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Short Counseling on Firearm Safety During Well Child Exams has Minimal Effect on Parental Firearm Ownership and Storage Practices

Question

  • In families who own guns, does firearm safety counseling during well-child visits, as opposed to usual care, decrease unsafe gun storage behaviors?

Clinical Bottom Lines

  1. Short counseling sessions in the context of well-child visits were not associated with decreases in gun ownership or safe storage practices.
  2. Counseling on the dangers of firearms does not prevent people from buying them.
  3. There was a strong trend toward purchase of trigger locks in the subset of patients who already had guns; however this failed to reach statistical significance. If you are willing to accept a higher p-value, the number needed to treat is 18, comparable with the efficacy of other counseling strategies.
  4. Even if one accepts this trend, the actual effect on firearm injuries is unclear.


Summary of Key Evidence

  1. Firearms are a significant cause of injury and death, both intentional and unintentional. Because most gun-injured patients die prior to reaching the hospital, primary prevention is crucial.
  2. A study of 1295 patients in a primary care setting selected from an HMO randomized patients to receive brief (60sec) verbal and written information on firearm safety in the context of a regular well-child visit or to routine care. Patients were surveyed on a variety of safety practices, but study focused on answers to firearm-related questions.
  3. Outcome measures were removal or acquisition of a firearm from the home or purchase of a safety device (gun lock box, locking gun cabinet, gun safe, or trigger lock).
  4. In the overall sample there were no significant differences between intervention and control groups.
  5. In the subset of patients who already owned firearms 8.0% in the intervention group purchased trigger locks vs. 2.5% in the control group. (p=0.06) With an absolute risk reduction of 5.5, the number needed to treat is 18.

Additional Comments

  • A similar study in 2003 examined the effect of verbal and/or written information on handgun safety in 156 of 1233 screened patients who owned firearms in a family medicine clinic (both adults and children, both acute and health maintenance visits). These investigators found that the intervention group was nearly twice as likely to make a "safe change" in handgun storage practices after a brief intervention. P=0.017, NNT 3.5 patients. Method of data collection was different, with entire survey devoted to firearm safety.

Citation

  1. List references here

CAT Author: Jennifer Laundy Meyers, MD

CAT Appraisers: Eugene Golding , MD

Date appraised: May 14, 2003

Last updated June 15, 2003
Department of Pediatrics and Communicable Diseases
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