Firearm injury prevention counseling: Are we missing the mark?

Objective. To determine whether pediatricians accurately estimate the likel ihood of gun ownership among their patients' families. Design. Self-administered, written surveys completed simultaneously by pedi atricians and their patients' parents. Setting. A total of 23 pediatric practices and hospital-based clinics in th ree cities in the United States. Subjects. A total of 66 pediatricians paired with 169 of their patients' pa rents. Main Outcome Measures. Parent survey: ownership and storage of guns, willin gness to admit gun ownership, and previous counseling by pediatrician. Pedi atrician survey: estimated prevalence of gun ownership, likelihood of gun o wnership by each participant family, and beliefs about firearm injury preve ntion counseling. Results. All parents who owned guns indicated they would acknowledge owning a gun if asked by their pediatricians. Of the participating families, 28% owned at least one gun; 39% of the homes with guns contained a gun that was unlocked, loaded, or both. Of the parents, 11% reported that their pediatr ician had discussed firearm safety with them. Pediatricians' average estima te of the overall prevalence of gun ownership in their patient populations was 25%. When asked to predict the likelihood of gun ownership by the speci fic families in the study, pediatricians predicted a 0% likelihood of gun o wnership for 33% of the families. Of those families, 30% reported owning at least one gun. Considering physician predictions of any likelihood of gun ownership >0% (1%-100%) to be a positive prediction and using parent report s as the gold standard, physician estimates of gun ownership were only 65% sensitive. Approximately half (55%) of the participating pediatricians beli eved that pediatricians should discuss gun safety with all families, and 98 % believed that pediatricians should discuss gun safety with all gun-owning families. Conclusions. Pediatricians believe that all families with guns should recei ve firearm safety counseling. However, pediatricians significantly underest imate the likelihood of gun ownership by specific families. Parents who own guns indicate that they would acknowledge gun ownership if their pediatric ian asked about guns in the home. Therefore, rather than relying on assumpt ions about whether particular patients seem likely to be gun owners, pediat ricians should ask all families whether they own guns.