Youth Firearm Injury Prevention: Applications from the Centers for Disease Control and Prevention–Funded Youth Violence Prevention Centers

The Centers for Disease Control and Prevention (CDC)–funded Youth Violence Prevention Centers (YVPCs) apply different models to reduce youth violence that are applicable to firearm violence because they are comprehensive, cut across ecological levels, and involve multisector partners that inform firearm injury prevention strategies. In addition, all YVPCs engage youths and communities in reducing violence, which may also be a useful approach to the prevention of firearm violence. YVPCs’ role in helping to address firearm violence is vital for public health because in 2019 firearms were the leading mechanism of death among youths aged 10 to 24 years in the United States.¹ Of the 7779 firearm-related deaths among youths in this age group in 2019, 4483 (57.6%) were attributable to homicide; 2972 (38.2%) to suicide; and 324 (4.2%) to unintentional, undetermined intent, or legal intervention.¹ In addition, firearms accounted for 4483 (90.3%) of the 4965 youth homicide deaths and 2972 (45.8%) of the 6488 youth suicide deaths in 2019.¹ In 2019, the youth firearm homicide rate was 7.06 per 100 000 and the youth firearm suicide rate was 4.68 per 100 000. Non-Hispanic Black youths experienced firearm homicide rates (31.02 per 100 000) that were 17.5 times higher than those of non-Hispanic White youths (1.77 per 100 000), and firearm homicides among non-Hispanic Black youths accounted for 66.2% of all youth firearm homicides in 2019.¹ In total, 7455 youths aged 10 to 24 years died by firearm homicide or suicide in 2019, which translates to more than 20 youths dying every day from these firearm-related injuries.¹ Overall, youth firearm mortality rates in 2019 were higher in rural areas (13.25 per 100 000) than in urban areas (12.00 per 100 000). Youth firearm suicide rates were higher in rural areas than urban areas (7.64 vs 3.48 per 100 000), and youth firearm homicide rates were higher in urban areas than rural area (8.14 vs 4.84 per 100 000).² Firearm-related mortality rates for youths have surpassed rates of motor vehicle (MV)–related deaths in the United States since 2016.¹ The fact is that between 2008 and 2017, the federal government spent on average $1 million annually on research addressing firearm-related deaths among those aged 1 to 18 years, compared with $88 million annually on research for MV-related deaths among youths.³

MULTIDISCIPLINARY PREVENTION STRATEGY

Prevention research strategies addressing firearm-related injuries require a multidisciplinary approach to identify modifiable risk and protective factors across multiple levels of the social ecology (https://bit.ly/31eSxUM). Over the past 20 years, federal funding of firearm research by the CDC and other federal agencies has been lower relative to other major causes of violence-related injury and death.³ At the federal level, Congress recently appropriated $25 million in fiscal year 2020 ($12.5 million each for the CDC and the National Institutes of Health [NIH]) to support this work (https://abcn.ws/2WU0wTD). This funding allows researchers to design studies specifically for firearm injury prevention.⁴ Our nation’s significant research investments to reduce MV-related morbidity and mortality have resulted in a range of evidence-based prevention strategies that cut across ecological levels, including behavioral (driver training), engineering (car design), and policy (graduated licensure) approaches.³ A similar approach to promote firearm safety can help reduce firearm-related morbidity and mortality among youths.

YVPC ECOLOGICAL APPROACH

The YVPCs have developed research and prevention approaches that inform both youth violence and firearm violence prevention by addressing common modifiable risk and protective factors. The University of Michigan YVPC, for example, focuses on community-engaged neighborhood improvement projects as a strategy to create protective community environments. This project, building on vacant lot remediation research shown to reduce gun assaults and youth homicide (https://bit.ly/3fNrDrW), includes working with local agencies in three cities to apply Busy Streets Theory⁵ to rehabilitate vacant properties, plant gardens, or create physical change that denotes ownership and community care (fencing, signage, mowing) to create vibrant and safe communities. The rehabilitation involves neighborhood residents, which builds social capital, cohesion, and collective efficacy. The Michigan YVPC also helped to develop an emergency medicine–based program (SafERteens) that reduces violence behaviors (e.g., aggression)⁶ and is included in the CDC’s comprehensive technical package of youth violence prevention strategies based on the best available evidence (https://bit.ly/3bynsgG). Researchers from the Michigan YVPC were involved in creating the NIH-funded Firearm Safety Among Children and Teens consortium of academics and practitioners that focuses on advancing firearm research through scoping reviews to define the state of the field and directions for research, developing a pipeline for training postdoctoral fellows, establishing a data repository, and funding pilot studies.⁷ The University of Louisville–Vanderbilt University YVPC partnership is focused on changing the narrative about youth violence for both residents and researchers. It emphasizes structural determinants of youth violence and engages youths in a community-wide campaign of diverse strategies to raise critical consciousness about the root causes of inequities in violence and about how addressing structural violence is youth violence prevention.

The University of Chicago, University of Colorado, and Virginia Commonwealth University (VCU) YVPCs are implementing tailored adaptations of the Communities That Care model (CTC; https://bit.ly/2PrdsAH). CTC is a scientifically tested, five-phase process that bridges local expertise to prevention science by providing community stakeholders with the structure, tools, and evidence-based interventions needed to address community-identified priorities (https://bit.ly/2PrdsAH). Central to CTC is engaging community partners to gather and use data to inform priorities; identify resources for and gaps in addressing priorities; and implement and test programs, practices, and policies to address those priorities. The Chicago CTC partnership engaged more than 70 community organizations to develop a community action plan. Its initial focus was on violence, but on the basis of local data, the community identified four core areas—youth and family violence prevention, education equity, trauma-informed care, and workforce development—so the partnership expanded its work to include multiple ecological levels. The University of Colorado YVPC uses the CTC structure to help two high-risk Denver communities scale up evidence-based youth violence prevention strategies. These communities are implementing the Promoting Alternative Thinking Strategies social–emotional learning program (https://bit.ly/3bGDVzz) in three elementary schools and five after-school settings. The Colorado YVPC also introduced a process that allows providers across multiple health care settings to identify youths at risk for violence and provide office-based interventions to decrease violent behaviors. The VCU YVPC and its community partners are implementing the CTC model plus a Walker Talker and Community Conversation (Plain Talk) component. To enhance the CTC model, Walker Talkers conduct community-driven outreach to inform residents about positive development opportunities for youths to reduce risk. Their strategy also connects residents with the CTC intervention and other programs and services while increasing awareness, capacity, and collaboration.

All the YVPCs serve communities experiencing significant racial disparities in youth violence in general and firearm violence in particular. The YVPCs also apply well-established community-based approaches designed to engage community organizations in developing multisectoral strategies for prevention. Although only the University of Michigan YVPC conducted research funded by NIH that is specifically relevant to firearm violence among youths, all the centers worked on contextual factors associated with youth violence that are also associated with firearm violence, including school climate, community violence exposures, and public perceptions of causes. The community-engaged approaches of the YVPCs also helped to identify solutions that focus on the root causes of violence across the United States, including changing the narrative from victim blaming to structural antecedents of violence and establishing coalitions of local voices to create strategies that integrate solutions across ecological levels.

SCIENCE-INFORMED PREVENTION

Science-informed firearm injury prevention is key to developing evidence-based strategies. Youth morbidity and mortality from firearm-related violence show no signs of abating without specific and focused research to inform prevention. Researchers do, however, know enough to begin applying public health approaches for violence prevention. Lessons learned from CTC implementation can inform other communities interested in organizing multisectoral, empirically driven planning, implementation, and evaluation processes to engage community organizations in developing prevention strategies tailored to each community. Community greening strategies designed to create busy streets are scalable evidence-based prevention approaches applicable to firearm injury prevention. Expanding research on emergency and general medicine settings for youth firearm prevention programs is also a promising direction for firearm injury prevention. Efforts that focus on root causes that begin to change the narrative of youth violence prevention from individualistic approaches to more social and public policy strategies are also applicable to firearm violence.

As the firearm violence prevention field grows through increased federal funding, lessons learned from the YVPCs can inform the development of evidence-based prevention strategies to reduce youth firearm morbidity and mortality. These lessons include multisector community partnerships, the creation of scalable and sustainable interventions, and the implementation of strategies across the social–ecological spectrum. The work of the YVPCs is an example of what can be done with funding from federal sources, yet it provides only a starting point from which to staunch the high rate of firearm violence.