Journal Issue: Children, Youth, and Gun Violence Volume 12 Number 2 Summer/Fall 2002
Working with Parents (2/2)
Gun Violence Prevention Approaches with Parents
Two very different approaches target behavior change among parents: legislative efforts to hold parents responsible for gun ownership and for their children's behavior, and gun safety counseling by health care providers. Although data are limited, research thus far indicates that these approaches are not very effective at convincing parents to alter their firearm ownership or storage practices.
Child Access Prevention Laws
Seventeen states have enacted some type of CAP law, holding parents or other adults responsible for unsafe storage of guns in their home. The scope of this law varies widely across states, as shown in the appendix to this article. In most states, the law applies only if a minor gains access to the gun, and in most states, violation of the law is a misdemeanor.
Opponents have questioned the need for CAP laws. Some argue that the laws intrude upon the privacy rights of gun owners and upon the rights of parents to raise and supervise their children as they see fit.20 Some researchers also assert that it is easier to persuade parents to behave differently than to legislate parental behavior change,5 and that positive approaches to behavior change are more effective than coercive approaches.
Others argue that enforcement of CAP laws is unlikely, because punishing parents who already suffer from tremendous guilt or from the loss of a child might be seen as cruel. Other laws that regulate parental behavior, such as laws mandating the correct use of car safety seats for children, are rarely enforced.21 Likewise, experts agree that in the case of pediatric firearm deaths, judges and juries would be unlikely to convict grieving parents.22 Thus far, only a handful of individuals have been cited for violating a CAP law. In one instance, for example, a mother was arrested when her eight-year-old son shot his nine-year-old half brother with a handgun. The neighbor of the mother was quoted in a news article as saying, "I don't know [why] they need to charge her with something. To me, it seems like losing your son would be punishment enough."23
The effectiveness of CAP laws in changing parents' gun-storage practices has also come under scrutiny. Some argue that there is no evidence that criminal liability legislation holding parents responsible for the delinquent acts of their children (such as drug use or gang activity) has altered parents' behavior.24 Other critics assert that a child who wants access to a weapon can find one easily, even if one is not stored in the home. In 1992, for example, researchers surveyed 970 high school juniors in Seattle, Washington; 34% reported that they could easily obtain a handgun. When asked where they would get the gun, only 7% said they would obtain it from home.25
Young children, however, are more likely to be involved in unsupervised accidental firearm incidents than in homicides or suicides, and the guns they use are typically found in their own homes.26–28 Up to 50% of parents who own guns keep them loaded and unlocked.29,30 Gun owners may believe that their children do not know where their gun is or, if they do know, that they would not touch the gun without permission. In a survey of 109 children and parents, however, nearly 14% of children reported that they knew where their parents' gun was kept, even though the parents of these children reported independently that the children did not know. Most alarmingly, 21% of the children who said their parents owned a gun reported having touched or played with that gun without permission.31
In support of the effectiveness of CAP laws, researchers in one study found that unintentional shooting deaths in 12 states, particularly among children under age 10, had declined by 23% in the years following the introduction of CAP laws from 1990 to 1994.29 A follow-up study, however, found that firearm deaths declined significantly only in the 3 states in which violations of the law are a felony. In the other 14 states with CAP laws, where violation is a misdemeanor, the law had no statistically significant effect.32
Gun Safety Counseling
The other approach to altering parent behavior is through education, typically delivered by health care providers. The AAP recommends counseling on home safety procedures as part of well-child visits, as the physician's practice may be an ideal setting in which to intervene with at-risk populations.33 A number of studies have demonstrated the effectiveness of messages from family physicians in increasing safety-related behavior, such as use of bicycle helmets, car seats, and cabinet latches.34,35 Physicians also have counseled parents successfully on reducing the risk of sudden infant death syndrome (SIDS) by placing infants on their backs to sleep.36
Researchers have found that counseling is more effective when conducted face-to-face, when the parents are made to feel that the suggestions are in part their own, and when the course of action meets the parents' needs; counseling is less effective when physicians simply distribute safety pamphlets.34,35 One obstacle to counseling is that parents tend to become "overwhelmed or confused by the number and variety of safety practices recommended."37 Another is that one-on-one counseling takes time, something that physicians rarely have. In fact, less than two minutes of a well-child visit are typically spent on health education.38 In a recent survey of health care providers who serve families with children ages five years and younger, 80% reported that they believe they should counsel on firearm safety, yet only 38% reported that they actually do.39 One explanation may be that physicians underestimate the number of families in their practice who own guns. In a recent comparison of physicians' predictions to actual gun ownership, pediatricians predicted a 0% likelihood of ownership for 33% of their families. Of those families, 30% reported owning at least one gun.40
Individual counseling may not be the most effective way to convince patient families to change their firearm use and storage practices in any case. In a survey of patients in 11 family practices, respondents reported that they did not view their physician as a credible source of information on firearm safety.41 Furthermore, according to a recent randomized, controlled trial involving 311 families, a single 60-second firearm safety counseling session during a well-child visit did not result in significant changes in gun ownership or storage practices among the families who initially reported owning guns.42 Even more discouraging are the results of a recent study involving parents of depressed youth. Among gun-owning families advised to remove the guns from their home because of the significant risk of suicide by their depressed adolescent, only 27% actually did so.43
One of the most widely used physician-based programs to educate parents about the risks of keeping a firearm in the home is the Steps to Prevent Firearm Injury program (STOP). This program was originally developed in 1994 by the Brady Center to Prevent Gun Violence and the AAP, and was replaced by STOP 2 in June 1998. Free of charge to physicians and parents, the program includes brochures and posters, a list of suggested readings, an audiocassette, and counseling tips. A recent study found that the STOP intervention did not result in a statistically significant decline in gun ownership or in improved gun-storage practices among families in a sample of inner-city pediatric patients.44 Evaluation of the STOP program bears replicating, however, as this study was limited by the lack of a control group and an inadequate sample size.
Overall, interventions with parents have shown little success in decreasing children's access to guns in the home. Unfortunately, as the rest of this article indicates, interventions with children have not shown much promise for reducing youth gun violence either.