Journal Issue: Children, Youth, and Gun Violence Volume 12 Number 2 Summer/Fall 2002
It is difficult to conclude this review without a certain degree of pessimism. The few behaviorally oriented programs to reduce youth gun injury and violence that have been evaluated have not shown great success. In fact, some critics argue that these programs may actually do more harm than good—by giving kids the impression that gun carrying is the norm, for example, or by increasing children's interest in using guns.
Given the limited potential of the programs discussed in this article, what advice can be given regarding the features of a behavioral program that is most likely to succeed? First, community-based approaches require an initial assessment of the needs of the community. Residents should be involved in planning and implementing the program, and a means of evaluating the program must be developed.
Second, programs directed toward parents should address the multiple false beliefs that can make parents resistant to behavior change. Parents must come to understand that their children are at risk for injury if a loaded gun is kept in the home, for example, regardless of any training their children may receive.Third, physicians should be better trained to discuss the issue of firearms with their patient families. More effective counseling might include an emphasis on the risk of having a gun in the home, an attempt to assess and allay the fears that prompt parents to keep a gun, and alternative positions for the short term (such as encouraging gun-owning families to purchase safety devices rather than advising them to remove guns from their homes).81 Also, because fathers (often the gun owners in families) typically do not bring their children to the physician, and because mothers may not be aware of unsafe gun-storage practices in their own homes, physicians may need to customize their message about gun safety to the parent who appears in their office.82
Finally, before even attempting to develop programs for children, researchers, policymakers, and practitioners should question whether children are the appropriate targets for intervention. Believing that children can learn to make life-or-death decisions regarding their safety around firearms may provide parents with a false sense of security and lower their vigilance.22 Young children, particularly boys, have difficulty identifying hazardous situations, taking preventative measures, and believing that they can be injured by a gun. Moreover, children trained to behave safely in a classroom setting may not generalize to a potentially fatal situation in their own home or in the home of a friend.
Older children, feeling invulnerable to injury and sensitive to peer pressure, may fail to heed safety messages they have learned. "Just Say No" programs may entice children to use guns, and skills-based programs may fail to adequately address the reasons that youth carry guns. Scare tactics and programs that lead adolescents to believe that carrying guns is the norm are especially problematic, have not demonstrated effectiveness, and—based on what researchers have learned about similar approaches to adolescent health issues—may even increase the very behavior they are designed to reduce. Peer-based approaches have shown mixed results thus far, and have not been adequately evaluated.
The AAP is especially doubtful of the educational approach to reducing firearm mortality and morbidity. In a policy statement released in April 2000, the AAP reaffirmed its stance that the most reliable and effective way to prevent firearm-related injuries in children and adolescents is to remove guns from children's homes and communities.83 It is difficult, in the face of the meager success of the behavior-oriented approaches reviewed here, to disagree.