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Putting Research into Action to Address Firearm Injury

On April 24, we were joined by Rebecca Cunningham, MD, Vice President for Research at the University of Michigan and Principal Investigator for the Firearm Safety Among Children and Teens Consortium, for an alliance discussion focused on using research to address the devastating public health toll of firearm injury. A few highlights from the conversation:

On what is firearm injury and why she got involved in firearm injury research:

“I think of firearm injury as many things. It’s not one type of type of injury – it’s school shootings and mass shootings. It’s peer and partner violence by gun. It’s young children and adolescents finding a gun that they shouldn’t have access to and having it accidentally go off. It’s community violence and street violence. It’s homicide. It’s suicide. These are all the different kinds of firearm injuries. I stood at the bedsides to take care of far too many young people, old people, community members, and all kinds of people who were injured by a gun [and thought] how we could prevent people from coming into my trauma bay.”

On who is affected by firearm injury:

“Over the past several decades, firearms have been the second leading cause of death among our children; in [2020, firearms] surpassed motor vehicle crashes to be the leading cause of death [for ages 1-19]. There are myths including, ‘this is an urban problem,’ or ‘this is an “X”-community problem.’ Overall, suicide rates are higher in our more rural communities and homicide rates by firearm are slightly higher in our urban communities. This is an issue for all of our communities.”

On funding research and finding solutions for firearm injuries:

“We must find the problem; identify risk and protective factors; develop and test prevention strategies; implement promising initiatives; monitor and evaluate effectiveness; and work again on the problem. That stepwise framework – which is the same for firearm injury as it is for any other type of injury and most diseases – means you need the data. We need research and funding for that. It’s important to generate the knowledge, which also takes research funding and research people. Then we must move that research to action, which also takes implementation work, research funding, and good examination of the solutions.”

“In the late 1990s, the Dickey Amendment was passed and that really silenced the federal funding around research on this topic, decreasing it dramatically across the CDC and across the NIH … If we’re not funding it, then that means we’re not generating the data, we’re not generating the knowledge, we’re not implementing the solutions to how we’re going to move ahead. By 2011, that meant we only had a handful of firearm researchers in the U.S. …. It’s not that there aren’t solutions that are possible for this, it’s that we weren’t trying to [fund or] find solutions for many years.”

On an evidence-based path forward:

“There’s a multitude of research-based paths forward that can decrease firearm injuries and death. There are individual-level interventions that will help, like counseling high-risk individuals on how they can be safer and not have interactions with guns. There are organizational-level interventions that can happen. Here, at the University of Michigan, we’ve developed a Firearm Injury Prevention Research Institute. At the community level, there’s many interventions that are possible, from campaigns on safe storage to urban renewal. Also, there are policy options, and they require research behind them to understand which policies work and which policies don’t. These policies can include things such as extreme risk protection orders, safe storage, and child access prevention CAP (Child Access Prevention) laws. One intervention alone will not work, but a combination across every level of our ecological system, with many efforts at each level, will be where we begin to decrease the terrible toll of death in our country.”