The Urgent Need for More Federal Funding for Pediatric Firearm Injury Prevention Research

Firearm injuries and deaths among children and youth in the United States have continued to increase over the last decade, despite increasing attention to this public health issue. Firearms are now the leading cause of death for US children and youth, overtaking motor vehicle crashes (MVCs) in 2017.1 In 2022, the most recent year of data available from the Centers for Disease Control and Prevention (CDC), there were 10 957 deaths resulting in 498 839 years of potential life lost from firearms in children and youth aged 0 to 24 years old.2 The reasons for this are multifactorial and more complex than for other leading causes of pediatric fatalities, including MVCs, drowning, cancer, and overdoses.2 However, despite the substantial role firearms have in causing pediatric mortality and morbidity, and a need to understand the complexity of the problem, there has been, and continues to be, remarkably little federal funding for firearm injury prevention research.In the early 1990s, the CDC funded rigorous research related to firearms. A seminal study published in 1993 concluded that having a firearm in the home increased the risk of death from a firearm, primarily from suicide and intimate partner violence.3 One reaction to this study resulted in the US Congress attempting to eliminate funding for the CDC's National Center for Injury Prevention and Control in 1996, which was unsuccessful. Nevertheless, the US Congress did successfully remove $2.6 million in appropriations to the CDC—the amount of funding designated for firearm injury research.4 This occurred with the passage of the Dickey Amendment, which stated no federal funds to the CDC could be used for research to "advocate or promote gun control."4Interpretation of the Dickey Amendment was extended to the National Institutes of Health (NIH) in 2011, eliminating almost all federal funding for firearm injury prevention research. Only with the continued rise of firearm violence, including increasing frequencies of mass shooting events like the Marjory Stoneman Douglas High School shooting in Parkland, Florida in 2018, was the Dickey Amendment reinterpreted.4 In 2020, the US Congress passed appropriations for firearm injury prevention research for a total amount of $25 million—for all ages, not just pediatrics—with $12.5 million for the CDC and $12.5 million for the NIH (Figure 1). Since then, congressional funding for the CDC and NIH has remained flat at $25 million in 2021, 2022, 2023, and 2024. Although overall federal research funding has demonstrated increases, peaking at $62.2 million in 2021, the most recent data from 2022 shows a decrease of more than $10 million in annual funding. Further, this year's funding was threatened again with the proposed elimination of the CDC's National Center for Injury Prevention and Control when the House Appropriations Committee approved the FY25 Labor, Health and Human Services, Education, and Related Agencies Appropriations Act.5 Although this version of the budget was not ultimately adopted by the US Congress, funding for firearm injury prevention research continues to be in jeopardy.Research funding for firearm injury prevention should be a science policy priority, given the long-term effects of pediatric firearm violence in measurable years of potential life lost and in the less measurable yet devastating effects on survivors and their communities. With essentially no dedicated federal research funding for pediatric firearm injury prevention for decades, few investments were available to build research infrastructure and career pathways for pediatric firearm injury prevention researchers. This is in stark contrast to other injury mechanisms and medical conditions, such as MVCs and pediatric cancer. Given the past dearth of support for any type of firearm injury prevention research, increasing investments are urgently needed now to fund research and build research infrastructure.Funding is essential to advance innovative research so we can better understand risk and protective factors to reverse this ongoing trend of increasing firearm injuries and deaths to our children and youth. We need to develop, study, and implement effective community, hospital, and school-based interventions for community firearm violence,6 and more comprehensive, accurate, and real-time data sources on not just fatal, but also nonfatal firearm injuries, must also be created, as we have for MVCs from the National Highway Safety Transportation Administration.1 Increased research funding is also critical to develop and grow a diverse and multidisciplinary research workforce because the decades-long funding gap resulted in a loss of nearly 3 generations of firearm injury prevention researchers. It will take years to fill this deficit of researchers not just in medicine but also in the fields of criminology, sociology, public health, law, and others. Additional researchers, research infrastructure, and research are essential to decrease firearm injuries and deaths by increasing our knowledge of risk and protective factors and effective injury prevention and harm reduction strategies and legislative policies. Because firearm violence affects individuals of all ages, these investments would also benefit public health more broadly.One important example of how federal research funding has improved health outcomes for children is in the treatment of pediatric cancer. Large investments in funding and research have led to tremendous advances in developing innovative agents and curative treatments through research and the development of the necessary research workforce and infrastructure.7 As a result, we have witnessed dramatic improvements not only in survival, with fatality rates decreasing more than 30% in the last 25 years (Figure 1), but also in quality of life for children during and after cancer treatment.7Motor vehicle safety is another area where we have seen resounding success in decreasing deaths and injuries to children.1 In addition to federal funding for research, federal databases provide detailed information on fatal and nonfatal crashes. Robust research funding has focused on decreasing death and disability due to MVCs. These resources have provided important information on risk and protective factors related to motor vehicle safety. As a result, effective interventions focused on the safety of motor vehicles, car seats, and roads and legislative policies have led to decreases in MVC deaths and nonfatal injuries for all ages. It is notable that motor vehicle safety was not a priority for motor vehicle manufacturers and was not supported by the federal government. Then, in the 1960s, the National Highway Safety Transportation Administration was established, which is responsible for keeping people safe on US roads and regulates the motor vehicle industry to build safer vehicles.1We assert that continued advocacy will be needed to maintain funding for firearm injury prevention research. Advocacy will also be needed to support funding for critical research institutions including the CDC and the NIH. Just as research funding has advanced the science for the treatment of pediatric cancer and motor vehicle safety, continued funding will be essential for advancing the science of firearm injury prevention. This is one critical part of the multipronged strategy that is needed to decrease firearm injuries and deaths to US children and youth.