Trends in youth risk behaviours and firearm injury in the USA over 20 years.

Background: Firearm injuries are the leading cause of death in children and adolescents in the USA. We hypothesised that high rates of risky behaviour in high school students are associated with firearm injury and death in this population.

Methods: We obtained data from the Youth Behaviour Risk Survey of the Centers for Disease Control and Prevention (CDC) and combined it with data from the CDC Web-based Injury Statistics Query and Reporting System, CDC Wide-ranging Online Data for Epidemiologic Research and American Community Survey, 2001-2020. We examined trends over time using a non-parametric test for trends.

Results: The percentage of high school-aged youth carrying a weapon in the preceding 30 days ranged from 13.2% in 2019 to 18.5% in 2005, without a statistically significant trend over time (p=0.051). Those carrying a weapon to school peaked at 6.5% in 2005 and steadily downtrended to 2.8% in 2019 (p=0.004). Boys consistently reported higher rates of weapon carriage, with white boys reporting higher rates than black boys. Firearm homicides among adolescents 14-18 years showed no significant change, ranging from 4.0 per 100k in 2013 to 8.3 per 100k in 2020. This varied considerably by sex and race, with black boys suffering a rate of nearly 60 per 100 000 in 2020 and white girls rarely exceeding 1/100 000 during the study period.

Conclusion: Self-reported weapon carriage among teens in the USA has steadily downtrended over time. However, shooting injuries and deaths have not. While the former suggests progress, the latter remains concerning.

Level of evidence: Level III; retrospective cohort study.