This Is Very Much Our Lane: Childhood Firearm Exposure and Adult Outcomes

The recent spate of mass shootings across the United States has led the president to declare gun violence a public health epidemic.¹  Among adolescents and young adults, suicide and homicide are the second- and third-leading causes of death, with approximately half of suicides and nearly 90% of homicides in this age group related to firearms.^2–4  In this issue of Pediatrics, Copeland et al⁵  present the first published prospective study in which the impact of childhood firearm exposure on adult outcomes is examined. This study can be used to inform interventions at the pediatric practice and public policy level.

Copeland et al⁵  test associations of childhood domestic gun access with subsequent adult criminality and suicidality. In this ≥20-year prospective, community-representative study conducted in North Carolina, researchers repeatedly measured household firearm exposure for children. These youth were managed into adulthood with multiple periodic assessments for suicidality and criminality. The proportion of the study sample for which follow-up data were available is noteworthy; 95% had at least 1 assessment at adulthood, and 83% of possible interviews were completed each assessment period. The magnitude of this prospective study must be acknowledged given the chilling environment for gun violence–related research.^6,7 

More than half of youth and caregivers reported the presence of firearms in the home, and of these, >60% had access to a gun and 25% owned a gun themselves. Gun ownership and access were associated with family dysfunction and parental history of problems. Children with behavioral or substance problems were more likely to have access to or own a gun. In the study, researchers also found associations between childhood firearm access and subsequent adult firearm ownership and carriage, exposure to gun violence, criminality, and suicidality. Interestingly, having a firearm in the home, without access as a child, was associated with owning and/or carrying a gun as an adult but not with criminality or suicidality.

Although 2 to 4 times higher odds of adult criminality and/or suicidality among participants with childhood gun access was found in this study, most participants with childhood firearm exposure, even in the highest risk groups, did not have later criminality or suicidality. In previous work, researchers have examined state-level policy on firearm access and its impact on childhood firearm deaths.⁸  As stated by the authors, there are applications for these data in researching and refining child access prevention laws to be more effective in reducing firearm-related injury and death. This is particularly salient considering the association between firearm access or ownership and family dysfunction and parental problems highlighted in this study. We would, however, strongly caution against legal restrictions for young adults based solely on childhood risk factors. As the authors of this study illustrate, risk factors are not destiny, and given the structural racism in our legal system, "criminality" is not evenly assessed or assigned. Furthermore, disparities in diagnosis of mental health issues and access to mental health treatment also impact assignment of risk factors.

We see application for these findings in suicide prevention because it is evident that means matter.⁹  Given the association between firearm access and later suicidality, further research and interventions should be focused on developing the best methods of counseling around access to lethal means. In the study, researchers found that having a gun in the home but no child access to the gun was only associated with adult owning and/or carrying and not suicidality or criminality, providing further support for harm reduction approaches that focus culturally competent counseling and conversation on safe storage to reduce child access.^10,11  Supporting families in restricting child access to firearms may save lives even into adulthood.

There is a paucity of research related to firearms in general and particularly interventions to reduce firearm morbidity and mortality. The US Congressional appropriation of funding for firearm research is welcomed.¹²  However, more funding and training opportunities are needed after decades of stifling firearm research.¹³  Resources should be prioritized to enhance practice and policy interventions to reduce firearm deaths in children and adolescents. With their study, Copeland et al⁵  illustrate that what happens in childhood in terms of firearm exposure matters in adulthood. This is very much our lane.