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Megan M. Attridge, MD
Marie E. Heffernan, PhD
Anne Bendelow, MPH
Carly G. Menker, MS
Matthew M. Davis, MD, MAPP
Karen Sheehan, MD, MPH

Firearm violence is a leading cause of pediatric morbidity and mortality in the United States. The presence of a firearm in the home poses an immense risk to children with significantly increased rates of suicide and unintentional injury by firearm. Furthermore, recent studies suggest children exposed to adverse childhood experiences (ACEs) and children with behavioral health disorders are at increased risk of experiencing firearm violence. Several studies have explored family demographic predictors of firearm ownership but have not explored the association of child ACEs and child behavioral health needs with the presence of a firearm in the home. The objective of this study was to explore an association between these factors, other family demographics, and the presence of a firearm in the home.

We collected data through the Voices of Child Health in Chicago Parent Panel Survey wave 2 (November 2020-February 2021), a longitudinal survey administered tri-annually in English and Spanish via web and phone to parents from all 77 neighborhoods in Chicago. Parents responded to questions about their child’s exposure to ACEs and behavioral health service utilization, parent health, their families’ experience with firearm violence, and their families’ demographics (including child age, parent age, race and ethnicity, gender, and level of education, and household income).

Overall, 382 of 1,436 (weighted to 22.0%) responding parents reported the presence of a firearm in the home. In the adjusted model, the odds ratio of firearm presence increased incrementally with increasing exposure to ACEs. Compared to a child in the household exposed to no ACEs, a child in the household exposed to two or more ACEs was associated with a 5.16 times higher odds ratio of firearm presence in the home (95% confidence interval (CI) 2.92-9.10). Similarly, compared to a child in the household who has not used behavioral health services, a child in the household who had was associated with a 2.10 times higher odds ratio of firearm presence in the home (95% CI 1.35-3.26). Presence of firearm in the home was also associated with higher household income, younger parent age (under 35 years), and male parent gender.

Chicago parents have higher odds of reporting the presence of a firearm in the home when living in a household with a child exposed to ACEs and with behavioral health needs. These findings are particularly important in the context of injury prevention, considering children experiencing ACEs and with behavioral health disorders may be at increased risk of experiencing firearm violence. These findings could inform future public health interventions and targeted safe storage messaging to prevent pediatric firearm injury.

Firearm presence in the household is associated with:
1) Children in the household with adverse childhood experiences
2) Children in the household with behavioral health services
3) Other family demographics including higher household income, younger parent age (under 35 years), and male parent gender.

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Ashley D. Cannon, MA
Kelsey AB Gastineau, MD

Between 2015 and 2020, 2,949 Americans died from unintentional gun injuries, including 573 children 17 years and younger. In contrast to fatal injuries, little is often known about the perpetrators of unintentional shootings. Approximately 30 million American children live in homes with firearms—up 7 million since 2015. Among these children, 4.6 million live in households with an unsecured firearm. This study sought to assess the scope of unintentional shootings by children 17 and younger in the United States to determine if differences exist by demographics, firearm, injury location, time, or state-level policies.

Demographic and injury data of perpetrators and victims of unintentional shootings by children 17 and younger in the US, from 1/1/2015–12/31/2020 were extracted from the #NotAnAccident Index. The #NotAnAccident Index contains media-report data, which is systematically flagged through Google Alerts, coded and uploaded weekly, and reliability and validity tested quarterly. This database contains data on date, location, victim and shooter demographics, shooting type, deaths and injuries, firearms, and incident summaries. Injury rates are calculated using state of occurrence and US Census data. State gun ownership estimates were obtained from the RAND Corporation. A series of descriptive analyses were conducted to compare across groups.

2,070 unintentional shootings by children resulted in 765 deaths and 1,366 nonfatal gun injuries over six years. The majority of perpetrators (83%, 1,715) and victims (76%, 1,628) were male. The mean age of shooters was 10.2 years (SD 5.5) and victims was 11.2 years (SD 8.1). Children were as likely to shoot themselves (49%, 1,004) as they were to shoot others (48%, 991). Most victims were under 18 years old (91%, 1,932). Shootings most often occurred in or around homes (70%, 1,456). Handguns were accessed in 55% (1,137) of shootings. Shootings occurred most frequently in July (1.12 average incidents per day) and on Saturdays (1.07 average incidents per day). Unintentional shootings by children increased during the COVID-19 pandemic; incidents increased 23%, deaths increased 31%, injuries increased 18%, and total victims increased 22% from March to December 2020 compared to the same period in 2019. States with 50% household gun ownership or greater had four times the number of victims from unintentional shootings by children compared to states with less than 30% gun ownership. Rates of death or injury were higher in states without secure storage laws (0.29–3.57) compared to states with laws (0–1.67).

Unintentional shootings by children are on the rise, but are preventable. Secure firearm storage practices, policies, and education efforts are needed. Gun owners, parents, the medical community, gun and gun storage sellers, and others can play a vital role in preventing unintentional shootings by storing their guns unloaded, locked, and separate from ammunition.

1. The scope of unintentional shootings by children and variations by gender, age, time, location, weapon, and state.
2. The importance of secure firearm storage practices and policies.
3. Policies and programs to prevent unintentional shootings by children.

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David C. Schwebel, PhD

Injury professionals immediately recognize the oft-cited statistic, “injuries are the leading cause of pediatric death in the US”. Less cited is the fact that this statistic has remained true for decades. WISQARS’ earliest available data, from 1981, lists 15,702 unintentional child (age 1-18) injury deaths, >5 times the fatalities for the next leading cause that year, malignant neoplasms (2,824 fatalities).

Over those decades, we have developed dozens of programs to reduce unintentional child injury death. Many were highly successful and others less so. It is surprising, however, that no widely disseminated popular book guides parents on keeping children safe from injury.

A handful of related books are on the market. Some specifically target environmental change to protect infant/toddler safety (e.g., Reich’s Babyproofing Bible, 2007, Fair Winds). Others target safety sub-domains, such as firearms (e.g., Luciano’s Guns the Right Way, 2015, Gun Digest) or sports (e.g., Canut’s Concussions and our Kids, 2012, Houghton-Mifflin-Harcourt). And, of course, broad child health books frequently include single injury prevention chapters.

Despite omnipresent smartphone use to seek parenting advice online, traditional parenting books still sell briskly. This abstract discusses the process of writing and publishing a popular book to help parents keep their children ages 0-12 safe from injury.

Successful parenting books on child injury must combine multiple goals. First, they should be theory-driven. The book was written with behavior change theory (e.g., Health Belief Model) in mind, seeking: (a) increased parental self-efficacy for behavior change to improve child safety, (b) altered peer norms, reinforcing the impression that other parents engage in safety behaviors and the reader should also, (c) recognition of susceptibility to injury events, accomplished through vignettes relating injury events emerging out of identifiable daily circumstances, and (d) education about potential severity of injury events, accomplished through vignettes that end sometimes with severe or fatal outcomes.

The book guides parents to implement household safety through the TAMS method (teach-act-model-shape), which is grounded in social learning theory and explains how to teach child safety, act through supervision and safeguarding, model safe behaviors, and shape children to make safe decisions as they grow. The book is sensitive to cultural differences and attentive to children’s development.

The ~2.5-year logistical process of writing the book, securing an agent and then publisher (Parenting Press), and refining text to achieve injury prevention goals as well as a fun, easy-to-read manuscript will be outlined.

With public release scheduled 9/20/22, three major outcomes are available: book sales, media hits, and Amazon rankings. Pre-order book sales are small, but media hits increasing, with recent inquiries from two major national news sources. Amazon rankings as of 5/22/22 are #5,517,974 (all books), #2829 (safety/first aid), #3676 (children’s studies/social science), and #7107 (parenting/family reference). Figures will be collected regularly and presented graphicly.

Books remain one of many tools in our multi-faceted, multi-disciplinary, multi-modal effort to reduce child injury. Historic absence of a theory-driven, empirically-supported popular parenting book is glaring. This publication fills that hole.

1. Theory-driven behavior change mechanisms for child safety can be delivered in the form of a popular parenting book.
2. Parents have capacity to enact change that protects their children’s safety.
3. Writing a popular book is a lengthy and complex process, but it can effectively deliver child injury prevention tools to a culturally diverse population of parents/caregivers.

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Briana Moreland, MPH
Neil Ortmann, MPH
Tessa Clemens, PhD

Drowning is the second leading cause of death among children aged 1 to 4 years and the second leading cause of unintentional injury death among children aged 5 to 14 years. American Indian or Alaska Native (AI/AN) and Black or African American (Black) children have drowning death rates consistently higher than White children. Studies comparing nonfatal and fatal injuries in the United States during 2020 to earlier years showed mixed effects of the COVID-19 pandemic. The objective of this study was to describe drowning deaths in 2020 among children and young adults by demographic characteristics and to compare 2020 rates to rates from 2010 to 2019.

Mortality data from the National Vital Statistics System (NVSS) were analyzed to describe unintentional drowning deaths among persons aged ?29 years by age, sex, race/ethnicity, and drowning location in 2020. International Classification of Disease 10th revision codes were used to identify unintentional drowning deaths (V90, V92, W65-W74). Changes in drowning death rates from 2019 to 2020 were compared to the annual percent change over the previous 10 years (2010-2019) using JoinPoint regression analysis.

In 2020, 1,589 persons aged ?29 years died from unintentional drowning. Drowning death rates were highest among children aged 1 to 4 years (2.73 per 100,000), males (1.93 per 100,000), Black persons (2.02 per 100,000), and AI/AN persons (1.97 per 100,000). Drowning death rates among persons aged ?29 years decreased 1.81% (95% CI: -3.02%, -0.59%) per year from 2010 to 2019 and increased 16.79% (95% CI: 8.35%, 25.24%) from 2019 to 2020. The largest increases in unintentional drowning death rates from 2019 to 2020 occurred in Black persons (23.73%), males (19.55%), persons aged 20 to 24 years (44.12%), and drownings in natural water (26.44%).

Drowning rates among persons aged ?29 years increased significantly from 2019 to 2020 during the COVID-19 pandemic; however, the reasons are not well understood. Further research is needed to assess how infrastructure disruptions that occurred during the COVID-19 pandemic (e.g., limited availability of swim lessons), influenced drowning rates among children and young adults. This information can be used to identify and strengthen drowning prevention strategies. Interventions such as learning basic swimming and water safety skills have the potential to reduce drowning deaths among children. CDC is working with partners to better understand disparities in drowning deaths and to increase access to interventions.

1. Identify children and young adult populations with disproportionality higher drowning rates.
2. Describe trends in U.S. drowning rates between 2010 and 2020.
3. Recognize how to develop and evaluate effective interventions that improve access to drowning prevention strategies