American youth suffer a rate of firearm trauma that is the highest in the industrialized world. (1) A comparison of international patterns of firearm mortality in youth less than 15 years of age found that US children had 17 times higher firearm-related homicides, 10 times higher firearm-related suicides, and nine times higher unintentional firearm-related deaths than youth in other industrialized nations. (2) Fatal firearm injuries are the second-leading cause of death of youth one to 19 years of age? Firearm deaths among American youth are most likely due to homicides (57%), followed by suicides (34%) (Figure 1).
For every youth killed by a firearm, a much greater number of youth are seriously injured. Estimates place the ratio of nonfatal to fatal firearm injuries at 4-5:1. (4) Many youth who survive firearm injuries suffer permanent disability that can result in severe academic and physical challenges.
The 1990s were characterized by a significant decline in violence-related behavior among US high school students. (5) Such high-risk behaviors as physical fighting, fighting on school property, carrying a weapon, and carrying a gun all significantly decreased. During the mid-1990s to the end of the decade, a significant decline also occurred in gun deaths of American youth? Whether a relationship exists between these changes has not been explored. Research published on factors associated with gun deaths has focused primarily on the adult population. (7-9) To date, limited published research has assessed behavioral risk factors for children and adolescents and their association with variations in firearm mortality. (10-12)
In adult populations, making threats has been identified as an important prelude to the perpetration of violence. Verbal threats are a common occurrence in youth encounters. (13) Fighting, weapon carrying, and abusing alcohol can all result in violence. Weapon carrying increases the potential for physical injury and death, especially if that weapon is a firearm. Studies with adults, and a few with adolescents, pertaining to firearm trauma found relationships with firearm ownership and firearms in the home, (7,14,15) gun control laws, (16,17) alcohol consumption, (17,18) poverty, (19,20) size of racial minority population, (17) level of urbanization, (21) violent crime rate, (22) firearm prevalence, (23) living with less than two parents, (24) and firearm trauma.
Death rates for firearms across various countries indicates different patterns of risk. Most firearm deaths among US youth are homicides, but among teen-agers in other countries are suicides. (6) It is also known that variations in youth firearm-related deaths in the United States vary by state. These state variations in firearm mortality can only be assessed by examining sociocultural variables across states in addition to assessment of personal risk behaviors, such as Youth Risk Behavior Survey (YRBS) data. This study assessed the association of the following factors with state variations in child and adolescent firearm deaths: childhood poverty rate, percent of single parent families, percent of population that is African American, percent of population that is Hispanic, percent of students carrying a gun, percent of students carrying a weapon, percent of students feeling unsafe, percent of students feeling sad/hopeless, percent of students academically at-risk, percent of students involved in fighting, percent of students engaging in binge drinking behavior, the violent crime rate for children and adolescents, individual gun laws in each state, prevalence of firearm ownership, and percent residing in urban areas. In addition to focusing on youth, the study is the first to assess adolescent risk behavior (as collected by the YRBS) in relation to child and adolescent firearm mortality.
This study specifically addressed the following question: Do selected behavioral risk factors assessed by the …