University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• Firearm related injury and death in children and adolescents is a public health problem in the United States. Would physician counseling in the context of an office visit be effective in promoting safe gun practices or reducing the number of homes with firearms?

Clinical Bottom Lines

1. In this randomized controlled trial, it does not appear that a brief, one time intervention in the context of a well child visit is effective in reducing firearm acquisition, leading to removal of firearms from the home or leading to higher rates of firearm safety device use.¹

Summary of Key Evidence

1. This study involved nine clinics in an urban/suburban area at which providers were randomized to either give a brief 60 second counseling intervention on gun safety and provide their patients with gun safety materials or to conduct well child visits per usual. 
2. Intervention and control groups of patients were demographically similar (618 families in intervention, 677 in control; almost equal percentage of male patients; similar racial backgrounds; both with gun ownership approaching 24%).  
3. Surveys were completed by families before the well child visit and 30 to 60 days after the visit.  
4. No statistically significant differences in acquisition of new firearms, removal of firearms from the home or acquisition of safety devices was found, although 8.0% of families in the intervention group purchased trigger locks compared with only 2.5% of families in the control group.

Additional Comments

• Other studies reviewed revealed that families in general are honest about their gun ownership status so it is likely that self reporting was accurate in the study.²
• Despite failure to show significant differences in this study, counseling may be more effective over the long term and is not harmful.  We know that behavior change does not occur quickly and this seems like it would be similar to smoking cessation which often requires repeated messages and office visits before patients become motivated to quit.  Physician organizations such as the AAP are strongly endorsing gun safety counseling in the context of health supervision visits.
• Laws vary from state to state regarding gun control and safety requirements so it may be difficult to come up with standardized counseling formats.
• No study has as of yet shown trigger locks and safety devices to be effective in prevention childhood death and injury by firearms. 

Citation

1. Grossman DC, et al.  Firearm safety counseling in primary care pediatrics: A randomized, controlled trial.  Pediatrics  2000; 106(1).
2. Becher EC, Christakis NA.  Firearm injury prevention counseling: Are we missing the mark?  Pediatrics 1999; 104(3).
3. AAP guidelines on firearm counseling.

CAT Author: Andrea Nederveld, MD

CAT Appraisers: Jonathan Fliegel, MD

Date appraised: September 11, 2001