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. Author manuscript; available in PMC: 2020 Dec 10.
Published in final edited form as: JAMA Pediatr. 2019 Aug 1;173(8):780–789. doi: 10.1001/jamapediatrics.2019.1494

Table 1.

Areas to Prioritize Research and Investment for Surveillance, Epidemiology, and Risk and Protective Factors of Child and Adolescent Firearm Injury Prevention

Priority Area Sample of Urgent Research Questions in This Priority Area
Understand recent epidemiologic trends and how demographic factors (race/ethnicity, sex, and socioeconomic status), development stages, and environmental differences (urban vs rural location, neighborhood effect, and culture) are associated with fatal and nonfatal firearm outcomes • How is the epidemiology of nonfatal firearm injuries similar or different from fatal firearm injuries?
• What explains underlying racial disparities observed across different types of firearm outcomes?
• What underlying factors beyond poverty differentiate different types of firearm injuries across regions of the United States?
• What is the role and involvement of girls and rural or sub urban children in firearm injury and firearm culture?
• Which risk and protective factors are most salient at which developmental period?
• How does developmental stage affect risk and protective factor exposure?
Understand how children and adolescents acquire firearms and patterns of adolescent firearm carriage • What are the different subgroups of adolescents who carry firearms (eg, episodic carriers vs persistent firearm carriers) and what factors differentiate these subtypes?
• What factors contribute to initiating and discontinuing firearm carriage?
• How do children and adolescents acquire or gain access to firearms?
• What is the motivation for acquisition, ownership, and carriage of firearms in adolescence?
• How does firearm diversion from the legal market to the illegal market affect child and adolescent firearm outcomes?
• What is the concordance or discordance between parents and their children regarding knowledge of firearm access and prior firearm handling among children?
Understand the incidence, patterns, and outcomes associated with defensive firearm use among children, adolescents, and their family members • How often, and in what circumstances, are children and adolescents actively protected by their own self-defensive firearm use or that of someone else (eg, friend, parent, or acquaintance)?
Understand the immediate and long-term costs associated with pediatric firearm outcomes • What are the immediate (eg, health care costs) and long-term (eg, criminal justice, disability, mental health, and societal) costs?
Understand how the availability, storage, and presence or use of a firearm in the home and/or in schools affects child and adolescent firearm outcomes • How are firearms stored in households with children and adolescents?
• How many schools in the country have armed adults?
• Among households with children, how do the characteristics of those with firearms differ from those without a firearm?
• How do the characteristics of firearm-owning households with children that practice safe firearm storage differ from households not practicing safe firearm storage?
• How do parents’ perceptions and attitudes toward firearm ownership and storage affect risk among children?
• How are storage decisions made in homes with children and adolescents?
Understand risk factors and their underlying mechanisms across ecological levels, especially those that extend beyond the individual level to include community, school, family, and peer factors • What are the risks across multiple ecological levels, with a focus on understudied family-level (including adverse childhood experiences and family intimate partner violence), school-level, and community-level factors?
• How does the socialization of children in a firearm culture (eg, hunting and media) and/or exposure to firearm violence (eg, neighborhood violence, violence in the home environment, and media portrayals of violence) positively or negatively influence outcomes?
• What event, situational, and contextual factors, including social network and contagion models, are associated with firearm outcomes?
Understand protective factors for firearm outcomes and their underlying mechanisms across all individual and socioecological levels (community, school, family, and peers) • What are key protective factors across ecological levels for child and adolescent firearm outcomes (before and after a firearm injury), and how do those factors interact with effects of risk?