The Safe Tennessee Project is dedicated to reducing gun violence in Tennessee, especially those shootings that are the result of child gaining access to a loaded, unsecured gun. As a community of physicians, academics, and concerned citizens, we are interested in evidenced-based solutions to these preventable tragedies. Researchers are as well, and have published numerous peer-reviewed studies linking child access prevention laws to reductions in child-involved unintentional shootings, juvenile suicides, and juvenile use of firearms for criminal activity.

Below are a number of academic research studies and medical organizations’ policy statements related to responsible firearm storage, child access prevention legislation, safe storage laws, and efficacy of gun safety training programs.

School-Based and Community-Based Gun Safety Educational Strategies for Injury Prevention
Cheryl Holly, EdD, RN, ANEF, FNAP, Sallie Porter, DNP, PhD, APN, FNAP, Mary Kamienski, RN, PhD, FAEN, FAAN, Aubrianne Lim, RN, BS
Health Promotion Practice (2018)
Key Findings: Gun safety programs do not improve the likelihood that children will not handle firearms in an unsupervised situation. Stronger research designs with larger samples are needed to determine the most effective way to transfer the use of the gun safety skills outside the training session and enable stronger conclusions to be drawn.

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Variability of child access prevention laws and pediatric firearm injuries
Emma, C. Hamilton, MD; Charles C Miller, III, PhD; Charles S Cox, Jr., MD; Kevin P. Lally,, MD; Mary T. Austin, MD, MPH
Journal of Trauma and Acute Care Surgery (2018)
Key Findings: After adjusting for race, sex, age, and socioeconomic income quartile, strong child access prevention (CAP) laws were associated with a significant reduction in all, self-inflicted , and unintentional pediatric firearm injuries. Weak CAP laws, which only impose liability for reckless endangerment, were associated with an increased risk of all pediatric firearm injuries. The association of CAP laws on hospitalizations for pediatric firearm injuries differed greatly depending on whether a state had adopted a strong CAP law or a weak CAP law. Implementation of strong CAP laws by each state, which require safe storage of firearms, has the potential to significantly reduce pediatric firearm injuries.

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Programs that Promote Safe Storage and Research on Their Effectiveness
United States Government Accountability Office (2017)
Key findings: Children who received instruction in gun safety were no more likely than those who did not to heed basic rules about what to do if they came across a gun — like leaving the room, not touching the gun or notifying an adult. Informational sessions or videos “did not instill consistent safe firearm habits in young children.” The NRA’s Eddie Eagle program did succeed at getting children between the ages of 4 and 6 to verbally repeat rules on what to do when they encounter a gun. But those same children were not significantly more likely than others who hadn’t gone through the Eddie Eagle training program to actually follow through with those behaviors when they encountered a gun.

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State Firearm Laws, Firearm Ownership, and Safety Practices Among Families of Preschool-Aged Children
Kate C. Prickett, MPAff, Alexa Martin-Storey, PhD, and Robert Crosnoe, PhD
American Journal of Public Health (2014)
Key findings: Firearm legislation and CAP laws interacted to predict ownership and storage behaviors, with unsafe storage least likely among families in states with both CAP laws and stronger firearm legislation.

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Firearm-Related Injuries Affecting the Pediatric Population
M. Denise Dowd, MD, MPH Robert D. Sege, MD, PhD
American Academy of Pediatrics, Policy Statement (2012)
Key point: “Evidence supports the effectiveness of regulation that limits child access to firearms…Trigger locks, lock boxes, gun safes, and safe storage legislation are encouraged by the AAP.”

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Teaching-Safety-Skills-to-Children-Prevention-of-Firearm-Injury-as-an-Exemplar-of-Best-Practice-in-Assessment-Training-and-Generalization-of-Safety-Skills
Raymond G Miltenberger, Ph.D., BCBA
Behavior Analysis in Practice (2008)
Key Findings: A behavioral skills training approach, in which the child receives instructions and modeling and then rehearses the skills with feedback in response to a variety of simulated situations, is more effective than an informational approach that does not have the active learning component. In situ assessment is the only way to determine if the child will use the skills in response to a seemingly real safety threat. Skills learned through BST do not always generalize to the natural environment.In situ training is the most reliable method for producing the generalized use of safety skills across a number of skill domains.

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Easy Access to Firearms: Juveniles’ Risks for Violent Offending and Violent Victimization
R. Barry Ruback, Jennifer N. Shaffer, and Valerie A. Clark
Journal of Interpersonal Violence (2010)
Key findings: Current access to firearms at home significantly increased the odds of both violent offending and violent victimization, even after controlling for prior access, prior offending, and prior victimization. This relationship persisted into early adulthood; access to firearms still significantly increased the odds of violent offending and violent victimization.

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Parental Misperceptions About Children and Firearms
Frances Baxley, MD; Matthew Miller, MD, ScD
Pediatrics and Adolescent Medicine (2006)
Key findings: Children younger than 10 years were as likely as older children to report knowing the storage location (73% vs 79%, respectively) and to report having handled a household gun (36% vs 36%, respectively). 39% of parents who reported that their children did not know the storage location of household guns and 22% of parents who reported that their children had never handled a household gun were contradicted by their children’s reports. In other words, kids often know where firearms are stored in the home and have actually handled them much more than parents realize.

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The Effect of Child Access Prevention Laws on Non-Fatal Gun Injuries
Jeff DeSimone and Sara Markowitz
National Bureau of Economic Research (2005)
Key findings: Results from Poisson regressions that control for various hospital, county and state characteristics, including state-specific fixed effects and time trends, indicate that CAP laws substantially reduce non-fatal gun injuries among both children and adults (a unique point about this study is that it looked at non-fatal injuries, which are much more common than deaths). When CAP laws are implemented, self-inflicted gun injuries fall by 64 percent for youth age 18 and under but do not decrease for adults.

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Michael B. Himle, Raymond G. Miltenberger, Brian J. Gatheridge, Christopher A. Flessner
Pediatrics (2004)
Key findings: Both programs were effective for teaching children to reproduce verbally the gun-safety message. The behavioral skills training program but not the Eddie Eagle GunSafe Program was effective for teaching children to perform gun-safety skills during a supervised role play, but the skills were not used when the children were assessed via real-life (in situ) assessments. Existing programs are insufficient for teaching gun-safety skills to children. Programs that use active learning strategies (modeling, rehearsal, and feedback) are more effective for teaching gun-safety skills as assessed by supervised role plays but still failed to teach the children to use the skills outside the context of the training session.

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The Effect of Child Access Prevention Laws on Unintentional Child Firearm Fatalities, 1979-2000
Lisa Hepburn, PhD, MPH, Deborah Azrael, PhD, MS, Matthew Miller, MD, ScD, MPH, and David Hemenway, PhD
Journal of Trauma and Acute Care Surgery (2005)
Key findings: Most states that enacted CAP laws experienced greater subsequent declines in the rate of unintentional firearm deaths for children age 0 to 14 compared with states not enacting the laws; however when adjusted for firearm prevalence and state and national effects the laws were associated with statistically significant declines only in Florida and California. Florida’s law, which is the oldest and one of the toughest (violation is a felony) resulted in a 51% reduction in accidental firearm deaths among children in that state over the eight years for which there was data.

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Association Between Youth-focused Firearm Laws and Youth Suicides
Daniel W. Webster, Jon S. Vernick, April M. Zeoli, Jennifer A. Manganello
Journal of the American Medical Association (2004)
Key findings: “We did find convincing evidence that the 18 CAP laws adopted during the study period led to an 8.3% reduction in suicide rates among youth aged 14 to 17 years. Firearms are used in approximately half of all youth suicides.

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Firearm Availability and Unintentional Firearm Deaths, Suicide, and Homicide among 5–14 Year Olds
Mathew Miller, MD, MPH, ScD, Deborah Azrael, PhD, and David Hemenway, PhD
Journal of Trauma and Acute Care Surgery (2001)
Key findings: A statistically significant association exists between gun availability and the rates of unintentional firearm deaths, homicides, and suicides.

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State Gun Safe Storage Laws and Child Mortality Due to Firearms
Peter Cummings, David Grossman, Frederick Rivara, and Thomas Koepsell
Journal of the American Medical Association (1997)
Key findings: CAP laws associated with a 23% decrease in unintentional shootings among children under 15 years old.