on the y axis and the intervention groups (Nudge+ and Nudge) on the x axis. Graph shows that the Nudge+ group had significantly greater reach than the Nudge group.
Reach (percentage of parents who received both components of the firearm storage program) when clinicians used Nudge+ or Nudge. Reprinted from “Implementation of a Secure Firearm Storage Program in Pediatric Primary Care: A Cluster Randomized Trial,” by R. S. Beidas et al., 2024, JAMA Pediatrics, 178(11), pp. 1104–1113. Copyright 2024 Beidas R. S. et al.

While both strategies resulted in increased implementation of the secure firearm storage program, the Nudge+ approach demonstrated significantly greater effectiveness. A notable 49% of clinicians who received Nudge+ delivered the intervention compared to just 22% of those who utilized the Nudge reminder alone.

Additionally, the enhanced support provided by the Nudge+ strategy did not demand extensive resources or significant effort. Clinics utilizing Nudge+ received merely 8.7 hours of supplementary support per clinic annually, primarily delivered through email or chat consultations.

Understanding the Impact of These Results on Pediatric Care

This study represents one of the first and largest investigations in the United States aimed at embedding universal secure firearm storage practices into routine pediatric care during well-child visits. The results underscore the substantial positive influence that low-burden and cost-effective support strategies can have on the implementation of secure firearm storage programs. Coupled with findings from a previous NIMH-funded study highlighting the strong willingness among clinicians to engage parents on the topic of firearm safety, a clear framework emerges for optimizing collaboration between clinicians and parents on this vital issue that can save lives.

While the study boasts numerous strengths, including a diverse participant pool, a randomized design, and an evidence-based methodology, it is important to note some limitations. Notably, there was no control group that followed standard care practices, and there were inherent challenges associated with utilizing electronic health records. The data collected did not specify the duration or extent of clinician discussions regarding firearm storage with parents, nor did it guarantee comprehensive documentation of these interactions. Furthermore, the study exclusively focused on cable locks, leaving open the possibility that other firearm securing methods could be more effective or better received by parents.

Looking ahead, researchers plan to analyze data from parent surveys conducted throughout the study to ascertain whether the secure firearm storage program led to tangible improvements in safety practices at home. Additionally, there are intentions to explore the applicability of these delivery strategies in other youth-serving environments such as community centers, after-school initiatives, and faith-based organizations.

Citation for Further Reading

Beidas, R. S., Linn, K. A., Boggs, J. M., Marcus, S. C., Hoskins, K., Jager-Hyman, S., Johnson, C., Maye, M., Quintana, L., Wolk, C. B., Wright, L., Pappas, C., Beck, A., Bedjeti, K., Buttenheim, A. M., Daley, M. F., Elias, M., Lyons, J., Martin, M. L., … Ahmedani, B. K. (2024). Implementation of a secure firearm storage program in pediatric primary care: A cluster randomized trial. JAMA Pediatrics, 178(11), 1104–1113. https://www.doi.org/10.1001/jamapediatrics.2024.3274

Funding Sources and Acknowledgments

Here you can find the original article; the photos and images used in our article also come from this source. We are not their authors; they have been used solely for informational purposes with proper attribution to their original source.

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6 thoughts on “Firearm Safety Strategies for Pediatric Primary Care”

  1. It’s refreshing to see these discussions around firearm storage, especially given how crucial it is for protecting our kids. Growing up, I remember my parents having conversations about gun safety, and they always reinforced the importance of keeping firearms locked up. It was just part of our household rules.

    Reply

  2. It’s really eye-opening to see such low percentages of households practicing safe firearm storage, especially with kids around. I remember a few years back when a friend of mine shared a story about a tragic accident in their neighborhood involving a child and an unsecured gun. It turned out the family had no idea about the risks. This just reinforces how crucial these conversations are in pediatric healthcare settings.

    Reply

    1. You bring up a really important point about how lacking awareness can lead to tragic outcomes. It’s genuinely disturbing to think about how often these accidents happen because families are simply not informed about the dangers of unsecured firearms. Your friend’s experience serves as a stark reminder of why we should talk about this more openly, especially in communities where kids are present.

      “You’re absolutely right—these conversations are vital! If you’re interested in learning more about safe firearm storage practices and resources to share with families, check out this helpful guide.”
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      Reply

      1. You bring up a really important point about how lacking awareness can lead to tragic outcomes. It’s genuinely disturbing to think about how often these accidents happen because families are simply not informed about the dangers of unsecured firearms. Your friend’s experience serves as a stark reminder of why we should talk about this more openly, especially in communities where kids are present.

        Reply

    2. It’s really sad to hear stories like the one you mentioned, and it’s something that many of us can relate to in one way or another. The statistics on safe firearm storage really are alarming, especially when we consider that kids are naturally curious and may not fully understand the dangers. Conversations about firearm safety don’t just belong in discussions among adults; they really need to happen in pediatric healthcare settings as you pointed out.

      Reply

    3. You bring up such an important point about the tragic incidents that can happen when gun safety isn’t taken seriously, especially with kids around. It’s heartbreaking to think about families who, like your friend’s neighbors, may not even realize the extent of the risk until it’s too late. It highlights how vital it is for us, as a community, to not just talk about safe gun storage but to really engage with families directly.

      “I completely agree; these discussions are vital! For more insights and tips on promoting safe firearm storage, check out this resource.”
      https://www.mentalhealthtips.xyz/6nz4

      Reply

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