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Gender in Children's Firearm Deaths: Using the Data to Guide Interventions

      To the Editor:
      Presaging the recent Presidential action on closing gun sale loopholes, the recent article by Grinshteyn and Hemenway
      • Grinshteyn E.
      • Hemenway D.
      Violent death rates: the United States compared to other high-income OECD countries, 2010.
      provides compelling evidence of the continuing staggering disparity in rates of firearms-related deaths between the US and other high-income developed countries.
      Among all the carefully compiled data presented by the authors, we choose here to highlight unintentional deaths. Total unintentional firearms deaths in the US were 6.2 times that of other high-income countries. When looking at the ratio by age groups, unintentional firearm deaths among children 5-14 years old in the US were 12.2 times that of other high-income countries, guns in children's environment clearly compounding the already heightened risk of accidental death. Prior work has estimated that 110 US children die annually from unintentional firearms injuries
      • Hemenway D.
      • Solnick S.J.
      Children and unintentional firearm death.
      ; and hospitalization for firearm injury has been estimated to be more than 10 times that figure.
      • Leventhal J.M.
      • Gaither J.R.
      • Sege R.
      Hospitalizations due to firearm injuries in children and adolescents.
      Moreover, looking closely at the firearms deaths in the US, it is noteworthy that for the 0-14-year age group, there are considerably more deaths among boys than girls (ratio around 4:1), agreeing with data from a 2003 cross-sectional study with the same methodology and data sources.
      • Richardson E.G.
      • Hemenway D.
      Homicide, suicide, and unintentional firearm fatality: comparing the United States with other high-income countries, 2003.
      These same striking sex differences were observed in the sample of 100 accidental firearms deaths in children (0-14 years) studied during the year following the Sandy Hook massacre, where 77% of victims and 82% of perpetrators were male.
      • Everytown for Gun Safety Support Fund
      Innocents lost: a year of unintentional child gun deaths.
      The findings merit some pause, as they speak strongly to the transmission of a hypermasculinized culture of firearm use
      • Stroud A.
      Good guys with guns hegemonic masculinity and concealed handguns.
      from adult to child, putting boys especially at higher risk of gun play and thus accidental deaths and injury due to firearms.
      The data of Grinshteyn and Hemenway
      • Grinshteyn E.
      • Hemenway D.
      Violent death rates: the United States compared to other high-income OECD countries, 2010.
      —which are probably an undercount of actual unintentional minors' deaths due to uneven classification schemes across states
      • Luo M.
      • McIntire M.
      Children and guns: the hidden toll.
      —nevertheless strongly support and elaborate several prior observations
      • Hemenway D.
      • Miller M.
      Public health approach to the prevention of gun violence.
      • Kassirer J.P.
      Guns, society, and medicine.
      that the most effective public health actions to be taken must address the gun culture—the demand—as well as the easy supply of guns to US citizens.
      President Obama's laudable action on closing gun loopholes is but one small piece of what will necessarily be, as termed by Wintemute,
      • Wintemute G.J.
      Tragedy's legacy.
      the work of generations. Similar to the successful effort employed by public health tobacco control specialists in de-normalizing cigarette smoking, we need to shift the perception and attitude of American youth toward firearms. Available data demonstrate that these interventions must clearly include strong gender content. Conversely, the multidisciplinary and ongoing work in other arenas to transform sex roles and expectations will actually help save our sons' lives and limbs, even at the very youngest ages.

      References

        • Grinshteyn E.
        • Hemenway D.
        Violent death rates: the United States compared to other high-income OECD countries, 2010.
        Am J Med. 2016; 129: 266-273
        • Hemenway D.
        • Solnick S.J.
        Children and unintentional firearm death.
        Inj Epidemiol. 2015; 2: 1-6
        • Leventhal J.M.
        • Gaither J.R.
        • Sege R.
        Hospitalizations due to firearm injuries in children and adolescents.
        Pediatrics. 2014; 133: 219-225
        • Richardson E.G.
        • Hemenway D.
        Homicide, suicide, and unintentional firearm fatality: comparing the United States with other high-income countries, 2003.
        J Trauma. 2011; 70: 238-243
        • Everytown for Gun Safety Support Fund
        Innocents lost: a year of unintentional child gun deaths.
        (2014. Available at:) (Accessed January 31, 2016)
        • Stroud A.
        Good guys with guns hegemonic masculinity and concealed handguns.
        Gender Soc. 2012; 26: 216-238
        • Luo M.
        • McIntire M.
        Children and guns: the hidden toll.
        The New York Times. 2013; (Available at:) (Accessed January 31, 2016)
        • Hemenway D.
        • Miller M.
        Public health approach to the prevention of gun violence.
        N Engl J Med. 2013; 368: 2033-2035
        • Kassirer J.P.
        Guns, society, and medicine.
        N Engl J Med. 2015; 372: 874-875
        • Wintemute G.J.
        Tragedy's legacy.
        N Engl J Med. 2013; 368: 397-399

      Linked Article

      • Violent Death Rates: The US Compared with Other High-income OECD Countries, 2010
        The American Journal of MedicineVol. 129Issue 3
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          Violent death is a serious problem in the United States. Previous research showing US rates of violent death compared with other high-income countries used data that are more than a decade old.
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      • The Reply
        The American Journal of MedicineVol. 129Issue 8
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          We appreciate the points made by Gollub and Ben Taleb about our paper.1 They highlight the disparity found regarding unintentional deaths when comparing the US with other high-income countries. As Gollub and Ben Taleb point out, we found that unintentional firearm deaths are 6.2 times higher in the US than they are in the other high-income countries and 12.2 times higher among children aged 5-14 years old. They also suggest that the unintentional firearm deaths are an undercount, evidence of which has been supported previously in the literature.
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