Research In Action

Our CHOP colleague Dr. Christopher Forrest and his collaborators recently published findings in JAMA identifying worsening trends in mortality, as well as chronic physical, developmental, and mental health concerns for US children compared to children in peer countries. This work confirmed what many of us feared: the health of American children continues to deteriorate, with preventable sources of injury, including firearm violence and motor vehicle crashes, contributing disproportionally to this decline.

In a cross-national comparison of mortality rates, researchers observed US children and adolescents were more likely to die than their peers in other high-income countries. Over their 16-year study period, there were a staggering 315,795 excess child and adolescent deaths in the US.

Among children and adolescents, US cause-specific death rates exceeded those of peer nations by significant margins. US children were over 15 times more likely to die from firearm injuries, over five times more likely to die from substance use-related causes, and nearly three times more likely to die from motor vehicle crashes compared to their non-US peers. The disparities in firearm and substance use-related deaths widened further between 2020 and 2022.

At the Center for Injury Research and Prevention (CIRP), our mission is to accelerate research to keep children safe — reducing injury and violence while promoting recovery. These findings highlight why our work remains urgent and lifesaving.

Firearms and Children

In 2023, 4,470 American youth lost their lives to firearm violence. The presence of firearms in homes and communities escalates risks — turning conflicts, mental health crises, and accidents into fatal outcomes.

CIRP partner program, the Center for Violence Prevention, addresses firearm violence in multiple ways. In clinical settings, we provide evidence-based, safe firearm storage education and distribute firearm locks to families. In schools, we deliver developmentally appropriate bullying prevention programs, building social and emotional skills to reduce peer conflict and avoid escalation to physical violence.

Our hospital-based Violence Intervention Program offers support to youth injured by violence who receive care in our Emergency Department. Our case management support bridges from the hospital to community-based services to support physical and psychosocial recovery. We also work closely with community-led initiatives, including Beyond the Bars, Prescribe Outside, and the Christian Street YMCA, to sustain community-based research efforts to support development and evaluation of youth violence prevention efforts across Philadelphia in the communities where young people live and play.

Motor Vehicle Crashes and Children

While progress in reducing child occupant fatalities — cut in half over the past two decades— has been achieved through stronger laws, public education, and improvements in vehicle and restraint designs, continued innovation to improve safety for children is urgently needed. The number of ED visits among children less than 15 years of age for non-fatal transportation-related injuries has continued to rise, reaching a five-year high of over 350,000 in 2023.

CIRP researchers maintain strong partnerships with industry to inform vehicle and child restraint design, advance testing protocols, and enhance automated driver assistance systems to effectively protect children and novice drivers. Our innovative biomechanics research helps ensure vehicles of the future provide better protection for the youngest passengers.

Additionally, CIRP investigators developed and validated the Virtual Driving Assessment (VDA), which exposes teens to simulated crash scenarios to assess and improve their driving skills. The VDA is now standard in 28 CHOP Primary Care practices, with over 10,000 teens having received personalized feedback on crash avoidance skills. We are leveraging the VDA as a novel assessment tool for a large-scale clinical trial to evaluate driver training interventions to reduce crash risk among newly licensed teen drivers through the DRIVER Study, currently enrolling across the Philadelphia area.

Looking Forward

Core to our mission at CIRP is conducting rigorous research leading to safer communities for young people to live to their full potential unencumbered by risk for and consequences of physical and emotional injury. As these recent data highlight, the on-going threat to children and adolescents’ health and well-being from preventable causes makes our mission more timely than ever. CIRP remains dedicated to developing innovative solutions to pediatric injury prevention, building partnerships to advance evidence to action, and driving meaningful change to change the story of safety outcomes over the next 15 years.