Firearm Injury Prevention Programs

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In this chapter we review the research on the effectiveness of primary,

secondary, and tertiary programs for the prevention of firearms injury.

Special attention is given to efforts to prevent the use of firearms by

youth. The first section summarizes behavioral interventions targeted toward

reducing firearms injury. The second part considers what is known

about technological interventions aimed at preventing firearms injury. In

both cases, the existing research is very limited.


In this section we review two aspects of behavioral interventions that

have been designed to prevent firearms injury: the structure and effectiveness

of the program plans in each case and the quality of the associated

outcomes research data.

The prevention of firearms violence has been addressed in a number of

ways, from legislative reform, to media campaigns, to educational interventions.

Educational interventions are typically employed in school settings,

with a focus on modifying the attitudes, knowledge, or behavior of individual

children. Other educational and media interventions have targeted

parents and older youth with messages designed to increase their knowledge

of the dangers of firearms as well as methods to ensure safe use and

storage. Most of these interventions are developed by well-meaning groups

or organizations whose concern for violence—or the potential of violence—

among the children leads them to be proactive. However, these programs

are rarely based on theoretical models or preliminary effectiveness data.

The implementation strategies lack structured evaluations and are not commonly

informed by an appreciation of the limitations of children’s developmental


Table 8-1 is a summary of the targeted populations, program design,

and evaluations of 11 selected interventions. This selection has been based

on the popularity of the program and whether the program has been peerevaluated

using randomized control groups. Most of these programs are

centered on educating children themselves about firearms and violence or

through programs involving parents or health care providers. Other comprehensive

programs, such as those listed by the Office of Juvenile Justice

and Delinquency Prevention (e.g., Boston Strategy to Prevent Youth Violence)

were not listed either because they incorporated suppression and

TABLE 8-1 Firearms Prevention Programs


Sponsor Target

and/or Type of Age or

Program Publisher Program Grade

Eddie National “Just say no” Pre-K

Eagle Rifle to

Gun Association grade 6



Steps to Brady Physician-directed Parents

Prevent Center to parent education

Firearm Prevent

Injury Gun

(STOP Violence


prevention strategies for many types of violence, or they were designed

specifically to deter illegal gun possession and use.

Outcome Measures

The impact of most of these types of behavioral interventions is measured

in terms of changes in knowledge, attitudes, and behavior. Specific

outcomes may include knowledge of the danger of guns and attitudes toward

firearms and violence. Changes in behavior are detected by proximal

and distal outcome measures for the individuals targeted. For example, if

the program is designed to educate parents about firearms safety, a proximal

behavior goal would be related to how a gun is stored in the home

Description of Program Evaluation

Motivational program for Hardy et al. (1996) evaluated a

children in pre-K through grade similar program and in posttest

1, with easy-to-understand found no difference between

rhymes; activity books for children’s behavior toward

grades 2-6; 7-minute video, firearms in both treated and

reward stickers, parent letter, control groups.

instructor guides, in-service Of three programs evaluated

video. The message: If you (STAR and STOP, see below),

see a gun, stop, don’t touch it, Howard (2001) ranks the Eddie

leave the area, and tell an adult. Eagle program the best based on

educational material appropriate

for developmental level and

presentation appearance of printed


Kit prepares health care Oatis et al. (1999) demonstrate in

providers to talk with a pre- and post-randomized trial

patients/clients and their that there was not a statistically

families about the dangers of significant drop in gun ownership

keeping a gun in the home. or improvement in gun storage

The fundamental goal is to after a practice-based intervention

assist the health care provider aimed to promote these behaviors.

in incorporating gun violence

prevention into routine injury

prevention counseling.


TABLE 8-1 Continued


Sponsor Target

and/or Type of Age or

Program Publisher Program Grade

Straight Talk Brady Center Skills-building Pre-K to

About Risks to Prevent grade 12

(STAR) Gun Violence

Safe San Jose Skills-building Juvenile

Alternatives Police offenders

and Violence Department ages 10-

Education (San Jose, 18


Options, Roy Farrell, Shock Grades 7

Choices, and M.D., and 8

Consequences Washington

(Cops and Physicians for

Docs) Social


In a Flash National Shock Middle

Emergency school

Medicine children

Association (ages



Description of Program Evaluation

Straight talk about risks of Using a randomized

firearm injury and death. prospective study design with

Age-appropriate lessons help 600 students, the Education

children identify trusted Development Center, Inc.

adults, deal with peer (LeBrun et al., 1999) found

pressure, and recognize risks STAR to be most effective for

related to gun handling. increasing gun safety

knowledge and attitudes for

children in grades 3-5 and only

moderately effective for older


Hardy (2002b) in a

randomized control study (34

children ages 4 to 7) concludes

that STAR-like programs are

ineffective in deterring

children’s play with guns.

One-day, 6-hour violence Arredono et al. (1999)

awareness class for juvenile demonstrate in pretest and

offenders and their parents. posttest evaluations that

recidivism rates declined at 2-

year follow-up, but no