Lax State Gun Laws Linked to More Firearm Deaths in Children

ORLANDO, Florida — Fewer children and teenagers die from gunshot injuries in states with strict gun laws than in states with more relaxed gun laws, according to two new studies with similar findings.

"Unfortunately, injury is the number one cause of death in children, and firearms are the leading cause of injury," Stephanie Chao, MD, from Lucile Packard Children's Hospital Stanford, reported here at the American Academy of Pediatrics 2018 National Conference.

"A child is 82 times more likely to die in our country from a firearm injury than in any other developed nation," she added.

Chao and her colleagues set out to look at this issue and seek an answer to "a very fundamental question: Do gun laws actually have the intended effect of decreasing death?"

And "they do, in fact, decrease gun deaths in children" Chao told Medscape Medical News.

Jordan Taylor

"Our findings point to some actionable items that could change, particularly at the state level, where there may be a bit more bandwidth to make some changes toward protecting kids," explained Jordan Taylor, MD, from the Stanford University School of Medicine in California.

In their study, Chao, Taylor, and their colleagues used the Brady score to rate the overall stringency of gun laws in each state, which ranged from –39 in Arizona, the state with the weakest laws, to +76 in California, the state with the strongest laws.

To evaluate child access prevention (CAP) laws in each state, the researchers looked at two classifications of legislation: laws that require guns to be stored safely (locked, unloaded, or both), and laws that impose liability for failing to prevent minors from gaining access to guns.

The analysis conducted by Chao's team controlled for many socioeconomic and demographic factors, including unemployment rates, poverty, urbanization, alcohol dependence, tobacco and marijuana use, high-school graduation rates, the number of registered firearms per 100,000 children in each state, and the strength of gun laws in neighboring states.

The annual rate of firearm-related mortality for youth was lower in states with stricter gun laws than in states with weaker laws (2.6 vs 5.0 per 100,000 children).

For the states, "Brady scores were significantly correlated with pediatric gun deaths after controlling for other factors," Chao reported.

CAP Laws Reduce Suicide Rate in Kids

CAP laws that prevent children from gaining access to guns, including locking mechanisms and storage requirements, also protect against suicide. Significantly fewer children died by firearm-related suicide each year in states with strong CAP laws than in states with weak CAP laws (0.63 vs 2.57 per 100,000 children), even after adjustment for other factors.

Chao said she hopes this research will contribute to a solution to the problem of firearm injury in children. "I think that everyone can agree, no matter how they feel about gun ownership, that no kid should die from guns."

With evidence showing that legislation does protect children, "we can take the next step to see what kind of legislation is most effective," Chao explained. "The 23 states that don't have child access protection laws would be a great, great starting point."

In the second study, researchers asked a similar question and came up with a similar answer.

Monika Goyal

"Stricter gun laws — specifically those requiring universal background checks for firearm and ammunition purchase — are associated with lower state-level firearm-related pediatric mortality rates," said Monika Goyal, MD, from Children's National Health System in Washington, DC.

"We would now like to see more research on the impact of legislation with respect to firearm-related injuries in children," she told Medscape Medical News.

Improved access to data and more comprehensive data on firearm injuries would be a big help. "We need data that allow the linkage of different types of datasets, and we do not have that currently," she pointed out.

I've seen the effects of gun violence on children first hand. It's devastating for the child, it's devastating for the families, it's devastating for the community, it's devastating for those of us who are caring for these children and families.

"I've seen the effects of gun violence on children first hand. It's devastating for the child, it's devastating for the families, it's devastating for the community, it's devastating for those of us who are caring for these children and families," Goyal said.

She and her team performed an ecologic analysis of 2015 data from the Web-based Injury Statistics Query and Reporting System, which was developed by the Centers for Disease Control and Prevention.

They adjusted for race, ethnicity, education, and poverty to measure the association between Brady Gun Law Scores and the presence of three state laws — universal background checks for firearm purchases, ammunition background checks, and identification for the purchase of firearms — that have been found to be associated with a reduction in overall deaths from firearms.

Of the 4528 children who died from firearm-related injuries in 2015, 87% were male and 51% were non-Hispanic white. That year, state-specific mortality rates ranged from 0 to 18 per 100,000 children.

An association was seen between the strength of firearm legislation and the rate of firearm-related mortality after race, ethnicity, education level, and median household income were controlled for.

For every 1 point increase in the Brady score, indicating stricter gun laws, firearm-related mortality decreased by 1%.

In states that required universal background checks for the purchase of a firearm, there was a 25% decrease in firearm-related deaths, and in states that required background checks for the purchase of ammunition, there was a 35% decrease.

"We need to do more research to understand which laws are most impactful in reducing firearm-related injury and death among children," Goyal said.

The bottom line is that locking a gun up does help prevent kids from hurting themselves or another person, unintentionally or intentionally.

Denise Dowd

Nonfatal injury and death from firearms has been a "huge problem" in the United States for many years, said Denise Dowd, MD, from Children's Mercy Hospital in Kansas City, Missouri.

Although CAP laws are effective, they are very heterogeneous. "Some of them are very strict, some of them are more lax," she told Medscape Medical News. "But the bottom line is that locking a gun up does help prevent kids from hurting themselves or another person, unintentionally or intentionally."

Telling a child not to touch a gun is not enough to prevent accidental shootings. "They're young, they're curious, and when they are teenagers they are impulsive," Dowd said.

It's a "mythical notion" that education is the way to keep kids safe, as the National Rifle Association purports, she added. Relying on education to keep your kid away from your firearms is a "very dangerous approach."

It is the responsibility of adults to keep the firearms locked, unloaded, and separate from ammunition, Dowd emphasized.

Chao, Taylor, Goyal, and Dowd have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2018 National Conference. Presented November 5, 2018.

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