Opinion Viewpoint
sions to the public. These current efforts have been aided by the emergence of intussusception concerns well after the vaccines had become widely used in the United States and internationally, allowing for substantial evidence of the benefits of the current vaccines to be available. For RotaShield, reports of intussusception appeared much earlier following its regulatory approval, such that its potential benefits could only be inferred from clinical trial results. Moreover, US officials involved in decision making regarding RotaShield later acknowledged that concern for preserving public confidence in vaccination generally—during a period when the safety of vaccines was challenged on multiple fronts—was at least as important to the resolution of that case as was a formal assessment of the risks and potential benefits of the first rotavirus vaccine.4,7 Public health officials were criticized at the time for not explicitly and publicly discussing the risks and benefits of RotaShield in the United States. Such a justification for their decision to end use of the vaccine could have more clearly highlighted the potential for different policy outcomes in countries where the consequences of diarrhea and dehydration following rotavirus infection were—and reARTICLE INFORMATION Published Online: October 7, 2013. doi:10.1001/jamapediatrics.2013.3771. Conflict of Interest Disclosures: None reported. REFERENCES 1. Clark HF, Offit PA, Parashar UD. Rotavirus vaccines. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. 6th ed. Edinburgh, Scotland: Saunders; 2013:669-687. 2. Cortese MM. Summary of intussusception risk and benefits of rotavirus vaccination in the United States. Centers for Disease Control and Prevention
VIEWPOINT
Brad J. Bushman, PhD School of Communication and Department of Psychology, The Ohio State University, Columbus, and Department of Communication Science, VU University Amsterdam, Amsterdam, the Netherlands.
main—profoundly more severe. Today, the straightforward, open discussions by the CDC and its advisors comparing the risks and benefits of the current generation of rotavirus vaccines provide policy makers, physicians, and citizens worldwide with a clearer understanding of the substantial benefits of the vaccines and their far more modest risks. At a time when the alleged, unsubstantiated risks of vaccines are too numerous to count, the prospect of public health officials acknowledging a known, potentially life-threatening risk associated with a widely administered childhood vaccine yet continuing to endorse its use may seem hazardous to efforts to preserve public support for vaccination. To the contrary, evidence-based public dialogues regarding the documented benefits and risks of medical interventions are not only appropriate but invaluable to collaborative efforts among governments, the public health and medical communities, and citizens to best promote the health of individuals and populations. The recent proceedings of the ACIP regarding rotavirus vaccines can serve as a model for the continued expansion of such deliberations throughout medicine and public health.
Advisory Committee on Immunization Practices; June 20, 2013. http://www.cdc.gov/vaccines/acip /meetings/downloads/slides-jun-2013/06 -Rotavirus-Cortese.pdf. Accessed July 31, 2013.
Intussusception among infants given an oral rotavirus vaccine [published correction appears in N Engl J Med. 2001;344(20):1564]. N Engl J Med. 2001;344(8):564-572.
3. Desai R, Cortese MM, Meltzer MI, et al. Potential intussusception risk versus benefits of rotavirus vaccination in the United States. Pediatr Infect Dis J. 2013;32(1):1-7.
6. Centers for Disease Control and Prevention (CDC). Withdrawal of rotavirus vaccine recommendation. MMWR Morb Mortal Wkly Rep. 1999;48(43):1007.
4. Schwartz JL. The first rotavirus vaccine and the politics of acceptable risk. Milbank Q. 2012;90(2):278-310.
7. Murphy TV, Smith PJ, Gargiullo PM, Schwartz B. The first rotavirus vaccine and intussusception: epidemiological studies and policy decisions. J Infect Dis. 2003;187(8):1309-1313.
5. Murphy TV, Gargiullo PM, Massoudi MS, et al; Rotavirus Intussusception Investigation Team.
The Weapons Effect On December 14, 2012, after shooting his mother, 20year-old Adam Lanza shot and killed 20 children and 6 employees at Sandy Hook Elementary School in Newtown, Connecticut. In the wake of the Newtown shootings, there has been considerable discussion about gun violence. What is conspicuously absent from these discussions, however, is the fact that just seeing guns can increase aggression.
Research Evidence Guns not only permit violence, they can stimulate it as well. The finger pulls the trigger, but the trigger may also be pulling the finger. Leonard Berkowitz, PhD, Emeritus Professor of Psychology, University of Wisconsin1
In 1967, Leonard Berkowitz, PhD, and Anthony LePage, PhD, conducted a study to determine whether the mere presence of a weapon could increase aggression.2 Angered participants were seated at a table that had a shotgun and a revolver on it—or badminton racquets and 1094
shuttlecocks in the control condition. The items on the table were described as part of another experiment that the researcher had supposedly forgotten to put away. The participant was supposed to decide what level of electric shock to deliver to an accomplice of the experimenter, whichwastheaggressionmeasure.Theexperimentertold participants to ignore the items, but apparently they could not. Participants who saw the guns were more aggressive (ie, gave more intense shocks to the accomplice) than were participants who saw the sports items. More than 50 other studies have replicated this effect, which has been dubbed the weapons effect.3 The effect occurs for angry and nonangry individuals, both inside and outside the laboratory. In one field experiment,4 for example, an accomplice driving a pickup truck remained stalled at a traffic light for 12 seconds. The truck contained either a military rifle in a gun rack mounted to the rear window or no rifle. The results showed that motorists honked more quickly and more frequently (the aggression measures) if the ac-
JAMA Pediatrics December 2013 Volume 167, Number 12
Copyright 2013 American Medical Association. All rights reserved.
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complice was driving a truck with a gun visible in the rear window than if there was no gun in the window. If you think about it, you would have to be foolish to honk your horn at a driver with a military rifle in his truck! But people were not thinking—they just automatically honked their horns after seeing the gun. Research also shows that drivers with guns in their vehicles drive more aggressively, even when numerous other factors are controlled (eg, sex, age, urbanization, census region, driving frequency).5 Weapons can even make people aggressive when they cannot see them. In a study conducted in our laboratory,6 for example, participants who were exposed to words describing weapons (eg, “gun”) for only 17/100ths of a second were more aggressive afterward than were participants exposed to nonaggressive words (eg, “water”). Although weapons effect studies have mainly used young adult participants, there is no reason to believe that the weapons effect would not also hold for children. For example, violent video games, which contain lots of guns, increase aggression in male and female players of all ages, regardless of the country in which they live.7 Even toy guns can produce a weapons effect by increasing nonplayrelated aggression as well as play-related aggression in children.
Guns, Guns, Everywhere American society is saturated with guns. You can even make a gun with a 3-dimensional printer that can fire bullets. Children who live in homes without guns may still be frequently exposed to guns in the mass media. A recent analysis of top-selling films found that the depiction of guns in violent scenes in PG-13–rated films that target youths has increased from the level of G-rated and PG-rated films in 1985, when theratingwasintroduced,toexceedthelevelofR-ratedfilmsby2012.8 By including guns in violent scenes, film producers may be inadvertently increasing aggression in youths via a weapons effect.
Gun Owner Responses to Learning About the Weapons Effect In Florida, a man with the Twitter name @Gun_Collector likes to show off his 115 guns on the photo-sharing website Instagram. In the ARTICLE INFORMATION Corresponding Author: Brad J. Bushman, PhD, School of Communication, The Ohio State University, 3127 Derby Hall, 154 N Oval Mall, Columbus, OH 43210 ([email protected]). Published Online: October 21, 2013. doi:10.1001/jamapediatrics.2013.3824. Conflict of Interest Disclosures: None reported. REFERENCES 1. Berkowitz L. Impulse, aggression, and the gun. Psychol Today. 1968;2(4):19-22. 2. Berkowitz L, LePage A. Weapons as aggression-eliciting stimuli. J Pers Soc Psychol. 1967;7(2, pt 1):202-207. doi:10.1037/h0025008.
jamapediatrics.com
months following the Newtownshooting, his followers increased from 8500 to more than 40 000. In a news story about @Gun_Collector, I was (accurately) quoted as saying, “the mere presence of weapons can increase aggression.” I received dozens of openly hostile comments from gun owners about this news story, via anonymous comments, e-mails, telephone calls, and letters. It is ironic that gun owners claim that the mere presence of a gun does not increase aggression, yet they have made some of the most aggressive comments I have ever received about my research, providing indirect evidence for the weapons effect. Such hostile comments may even prevent some researchers from talking to the press (and therefore educating the public) about the weapons effect. Pediatricians who tell gun owners about the weapons effect may likewise receive hostile comments. Unfortunately, this vocal minority dominates public discussion (and public policy).
Understanding the Weapons Effect Can Help Families Out of sight, out of mind. John Heywood, English writer
Research has shown that children are naturally curious about guns, have difficulty distinguishing a real gun from a toy gun, are prone to handling guns, and can shoot themselves or others with guns.9 More than a third (35%) of American homes with children have at least 1 firearm.10 In other words, more than 22 million children in 11 million homes are exposed to actual firearms every day. In only 39% of these homes are firearms locked, unloaded, and separate from ammunition, as recommended by the American Academy of Pediatrics. To reduce the weapons effect, gun owners could not only follow the American Academy of Pediatrics recommendations but also keep guns out of sight of family members rather than visibly displayed in glass cabinets or on shelves. Parents can also give their children toys other than guns and reduce exposure to guns in the mass media by monitoring the media their children consume.
3. Carlson M, Marcus-Newhall A, Miller N. Effects of situational aggression cues: a quantitative review. J Pers Soc Psychol. 1990;58(4):622-633.
prosocial behavior in eastern and western countries: a meta-analytic review. Psychol Bull. 2010;136(2):151-173.
4. Turner CW, Layton JF, Simons LS. Naturalistic studies of aggressive behavior: aggressive stimuli, victim visibility, and horn honking. J Pers Soc Psychol. 1975;31(6):1098-1107.
8. Bushman BJ, Jamieson PE, Weitz I, Romer D. Gun violence trends in movies. Pediatrics. In press.
5. Hemenway D, Vriniotis M, Miller M. Is an armed society a polite society? guns and road rage. Accid Anal Prev. 2006;38(4):687-695. 6. Subra B, Muller D, Bègue L, Bushman BJ, Delmas F. Automatic effects of alcohol and aggressive cues on aggressive thoughts and behaviors. Pers Soc Psychol Bull. 2010;36(8):1052-1057. 7. Anderson CA, Shibuya A, Ihori N, et al. Violent video game effects on aggression, empathy, and
9. American Academy of Pediatrics. Is there a gun where your child plays? asking can save lives. http://www.aap.org/en-us/about-the-aap/aap -press-room/pages/Is-there-a-Gun-Where-Your -Child-Plays-Asking-Can-Save-Lives.aspx. Accessed July 25, 2013. 10. Schuster MA, Franke TM, Bastian AM, Sor S, Halfon N. Firearm storage patterns in US homes with children. Am J Public Health. 2000;90(4):588-594.
JAMA Pediatrics December 2013 Volume 167, Number 12
Copyright 2013 American Medical Association. All rights reserved.
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sions to the public. These current efforts have been aided by the emergence of intussusception concerns well after the vaccines had become widely used in the United States and internationally, allowing for substantial evidence of the benefits of the current vaccines to be available. For RotaShield, reports of intussusception appeared much earlier following its regulatory approval, such that its potential benefits could only be inferred from clinical trial results. Moreover, US officials involved in decision making regarding RotaShield later acknowledged that concern for preserving public confidence in vaccination generally—during a period when the safety of vaccines was challenged on multiple fronts—was at least as important to the resolution of that case as was a formal assessment of the risks and potential benefits of the first rotavirus vaccine.4,7 Public health officials were criticized at the time for not explicitly and publicly discussing the risks and benefits of RotaShield in the United States. Such a justification for their decision to end use of the vaccine could have more clearly highlighted the potential for different policy outcomes in countries where the consequences of diarrhea and dehydration following rotavirus infection were—and reARTICLE INFORMATION Published Online: October 7, 2013. doi:10.1001/jamapediatrics.2013.3771. Conflict of Interest Disclosures: None reported. REFERENCES 1. Clark HF, Offit PA, Parashar UD. Rotavirus vaccines. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. 6th ed. Edinburgh, Scotland: Saunders; 2013:669-687. 2. Cortese MM. Summary of intussusception risk and benefits of rotavirus vaccination in the United States. Centers for Disease Control and Prevention
VIEWPOINT
Brad J. Bushman, PhD School of Communication and Department of Psychology, The Ohio State University, Columbus, and Department of Communication Science, VU University Amsterdam, Amsterdam, the Netherlands.
main—profoundly more severe. Today, the straightforward, open discussions by the CDC and its advisors comparing the risks and benefits of the current generation of rotavirus vaccines provide policy makers, physicians, and citizens worldwide with a clearer understanding of the substantial benefits of the vaccines and their far more modest risks. At a time when the alleged, unsubstantiated risks of vaccines are too numerous to count, the prospect of public health officials acknowledging a known, potentially life-threatening risk associated with a widely administered childhood vaccine yet continuing to endorse its use may seem hazardous to efforts to preserve public support for vaccination. To the contrary, evidence-based public dialogues regarding the documented benefits and risks of medical interventions are not only appropriate but invaluable to collaborative efforts among governments, the public health and medical communities, and citizens to best promote the health of individuals and populations. The recent proceedings of the ACIP regarding rotavirus vaccines can serve as a model for the continued expansion of such deliberations throughout medicine and public health.
Advisory Committee on Immunization Practices; June 20, 2013. http://www.cdc.gov/vaccines/acip /meetings/downloads/slides-jun-2013/06 -Rotavirus-Cortese.pdf. Accessed July 31, 2013.
Intussusception among infants given an oral rotavirus vaccine [published correction appears in N Engl J Med. 2001;344(20):1564]. N Engl J Med. 2001;344(8):564-572.
3. Desai R, Cortese MM, Meltzer MI, et al. Potential intussusception risk versus benefits of rotavirus vaccination in the United States. Pediatr Infect Dis J. 2013;32(1):1-7.
6. Centers for Disease Control and Prevention (CDC). Withdrawal of rotavirus vaccine recommendation. MMWR Morb Mortal Wkly Rep. 1999;48(43):1007.
4. Schwartz JL. The first rotavirus vaccine and the politics of acceptable risk. Milbank Q. 2012;90(2):278-310.
7. Murphy TV, Smith PJ, Gargiullo PM, Schwartz B. The first rotavirus vaccine and intussusception: epidemiological studies and policy decisions. J Infect Dis. 2003;187(8):1309-1313.
5. Murphy TV, Gargiullo PM, Massoudi MS, et al; Rotavirus Intussusception Investigation Team.
The Weapons Effect On December 14, 2012, after shooting his mother, 20year-old Adam Lanza shot and killed 20 children and 6 employees at Sandy Hook Elementary School in Newtown, Connecticut. In the wake of the Newtown shootings, there has been considerable discussion about gun violence. What is conspicuously absent from these discussions, however, is the fact that just seeing guns can increase aggression.
Research Evidence Guns not only permit violence, they can stimulate it as well. The finger pulls the trigger, but the trigger may also be pulling the finger. Leonard Berkowitz, PhD, Emeritus Professor of Psychology, University of Wisconsin1
In 1967, Leonard Berkowitz, PhD, and Anthony LePage, PhD, conducted a study to determine whether the mere presence of a weapon could increase aggression.2 Angered participants were seated at a table that had a shotgun and a revolver on it—or badminton racquets and 1094
shuttlecocks in the control condition. The items on the table were described as part of another experiment that the researcher had supposedly forgotten to put away. The participant was supposed to decide what level of electric shock to deliver to an accomplice of the experimenter, whichwastheaggressionmeasure.Theexperimentertold participants to ignore the items, but apparently they could not. Participants who saw the guns were more aggressive (ie, gave more intense shocks to the accomplice) than were participants who saw the sports items. More than 50 other studies have replicated this effect, which has been dubbed the weapons effect.3 The effect occurs for angry and nonangry individuals, both inside and outside the laboratory. In one field experiment,4 for example, an accomplice driving a pickup truck remained stalled at a traffic light for 12 seconds. The truck contained either a military rifle in a gun rack mounted to the rear window or no rifle. The results showed that motorists honked more quickly and more frequently (the aggression measures) if the ac-
JAMA Pediatrics December 2013 Volume 167, Number 12
Copyright 2013 American Medical Association. All rights reserved.
Downloaded From: http://archpedi.jamanetwork.com/ by a University of Texas at Austin User on 06/05/2015
jamapediatrics.com
Opinion
complice was driving a truck with a gun visible in the rear window than if there was no gun in the window. If you think about it, you would have to be foolish to honk your horn at a driver with a military rifle in his truck! But people were not thinking—they just automatically honked their horns after seeing the gun. Research also shows that drivers with guns in their vehicles drive more aggressively, even when numerous other factors are controlled (eg, sex, age, urbanization, census region, driving frequency).5 Weapons can even make people aggressive when they cannot see them. In a study conducted in our laboratory,6 for example, participants who were exposed to words describing weapons (eg, “gun”) for only 17/100ths of a second were more aggressive afterward than were participants exposed to nonaggressive words (eg, “water”). Although weapons effect studies have mainly used young adult participants, there is no reason to believe that the weapons effect would not also hold for children. For example, violent video games, which contain lots of guns, increase aggression in male and female players of all ages, regardless of the country in which they live.7 Even toy guns can produce a weapons effect by increasing nonplayrelated aggression as well as play-related aggression in children.
Guns, Guns, Everywhere American society is saturated with guns. You can even make a gun with a 3-dimensional printer that can fire bullets. Children who live in homes without guns may still be frequently exposed to guns in the mass media. A recent analysis of top-selling films found that the depiction of guns in violent scenes in PG-13–rated films that target youths has increased from the level of G-rated and PG-rated films in 1985, when theratingwasintroduced,toexceedthelevelofR-ratedfilmsby2012.8 By including guns in violent scenes, film producers may be inadvertently increasing aggression in youths via a weapons effect.
Gun Owner Responses to Learning About the Weapons Effect In Florida, a man with the Twitter name @Gun_Collector likes to show off his 115 guns on the photo-sharing website Instagram. In the ARTICLE INFORMATION Corresponding Author: Brad J. Bushman, PhD, School of Communication, The Ohio State University, 3127 Derby Hall, 154 N Oval Mall, Columbus, OH 43210 ([email protected]). Published Online: October 21, 2013. doi:10.1001/jamapediatrics.2013.3824. Conflict of Interest Disclosures: None reported. REFERENCES 1. Berkowitz L. Impulse, aggression, and the gun. Psychol Today. 1968;2(4):19-22. 2. Berkowitz L, LePage A. Weapons as aggression-eliciting stimuli. J Pers Soc Psychol. 1967;7(2, pt 1):202-207. doi:10.1037/h0025008.
jamapediatrics.com
months following the Newtownshooting, his followers increased from 8500 to more than 40 000. In a news story about @Gun_Collector, I was (accurately) quoted as saying, “the mere presence of weapons can increase aggression.” I received dozens of openly hostile comments from gun owners about this news story, via anonymous comments, e-mails, telephone calls, and letters. It is ironic that gun owners claim that the mere presence of a gun does not increase aggression, yet they have made some of the most aggressive comments I have ever received about my research, providing indirect evidence for the weapons effect. Such hostile comments may even prevent some researchers from talking to the press (and therefore educating the public) about the weapons effect. Pediatricians who tell gun owners about the weapons effect may likewise receive hostile comments. Unfortunately, this vocal minority dominates public discussion (and public policy).
Understanding the Weapons Effect Can Help Families Out of sight, out of mind. John Heywood, English writer
Research has shown that children are naturally curious about guns, have difficulty distinguishing a real gun from a toy gun, are prone to handling guns, and can shoot themselves or others with guns.9 More than a third (35%) of American homes with children have at least 1 firearm.10 In other words, more than 22 million children in 11 million homes are exposed to actual firearms every day. In only 39% of these homes are firearms locked, unloaded, and separate from ammunition, as recommended by the American Academy of Pediatrics. To reduce the weapons effect, gun owners could not only follow the American Academy of Pediatrics recommendations but also keep guns out of sight of family members rather than visibly displayed in glass cabinets or on shelves. Parents can also give their children toys other than guns and reduce exposure to guns in the mass media by monitoring the media their children consume.
3. Carlson M, Marcus-Newhall A, Miller N. Effects of situational aggression cues: a quantitative review. J Pers Soc Psychol. 1990;58(4):622-633.
prosocial behavior in eastern and western countries: a meta-analytic review. Psychol Bull. 2010;136(2):151-173.
4. Turner CW, Layton JF, Simons LS. Naturalistic studies of aggressive behavior: aggressive stimuli, victim visibility, and horn honking. J Pers Soc Psychol. 1975;31(6):1098-1107.
8. Bushman BJ, Jamieson PE, Weitz I, Romer D. Gun violence trends in movies. Pediatrics. In press.
5. Hemenway D, Vriniotis M, Miller M. Is an armed society a polite society? guns and road rage. Accid Anal Prev. 2006;38(4):687-695. 6. Subra B, Muller D, Bègue L, Bushman BJ, Delmas F. Automatic effects of alcohol and aggressive cues on aggressive thoughts and behaviors. Pers Soc Psychol Bull. 2010;36(8):1052-1057. 7. Anderson CA, Shibuya A, Ihori N, et al. Violent video game effects on aggression, empathy, and
9. American Academy of Pediatrics. Is there a gun where your child plays? asking can save lives. http://www.aap.org/en-us/about-the-aap/aap -press-room/pages/Is-there-a-Gun-Where-Your -Child-Plays-Asking-Can-Save-Lives.aspx. Accessed July 25, 2013. 10. Schuster MA, Franke TM, Bastian AM, Sor S, Halfon N. Firearm storage patterns in US homes with children. Am J Public Health. 2000;90(4):588-594.
JAMA Pediatrics December 2013 Volume 167, Number 12
Copyright 2013 American Medical Association. All rights reserved.
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