NEW YORK (Reuters Health) - Children and teenagers living in the most-rural parts of the U.S. are as likely to die by gun violence as those in big cities, a new study finds.
The findings, say researchers, counter the common belief that gun violence is mainly an urban problem.
The study found that from 1999 through 2006, 23,649 Americans age 19 or younger died from gunshots. Rates in the most-rural and most-urban counties were nearly the same -- at 4 deaths per 100,000 children and teens, and 4.6 per 100,000, respectively.
There were, however, different patterns when it came to the type of gun violence, the researchers report in the journal Pediatrics.
Children and teens in urban areas were more likely to be a victim of homicide than those in rural areas; but that was counter-balanced by higher rates of gun suicide and accidental shooting deaths among kids in rural counties.
"I think the popular perception is that (gun violence) is an urban problem," said lead researcher Dr. Michael L. Nance, of Children's Hospital of Philadelphia. "But this is something everyone has to worry about."
The findings, he told Reuters Health, could help local policy makers in developing the types of prevention efforts most likely to be useful in their areas: in urban centers, firearm homicide is the biggest threat to kids; in rural areas, it's suicide.
In the most-urban counties -- those with a metropolitan area of at least 1 million people -- there were 3.8 gun homicides per 100,000 children and teens age 19 or younger.
In the most-rural counties -- defined as being either "completely rural" or having an urban population of less than 2,500 and no nearby metropolitan area -- the gun-homicide rate was just under 0.8 per 100,000.
The picture was reversed, however, when it came to gun suicides, with the most-rural areas having a fourfold higher rate than the most-urban ones: 2.75 versus 0.7 suicides per 100,000 kids.
The rate of accidental gun death was 0.5 per 100,000 in the most-rural counties, compared with 0.1 per 100,000 in the most urban.
Nance said that the message for parents is much the same as it is for policy makers: guns are a problem everywhere, though the nature of the threat generally differs between rural and urban areas.
In rural areas, efforts to prevent teen suicide in general and to improve gun safety -- like keeping guns in the home properly locked away and educating kids on the dangers of firearms -- would be most useful. Household guns, Nance and his colleagues note, have also been linked to a heightened risk of suicide.
In highly urban areas, efforts to curb community violence would likely do the most to reduce child and teen gun deaths.
While the current study focused on gun deaths, Nance noted that rates of non-firearm accidental deaths also tended to rise substantially as counties grew progressively rural.
In the most-rural counties, there were roughly 26 accidental non-firearm deaths per 100,000 residents age 19 and younger -- versus 10 per 100,000 in the most-urban counties.
Nance said the question for future studies is to see why this death rate is so much higher in rural areas.
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Pediatrics, June 2010.