Reducing Youth Firearm Injuries and Suicides Community Collaboration -- Gun Laws

In 2012, 9-year-old Maximos Herbert discovered a loaded and unlocked gun underneath his father's bed and a few minutes later an accidental gunshot wound to the head ended his life (Brindley, 2013). According to the prosecutor who charged Mr. Herbert with negligent storage of firearms, parents involved in such incidents are so traumatized by the death or injury of their child that rarely are they prosecuted or serve time. Yet parents continue to store loaded and unlocked guns in their homes. To make matters worse the National Rifle Association (NRAs) continues to promote gun ownership among 5- to 12-year-olds with similarly tragic results (DeFilippis & Hughes, 2014). In Kentucky, 2-year-old Caroline Starks was fatally shot by her 5-year-old brother minutes after he received a .22 caliber rifle for his birthday. The mother, believing the rifle was unloaded, had left the room for only a moment when the tragedy occurred.

In an attempt to stem the tide of injuries and deaths resulting from loaded and unlocked guns in the hands of children, several states have passed child access prevention (CAP) laws (Brindley, 2013). Despite the mounting evidence that that these laws are effective (Webster, Vernick, Zeoli, & Manganello, 2004; Hepburn, Azrael, Miller, & Hemenway, 2006; DeSimone, Markowitz, & Xu, 2013) some states continue to allow parents to store unlocked and loaded firearms in their homes within easy reach of children. Towards the goal of reducing the prevalence of youth injuries and death due to improperly secured firearms this essay will propose a community collaboration to address this issue. The relevant stakeholders will be identified and the communication strategy discussed in detail.

Justification for a Community Coalition

Webster and colleagues (2004) examined the relationship between gun laws and the suicide rates among teens. The gun laws of interest were age restrictions for the purchase/possession of handguns and CAP laws, while the outcome of interest was suicides with firearms. Of the two types of laws, only CAP laws were associated with a significant reduction in firearm suicides for the age group 14 to 17 (rate ratio, 0.89; 95% CI, 0.83-0.96). This finding is particularly salient given that 62% of all suicides between the ages of 14 and 20 are committed using a firearm; between the years 1976 and 2001 almost 40,000 adolescents ended their lives in this manner. When the rates of firearm-related deaths were evaluated across states with and without CAP laws, only Florida and California experienced significant reductions in this outcome for the age group 0 to 14 (Hepburn et al., 2006). The rates of firearm accidental deaths among this age group were also impacted by the severity of the penalty assessed against the responsible parent or caregiver, such that states that impose felonies experienced the greatest reduction in firearm-related deaths. Firearm-related injuries among youth are much more common, with close to 6,000 reported for 2009 alone (DeSimone, Markowitz, & Xu, 2013). An examination of hospital discharge data for the period from 1988 to 2003 revealed that CAP laws were associated with a 26% reduction in self-inflicted, non-lethal gun injuries among youth. The economic benefit realized by preventing these injuries was estimated to be in the millions due to reductions in direct and indirect health care costs. Clearly, there appears to be a significant individual and societal benefit associated with CAP laws.

Communicating the necessity of locking guns in homes with children has been problematic (Coyne-Beasley, Schoenbach, & Johnson, 2001). Parent education in the primary care setting seems to have little effect, but a program that provided confidential firearm safety counseling, free gun locks, and unlimited access to health care professionals for counseling had a significant impact (p = .02) on storage practices among gun owners with children. This program involved a community coalition consisting of firearm safety experts, law enforcement personnel, and health professionals. Locking unloaded guns separately from ammunition and in a location inaccessible to children is considered best practice by the Children's Safety Network (2013).

Improving Firearm Storage Safety Practices in Homes with Children

The possible participants in community collaboration to reduce youth gun accidents were alluded to in the preceding paragraph. Gun safety experts, law enforcement professionals, and health professionals would constitute the professional arm of the collaboration. However, community collaborations have been defined as a collaborative effort between professionals and grassroots leaders with the aim of providing a place at the table for those most impacted by the health or safety issue (Clark et al., 2006). Securely storing firearms to protect children from harm has the greatest impact on parents, aside from the children, so the success of...

Even parents who diligently secure their firearms away from their children would have a stake in the outcome because their child could gain access to an unlocked and loaded weapon in a friend's home or be exposed to a loaded weapon should a fellow classmate bring his or her father's gun to school. In addition to parents, youth should be actively encouraged to contribute to the collaboration because they may provide unique perspectives and feedback on firearm safety in their own homes and the homes of their friends (Center for Prevention Research and Development, 2006, p. 3). Attaining a critical mass of parent and youth participation would be essential to a successful collaboration.
The ultimate responsibility for improving the health of a community resides with the government, in the form of the public health department (Institute of Medicine, 2002, p. 185). Engaging the participation of the public health department is essential for two reasons. First, the success of any public health initiative depends to a significant extent on cooperation between the public health department and stakeholders in the community. Second, the local health department can provide an invaluable service by setting an evidence-based agenda. Although the health department could also assume the role of leadership, members of the public who have the greatest stake in the outcome would be the best choice because public health departments are bureaucracies and therefore prone to indifference. The public health department can best serve the collaboration by providing the information, planning, and funding necessary to make the collaboration a success.

Other important considerations are the history, neighborhood environment, and economic, ethnic, political, and religious diversity of the target community (Center for Prevention Research and Development, 2006, p. 3). Accordingly, the success of the collaboration's mission will be proportional to how representative the participants are of the community. In addition, each participant should enjoy equal standing within the collaboration.

If a representative sample of gun shop owners could be convinced to become active participants, the collaboration would be strengthened in a number of ways. Gun shop owners could act as gun safety and gun lock experts, in addition to providing information to customers at the point of sale. The Chamber of Commerce should be encouraged to participate, not only because many of the members are probably parents, but also because participation would provide access to corporations within the community through a respected partner and provide a valuable conduit for communication to the wider community.

Communications analysis

The main stakeholders in the collaboration are the following: (1) parents, (2) youth, (3) public health department, (4) primary care providers, (5) law enforcement, (6) gun shop owners, and (7) the chamber of commerce. Other possible participants include school boards, school administrators, teachers, healthcare organizations (hospitals and insurers), and child safety advocacy organizations like the Children's Safety Network (2013). Although a top-down approach to building the collaboration seems feasible, if not optimal, experience with such programs has shown this strategy to be ineffective (McLean, 1997). The approach with the best record of success is community-driven, where the experts serve supportive roles. Community leaders, including political and religious leaders, can therefore play an important role in ensuring the community is the loudest voice in the room. The engagement of political leaders will also be necessary for pushing CAP legislation towards passage.

Effective communication is key to any successful collaboration (McLean, 1997). Of primary importance is credibility, which can be achieved by the hiring of community members that will be perceived as representative. This eliminates the distrust that experts seem to naturally elicit in non-experts. Once the 'face' of the collaboration mirrors the wider community it becomes easier to implement a Freirian approach to community mobilization, which consists of listening, dialogue, and action. Listening involves experts gaining access to the community through credible representatives so that they can learn about the history and perspectives of the community. Listening, if done well, will also help to build relationships with members of the community. For this collaboration, listening would probably involve attending school board meetings, PTA nights, town hall meetings, and talking with various stakeholders, including law enforcement personnel, gun shop owners, business owners, primary care providers, clinicians staffing emergency departments and pediatric wards, parents, and children.

During this process extensive field notes are taken, which will form the foundation upon which dialogues with community members will be undertaken…