National Academies Press: OpenBook
« Previous: 1 Introduction
Suggested Citation:"2 Framing the Issue: Firearm Injuries and Health Care's Role in Depolarizing a Public Health Crisis." National Academies of Sciences, Engineering, and Medicine. 2022. Integrating Firearm Injury Prevention into Health Care: Proceedings of a Joint Workshop of the National Academies of Sciences, Engineering, and Medicine; Northwell Health; and PEACE Initiative. Washington, DC: The National Academies Press. doi: 10.17226/26707.
×

2

Framing the Issue: Firearm Injuries and Health Care’s Role in Depolarizing a Public Health Crisis

The workshop began with a presentation by Debra Houry of the Centers for Disease Control and Prevention (CDC), who provided an overview of firearm injury, prevention, and the role of health care systems in addressing this public health crisis. Houry said that her years as an emergency physician have made preventing firearm violence important to her, having seen firsthand the devastating toll of firearm violence on individuals, families, and entire communities. Firearm injury and death, she explained, have a tremendous impact on the safety and well-being of all Americans, with firearms taking the life of nearly 124 people every day, more than half by suicide. From 2019 to 2020, homicide rates overall increased by 30 percent, with firearm homicides increasing by 35 percent, resulting in the highest firearm homicide rate in decades, Houry explained (Asher, 2021; Johns Hopkins Center for Gun Violence Solutions, 2022). She noted that more people suffer nonfatal firearm-related injuries than die, and many of these victims experience lifelong physical and emotional consequences ranging from cognitive problems to paralysis. Moreover, the effects of firearm violence extend beyond victims and their families, affecting the community’s sense of safety, affecting everyday decisions, and costing the United States tens of billions of dollars a year in medical and lost productivity costs.

While firearm injury and death affect people of all ages and in all communities, some groups are at higher risk. Racial and ethnic minorities, and particularly young Black males, have the highest risk for firearm homicides, said Houry, with rural and tribal communities, males, and veterans experiencing high rates of suicide by firearm. Most female homicide victims are killed by an intimate partner. Houry said:

Suggested Citation:"2 Framing the Issue: Firearm Injuries and Health Care's Role in Depolarizing a Public Health Crisis." National Academies of Sciences, Engineering, and Medicine. 2022. Integrating Firearm Injury Prevention into Health Care: Proceedings of a Joint Workshop of the National Academies of Sciences, Engineering, and Medicine; Northwell Health; and PEACE Initiative. Washington, DC: The National Academies Press. doi: 10.17226/26707.
×

Prevention efforts must consider the societal conditions disproportionately experienced by Black youth and other communities of color, and really address the root causes of violence. Violence is often the result of individual, family, and environmental factors that can accumulate over time.

As a result, she added, a comprehensive public health approach that targets risk and protective factors, with a focus on both short-term and long-term solutions, is critical to reducing community violence.

CDC’s public health approach to preventing death and injury from firearms focuses on data collection and surveillance, research to understand and apply effective strategies, and cross-sector collaborations. To help communities identify the most effective strategies, Houry explained, CDC releases resources based on best available evidence on topics such as youth violence prevention and suicide prevention. These resources compile strategies that can help communities prevent violence, including firearm-related violence. Examples of evidence-supported strategies that Houry cited include reaching people at greatest risk through safe storage and hospital-based programs, improving the physical built environment through greening initiatives such as cleaning vacant lots and planting grass and trees, preventing future risk and lessening the harms of violence exposure through hospital–community partnerships and treatment services, and informing policies and programs that enhance economic and social stability by connecting youth to caring adults and activities, such as mentoring and after school programs.

Health care professionals and systems play an essential role in strategies to reduce violence in communities, said Houry. “Using a trauma-informed approach, we can improve patient–clinician encounters and lessen retraumatization,” she explained. “This approach assumes that any person seeking services may have experienced traumas such as prior violence exposure, concentrated poverty, or racism.” Hospital-based violence intervention programs are multidisciplinary programs that bring trauma-informed care to the patient while in the hospital and help deescalate violent situations. These programs can identify patients at risk of repeat violent injury and link them with hospital and community-based resources aimed at addressing underlying risk factors for violence, said Houry.

Houry then highlighted several examples of different types of interventions and strategies for reducing firearm-related violence. The first, Caught in the Crossfire, is a peer-led intervention that meets young shooting victims where they are, whether that is at home, the hospital bedside, or school (Becker et al., 2004). Evaluations found that 98 percent of the participants were not rehospitalized for violence-related injuries, and 90 percent of young shooting victims who returned from the juvenile justice system were not rearrested (Youth Alive!, n.d.). The second example, Virginia Commonwealth

Suggested Citation:"2 Framing the Issue: Firearm Injuries and Health Care's Role in Depolarizing a Public Health Crisis." National Academies of Sciences, Engineering, and Medicine. 2022. Integrating Firearm Injury Prevention into Health Care: Proceedings of a Joint Workshop of the National Academies of Sciences, Engineering, and Medicine; Northwell Health; and PEACE Initiative. Washington, DC: The National Academies Press. doi: 10.17226/26707.
×

University’s Bridging the Gap Program, provides services to youth who have been admitted to the university’s center for violent injuries. In this program, case managers connect youth and their families with the services required to break the cycle of violence and reduce the rate of reinjury and subsequent health care demands and costs often associated with violent injuries. CDC, said Houry, is currently funding an evaluation of this program.

As an example of how hospital–community partnerships can strengthen connections between the acute treatment of violence-related injuries and community assistance, Houry cited SafERteens (Cunningham et al., 2012). This emergency department intervention for youth uses motivational interviewing, skill building, and referrals to services to reduce the perpetration and victimization of peer violence, alcohol use, and dating violence (Carter et al., 2022; Roche et al., 2022). The Cardiff Model, another example, is a framework for sustained partnerships between health care, law enforcement, public health agencies, and other government agencies (Kohlbeck et al., 2022; Mercer Kollar, 2018). This multiagency approach to violence prevention, said Houry, relies on the strategic use of information from health and law enforcement organizations to improve policing and community violence prevention programs (Boyle et al., 2013; Levas et al., 2018; Mercer Kollar et al., 2020). The Cardiff Model has demonstrated a 42 percent reduction in hospital admissions from violence-related injuries and $15 in health systems savings for every dollar spent (CDC, 2021).

Houry said that clinicians can bring their expertise to discussions on the accurate, timely, and local data that are essential to understand inequities in violence, to guide prevention decisions, and to enable ongoing evaluation in health system-level quality improvement. Health care providers can also discuss the safe storage of firearms at home with patients. The safe storage of firearms can reduce the risks for injury by separating individuals at risk for harm from easy access to lethal means. Such practices may include educational counseling around storing firearms locked in a secure place, unloaded, and separate from ammunition as well as the provision of a safety device.

Another program focuses on emergency department counseling on lethal means and trains psychiatric emergency clinicians to provide lethal means counseling and safe storage boxes to parents of youth receiving care for suicidal behavior (Runyan et al., 2018; Siry et al., 2021a,b). Among parents who indicated the presence of guns in the home at pretest, all reported they had locked up their guns at posttest.

CDC’s Injury Center, said Houry, relies on two key data sources. The National Violent Death Reporting System collects detailed information on violent deaths by pooling more than 600 unique data elements from multiple sources, including law enforcement reports, death certificates, and medical examiner reports, into a usable, anonymous database. The Firearm Injury

Suggested Citation:"2 Framing the Issue: Firearm Injuries and Health Care's Role in Depolarizing a Public Health Crisis." National Academies of Sciences, Engineering, and Medicine. 2022. Integrating Firearm Injury Prevention into Health Care: Proceedings of a Joint Workshop of the National Academies of Sciences, Engineering, and Medicine; Northwell Health; and PEACE Initiative. Washington, DC: The National Academies Press. doi: 10.17226/26707.
×

Surveillance through Emergency Rooms program supports 10 state health departments’ efforts to collect and share nonfatal firearm injuries based on syndromic surveillance data.

CDC has also funded 16 awards for research projects to inform efforts to prevent firearm-related violence, injuries, and crime. These awards focus on identifying effective strategies to keep individuals and communities safe from firearm-related injuries. “Through this work, we will be able to better understand the characteristics of firearm violence and the effectiveness of interventions,” said Houry. One project, for example, is looking at the effectiveness of a hospital-based violence prevention program for reducing risk of firearm-related violence and injury in adult victims of violence. Several other projects are collecting data and vetting interventions that have the potential to reduce firearm injuries in large urban communities of color.

Since 2000, CDC has funded 17 youth violence prevention centers that have partnered with communities experiencing high rates of violence. The Michigan Youth Violence Prevention Center, for example, developed community collaborations that resulted in the healthy development of youth in neighborhoods in Flint, Michigan (Kingston et al., 2021). Using six different strategies, the participating communities have seen a 38 percent decrease in youth assault-related injuries among those seeking treatment in the emergency department and a 25 percent decrease in youths’ likelihood of being victims of a violent assault (Heinze et al., 2016).

Houry said that firearm injury and violence are substantial public health threats demanding urgent action to support and scale up intervention efforts in communities across the country. “We are committed to being a partner with each of you as we have collectively advanced this work to improve the health and safety of our communities,” said Houry, and going forward, CDC will continue to work at gathering more timely and accurate data on firearm injury and death that can inform prevention efforts. For example, communities can now use syndromic surveillance data to drive changes and respond to hot spots.

In terms of what she sees as the most important questions for health care providers and community members on which to focus in the years ahead, Houry said she would like to better understand who the right people are to have discussions with about safe storage and similar interventions. While it might be clinicians, there is some research suggesting that law enforcement or a trusted partner might be the right avenue for having those discussions. Similarly, she would like to see research looking at the best way and best moment in a hospital setting to counsel about safe storage. Another of CDC’s priorities is to look at how to engage communities to build resilience and decrease violence overall so that communities do not have to deal with severe violence. Houry said she was interested in how to best use telehealth, social media, and other interventions to prevent firearm violence.

Suggested Citation:"2 Framing the Issue: Firearm Injuries and Health Care's Role in Depolarizing a Public Health Crisis." National Academies of Sciences, Engineering, and Medicine. 2022. Integrating Firearm Injury Prevention into Health Care: Proceedings of a Joint Workshop of the National Academies of Sciences, Engineering, and Medicine; Northwell Health; and PEACE Initiative. Washington, DC: The National Academies Press. doi: 10.17226/26707.
×

On a final note, Houry said that hospital-based programs can access CDC research grant announcements via the CDC Injury Center website.1 These solicitations are usually open to universities, hospitals, and state health departments, she said. CDC, she explained, uses a peer-review process similar to NIH’s to make grant awards. If CDC receives a budget increase in 2023, it will have another funding announcement next year.

___________________

1 Available at https://www.cdc.gov/injury/fundedprograms/foa/index.html (accessed August 10, 2022).

Suggested Citation:"2 Framing the Issue: Firearm Injuries and Health Care's Role in Depolarizing a Public Health Crisis." National Academies of Sciences, Engineering, and Medicine. 2022. Integrating Firearm Injury Prevention into Health Care: Proceedings of a Joint Workshop of the National Academies of Sciences, Engineering, and Medicine; Northwell Health; and PEACE Initiative. Washington, DC: The National Academies Press. doi: 10.17226/26707.
×

This page intentionally left blank.

Suggested Citation:"2 Framing the Issue: Firearm Injuries and Health Care's Role in Depolarizing a Public Health Crisis." National Academies of Sciences, Engineering, and Medicine. 2022. Integrating Firearm Injury Prevention into Health Care: Proceedings of a Joint Workshop of the National Academies of Sciences, Engineering, and Medicine; Northwell Health; and PEACE Initiative. Washington, DC: The National Academies Press. doi: 10.17226/26707.
×
Page 9
Suggested Citation:"2 Framing the Issue: Firearm Injuries and Health Care's Role in Depolarizing a Public Health Crisis." National Academies of Sciences, Engineering, and Medicine. 2022. Integrating Firearm Injury Prevention into Health Care: Proceedings of a Joint Workshop of the National Academies of Sciences, Engineering, and Medicine; Northwell Health; and PEACE Initiative. Washington, DC: The National Academies Press. doi: 10.17226/26707.
×
Page 10
Suggested Citation:"2 Framing the Issue: Firearm Injuries and Health Care's Role in Depolarizing a Public Health Crisis." National Academies of Sciences, Engineering, and Medicine. 2022. Integrating Firearm Injury Prevention into Health Care: Proceedings of a Joint Workshop of the National Academies of Sciences, Engineering, and Medicine; Northwell Health; and PEACE Initiative. Washington, DC: The National Academies Press. doi: 10.17226/26707.
×
Page 11
Suggested Citation:"2 Framing the Issue: Firearm Injuries and Health Care's Role in Depolarizing a Public Health Crisis." National Academies of Sciences, Engineering, and Medicine. 2022. Integrating Firearm Injury Prevention into Health Care: Proceedings of a Joint Workshop of the National Academies of Sciences, Engineering, and Medicine; Northwell Health; and PEACE Initiative. Washington, DC: The National Academies Press. doi: 10.17226/26707.
×
Page 12
Suggested Citation:"2 Framing the Issue: Firearm Injuries and Health Care's Role in Depolarizing a Public Health Crisis." National Academies of Sciences, Engineering, and Medicine. 2022. Integrating Firearm Injury Prevention into Health Care: Proceedings of a Joint Workshop of the National Academies of Sciences, Engineering, and Medicine; Northwell Health; and PEACE Initiative. Washington, DC: The National Academies Press. doi: 10.17226/26707.
×
Page 13
Suggested Citation:"2 Framing the Issue: Firearm Injuries and Health Care's Role in Depolarizing a Public Health Crisis." National Academies of Sciences, Engineering, and Medicine. 2022. Integrating Firearm Injury Prevention into Health Care: Proceedings of a Joint Workshop of the National Academies of Sciences, Engineering, and Medicine; Northwell Health; and PEACE Initiative. Washington, DC: The National Academies Press. doi: 10.17226/26707.
×
Page 14
Next: 3 Health Care Strategies to Reduce Firearm Injury and Mortality »
Integrating Firearm Injury Prevention into Health Care: Proceedings of a Joint Workshop of the National Academies of Sciences, Engineering, and Medicine; Northwell Health; and PEACE Initiative Get This Book
×
 Integrating Firearm Injury Prevention into Health Care: Proceedings of a Joint Workshop of the National Academies of Sciences, Engineering, and Medicine; Northwell Health; and PEACE Initiative
Buy Paperback | $18.00 Buy Ebook | $14.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

The staggering number of deaths and emergency department visits caused by firearm injuries has only grown with time. Costs associated with firearm related injuries amount to over a billion dollars annually in the United States alone, not including physician charges and postdischarge costs.

To address this epidemic, in April of 2022, the National Academies of Sciences, Engineering, and Medicine's Board on Population Health and Public Health Practice, in collaboration with Northwell Heath and the PEACE Initiative, brought together firearm injury prevention thought leaders to explore how health systems can integrate interventions for firearm injury prevention into routine care for the purpose of improving the health of patients and communities. The workshop speakers discussed strategies for firearm injury and mortality prevention and its integration into routine care. Speakers also explored facilitators and barriers to implementation strategies, and how health systems might work to overcome those barriers.

READ FREE ONLINE

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!