P3A296: Evaluating Pediatrician Perspectives and Practice Patterns for Firearm Safety Counseling

Background: Secure firearm storage has been shown to significantly reduce pediatric firearm deaths from all causes. The provision of firearm safety counseling at pediatric visits has been shown to increase rates of reported secure firearm safe storage within the home. And although most pediatricians agree firearm safety counseling is important few currently provide routine evidence-based screening and interventions in their practice consistently. The primary objective of this study was to identify the frequency of firearm safety counseling by pediatricians along with self-reported barriers to counseling. The secondary objective was to identify types of firearm safety resources needed to facilitate firearm safety counseling.

Methods: We conducted a cross-sectional survey study of pediatricians currently practicing in a southeastern state. A 37-question online survey was designed and beta-tested by the study team. This survey included questions regarding physician demographics, firearm exposure/ownership, practice settings, current firearm safety counseling practices and barriers, and preferences for firearm safety resources/training material. Surveys were distributed to pediatricians via the American Academy of Pediatrics (AAP) state chapter listserv and a regional pediatric network listserv. Descriptive statistics were used including median (IQR) and counts (%).

Results: A total of 53 respondents participated in this convenience sample. 17% owned a firearm. The majority of participants were 51 years or older (73%), White (77%), had children of their own (74%), and had never received in-person firearm training (70%). Practice settings included suburban (50%), urban (28%), and rural (17%) with annual patient volumes of a median of 8,750 patients (IQR: 4,500 - 25,000). Among the pediatricians surveyed, 80% agreed or strongly agreed that it is their responsibility to provide firearm safety counseling. However, more than 40% of pediatricians reported they do not provide firearm safety counseling at every age group visit. Pre-school (58%) and adolescent (57%) were the most frequent well-child visit age groups where families receive firearm safety counseling, while families of newborns (11%) and infants (13%) were least frequently counseled. Not enough time (64%) was the most frequently selected, as one of the top three barriers, for not giving firearm safety counseling. The next most frequent barrier to firearm safety counseling was political or cultural reasons (38%) followed by a lack of available resources (34%). Only 25% of respondents agreed they had adequate resources to provide guidance on firearm safety. Educational pamphlets, on firearm safety, were the most frequently selected preferred resource (60%) to aid physician firearm safety counseling.

Conclusion: Pediatricians agree that it is their responsibility to discuss firearm safety at well-child visits. However, counseling occurs infrequently due to barriers such as time, cultural/political beliefs, and resources. Development and dissemination of firearm safety educational resources are critical in assisting pediatricians to provide firearm safety counseling.