Researchers in the Center for Violence Prevention (CVP) at Children’s Hospital of Philadelphia (CHOP) collaborated with a team led by Lurie Children’s Hospital in Chicago that found children living in areas with the lowest Child Opportunity Index (COI), a measure that assesses factors like education, socioeconomic resources and access to health environments, were more than twice as likely to experience another violent injury within a year of an initial firearm related emergency department (ED) visit. The retrospective study was published recently in the journal JAMA Pediatrics.
The effort was also part of a longstanding collaboration between pediatric researchers and the Children’s Hospital Association (CHA), which organizes the Children’s Hospital Association’s multi-disciplinary research collaborative (CHARGE) Firearm Injury Prevention Research Group.
Researchers analyzed data from 6,681 children treated for firearm injuries at one of 49 pediatric hospitals across the United States between 2016 and 2023. Of these children, 116 (1.7%) experienced another violent injury within one year. The risk was particularly high for adolescents aged 15 to 16, non-Hispanic Black children and those living in urban areas, citing neighborhood-level disadvantage as a key predictor of recurrent violence. The study found that 51.7 % of reinjured children reside in a community with the lowest COI. Prior research has shown that children from low COI neighborhoods already face an elevated risk of firearm injury, and this study suggests the same social inequities are associated with violent reinjury.
“Our findings emphasize the urgent need for targeted interventions to address the root causes of firearm violence in children,” said Joel Fein, MD, MPH, a study author and co-director of CVP at Children’s Hospital of Philadelphia. “Hospital-based violence prevention programs, which provide wraparound care and social support for injured children, could be expanded to help reduce reinjury risks. Addressing structural and social drivers of health is essential for long-term progress in preventing firearm injures among children.”
The researchers also recommend that healthcare providers consider integrating COI data into patient assessments to identify and support those at the highest risk. They stressed the importance of systemic changes to strengthen disinvested communities. Future research will explore the effectiveness of COI as part of a predictive tool for identifying and prioritizing at-risk children during the initial injury visits, potentially guiding more proactive interventions.
Kemal S. Hall et al. “Child and Neighborhood-Level Factors and Violent Reinjury Among Children with Firearm Injuries.” JAMA Pediatrics. Online March 03, 2025. DOI: 10.1001/jamapediatrics.2024.6842
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Researchers in the Center for Violence Prevention (CVP) at Children’s Hospital of Philadelphia (CHOP) collaborated with a team led by Lurie Children’s Hospital in Chicago that found children living in areas with the lowest Child Opportunity Index (COI), a measure that assesses factors like education, socioeconomic resources and access to health environments, were more than twice as likely to experience another violent injury within a year of an initial firearm related emergency department (ED) visit. The retrospective study was published recently in the journal JAMA Pediatrics.
The effort was also part of a longstanding collaboration between pediatric researchers and the Children’s Hospital Association (CHA), which organizes the Children’s Hospital Association’s multi-disciplinary research collaborative (CHARGE) Firearm Injury Prevention Research Group.
Researchers analyzed data from 6,681 children treated for firearm injuries at one of 49 pediatric hospitals across the United States between 2016 and 2023. Of these children, 116 (1.7%) experienced another violent injury within one year. The risk was particularly high for adolescents aged 15 to 16, non-Hispanic Black children and those living in urban areas, citing neighborhood-level disadvantage as a key predictor of recurrent violence. The study found that 51.7 % of reinjured children reside in a community with the lowest COI. Prior research has shown that children from low COI neighborhoods already face an elevated risk of firearm injury, and this study suggests the same social inequities are associated with violent reinjury.
“Our findings emphasize the urgent need for targeted interventions to address the root causes of firearm violence in children,” said Joel Fein, MD, MPH, a study author and co-director of CVP at Children’s Hospital of Philadelphia. “Hospital-based violence prevention programs, which provide wraparound care and social support for injured children, could be expanded to help reduce reinjury risks. Addressing structural and social drivers of health is essential for long-term progress in preventing firearm injures among children.”
The researchers also recommend that healthcare providers consider integrating COI data into patient assessments to identify and support those at the highest risk. They stressed the importance of systemic changes to strengthen disinvested communities. Future research will explore the effectiveness of COI as part of a predictive tool for identifying and prioritizing at-risk children during the initial injury visits, potentially guiding more proactive interventions.
Kemal S. Hall et al. “Child and Neighborhood-Level Factors and Violent Reinjury Among Children with Firearm Injuries.” JAMA Pediatrics. Online March 03, 2025. DOI: 10.1001/jamapediatrics.2024.6842
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