Firearm Violence

  • handgun

Development of a Youth Firearm Risk and Safety Assessment Tool (Youth-FiRST)  


In 2013, 1,258 children (1.71 per 100,000) died by gunshot and an additional 6,103 (8.29 per 100,000) had a nonfatal gunshot injury.  Additionally, in 2010 youth firearm-related fatal and nonfatal injuries resulted in an estimated $2.6 billion in combined medical and work loss costs. Carrying a firearm is a key risk factor for youth violence.  Approximately 770,000 U.S. adolescents (ages 12–17) report carrying a handgun in a given year.   Witnessing firearm-related violence can also have serious mental health consequences. Acknowledging these striking numbers, a wide range of policy interventions have been developed to help reduce such violent crimes, with mixed-results. Still, we know surprisingly little about children's exposure to guns and the implications of that exposure on risk for violence, injury, and death.  This is despite policy statements and recommendations from groups like the American Academy of Pediatrics, the American Psychological Association,  and the USDHHS Healthy People 2020 emphasizing the importance of finding strategies for reducing the risks associated with children's firearm access and exposure. 

Past research on youth firearm exposure has focused on only a limited range of exposures, such as firearm carrying on school property, yet youth firearm exposure is not limited to schools or to carrying. Further, our past work has found that the presence of a gun as part of victimization is a particularly traumatizing experience for children, even after considering other victimization characteristics. It is critical to better understand the role of guns in children's lives today and to identify subgroups of youth for whom these exposures are harm-producing. Although there are comprehensive studies of adult firearm exposure, there are no instruments that cover the full spectrum of childhood firearm exposure. Such a lack of youth-focused surveys limits the ability to assess the developmental impact of exposure and identify the most important targets for policy and programs that aim to reduce firearm-related fatal and nonfatal injury among youth. Indeed, there are considerations unique to childhood, such as inappropriate or illegal access to firearms, exposure to gun violence involving caregivers which may be particularly traumatic, and the developmental impact of exposure to effective gun safety practices. In addition to different considerations regarding exposure, there are also important methodological adaptations that are necessary for youth, including more careful attention to reading level and avoiding use of legalistic terms. Exposure to firearm violence research and policy has been fragmented and programming, such as it exists, tends to be targeted at narrow age ranges.   


Objective 1: Develop the first comprehensive, developmentally focused Youth Firearm Risk and Safety Tool (Youth-FiRST).

Objective 2: Pilot test the Youth-FiRST within three communities at high-risk for gun violence – rural Appalachia, TN, urban Philadelphia, PA, and urban Boston, MA.


The Youth-FiRST will be the first assessment tool to fully cover youth firearm exposure, access, and safety practices across the developmental span of childhood. Items will be developed through a mixed-methods approach, including focus groups with youth and caregivers in Appalachia, TN, Philadelphia, PA, and Boston, MA; review by experts; and cognitive interviews with child respondents, ages 10-15, for comprehension. Specific attention will be paid to establishing overlapping, age-specific items that incorporate information about potential vulnerabilities to risky firearm exposure (i.e., victimization, stressful life events, neighborhood conditions) by identifying scale items that can be considered common across age groups and items that should be age-specific.

Once the Youth-FiRST is finalized, pilot data will be gathered from 600 participants: 300 youth, ages 10-17, and 300 caregivers of children, ages 2-9 (proxy interviews), to establish psychometrics including internal consistency, factor structure, and construct validity using techniques such as Item Response Theory and Differential Item Functioning. Subsequent fielding on the Youth-FiRST (to be proposed as future R01s) will allow for evaluation and refinement of the items and establishment of national and diagnostic norms.


This project, funded by the National Institute of Health (1R21 HD086464-01A1), is the first phase of a new initiative of the CCRC - to increase appreciation of the true burden of firearm exposure and firearm violence on the most vulnerable segment of the population.  Such knowledge is critical for understanding the role of guns in children's lives today and to identify subgroups of youth for whom these exposures are harm-producing.  To this end, findings from the current study will help the public health field address youth exposure to firearms and associated violence exposure using a more integrative approach. 

For more information contact:
Kimberly J. Mitchell, PhD
Research Associate Professor of Psychology
Crimes against Children Research Center
(603) 862-4533