The Third Rail of Pediatric Communication: Discussing Firearm Risk and Safety in Well-Child Exams

ABSTRACT

This research endeavors to understand how pediatricians and parents discuss – or do not discuss – firearm risks for children during well-child visits. Through individual semi-structured interviews with 16 pediatric providers and 20 parents, the research explores discursive barriers to open conversation, perspectives on anticipatory guidance, and new ideas for culturally competent messaging. The research focuses particularly on how parents’ and providers’ perspectives on firearm risk communication are tied to cultural norms and expectations. One salient theme that emerged is that the American Academy of Pediatrics recommendation that pediatricians ask parents about ownership status is deemed undesirable by pediatricians and parents because of the delicate intercultural setting. Born out of pediatric and parent experiences, and mindful of culturally salient barriers, this study offers alternative strategies for discussing firearm risk in well-child exams.

Notes

1. These regulations include trigger locks, lock boxes, personalized safety mechanisms, and trigger pull weights that are too high for young children.

2. Gun lock refers to an external firearm safety device that can block or prevent the firing function, such as trigger locks, cable locks, and so on, but does not include internal safety or safety catch.

3. Biometric technology uses behavioral or physiological characteristics such as fingerprint or voice recognition or an identification number (Krishan & Mostafavi, 2018). These features allow the boxes to be opened quickly by an authorized individual, which may eliminate the concern of reduced accessibility for personal and home defense (National Shooting Sports Foundation, 2013).

4. Although men are about twice as likely to own firearms than women (Parker et al., 2017), women are more likely to attend well-child visits than men (Yogman & Garfield, 2016). Broadly, 42 percent of American adults report that they live with a gun in their household (Parker et al., 2017). People who live in rural areas are 2.5 times more likely to own a gun (46%) than people who live in urban areas (19%), with people in the suburbs being in between (28%). White men are the majority owners of firearms (48%) with men of color half as likely (24%) to own them (Parker et al., 2017).

5. Parent participants are indicated by PA and provider participants are indicated by PR.

Additional information

Funding

All phases of this study were supported by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH).