Improving Firearm Safety in Pediatric Primary Care
• Research Highlight
Firearm injuries and deaths among young people are a major public health concern. While secure storage is a proven safety measure, less than 30% of homes with children report storing firearms locked and unloaded . In a new study funded by the National Institute of Mental Health, researchers aimed to address this gap by testing the effectiveness of two scalable approaches to promoting safe firearm storage when used during routine well-child visits.
What is the secure firearm storage program?
Multiple medical associations and the Office of the U.S. Surgeon General endorse clinicians as a critical source of firearm-related safety guidance. Pediatric clinicians are trusted messengers who regularly discuss safety topics with parents and other guardians, and both parents and clinicians feel it is appropriate to include firearm storage alongside other safety discussions. Teaching parents how to store firearms securely can help save lives, with studies showing that clinicians talking to parents about firearm safety improves storage practices at home.
With this in mind, a team of researchers and clinicians (in partnership with health leaders, firearm safety experts, and caregivers) developed a secure firearm storage program called S.A.F.E. (Suicide and Accident prevention through Family Education) Firearm .
Pediatric clinicians deliver the program during well-child visits. It consists of having a brief conversation with parents about the importance of secure firearm storage and offering them a free cable lock. The program is easy to implement and takes up less than a minute during well-child visits. In a prior clinical trial , parents who received the original S.A.F.E. Firearm program were twice as likely to store firearms safely at home. However, the program has not been implemented widely, and this study sought to make it easier to do so.
What did researchers do in the study?
The research team, led by Rinad Beidas, Ph.D. , at the Northwestern University Feinberg School of Medicine, tested two approaches to implementing the S.A.F.E. Firearm program in pediatric primary care.
Clinicians saw over 47,300 children aged 5 to 17 years for well-child visits during the study. The visits took place at 30 pediatric clinics in two large and diverse health care systems in Michigan and Colorado. The participating clinics were part of the Mental Health Research Network , a consortium of research centers located in health care systems and dedicated to improving patient mental health.
The researchers randomly assigned the clinics to use one of two simple support strategies and compared the strategies’ effectiveness in promoting the delivery of the firearm program:
- Nudge: Clinicians were reminded to deliver the program via an automatic reminder in patients’ electronic health records.
- Nudge+: Clinicians received the reminder plus 1 year of facilitation to implement the program (examples of facilitation included guidance on talking to parents, help with implementation roadblocks, and feedback on clinic performance).
What did the study find?
Before the study, about 2% of pediatric clinicians reported offering safe storage counseling and cable locks during well-child visits. Following the use of Nudge or Nudge+, the number of clinicians engaging in those behaviors rose significantly.
Although both strategies led to an increase in delivering the two components of secure firearm storage, the Nudge+ strategy (reminder and facilitation) proved to be much more impactful. Significantly more clinicians who received Nudge+ delivered the intervention (49%) compared to those who received the Nudge reminder only (22%).
Not only did the extra support increase the delivery of the program, but it did not require a lot of extra resources or effort. Nudge+ clinics received only 8.7 hours of additional support per clinic each year, which mainly came from email or chat.
What do the results mean?
This is one of the first and largest studies in the United States focused on implementing universal secure firearm storage as a routine and regular part of well-child visits. The findings demonstrate the large positive impact of using low-burden and relatively inexpensive support strategies to deliver a secure firearm storage program during pediatric primary care. Combined with results from a prior NIMH-funded study demonstrating the high support among clinicians in engaging with parents about firearm storage safety, a compelling picture emerges about how best to support clinicians and clinics in collaborating with parents around this life-saving topic.
The study had many strengths, including diverse participants, a randomized study design, and an evidence-informed approach. However, it also had some limitations. For instance, there was no control group that delivered care as usual. There are also the constraints of electronic health records: The data do not indicate how long and to what degree clinicians discussed firearm storage with parents, nor is it guaranteed that clinicians always documented those talks. In addition, the study focused only on cable locks, and there may be other methods for securing firearms that are more effective or more acceptable to parents.
Next steps for the researchers include analyzing data from surveys conducted with parents throughout the study to determine whether receiving the secure firearm storage program improved actual safety practices at home. The researchers also plan to test these strategies for delivering the program in other settings that serve youth, like community centers, after-school programs, and faith-based organizations.
Reference
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