Safe Gun Storage and Risk of Pediatric Firearm Suicide

Background: In 2019, firearms became the leading cause of death in pediatrics making the epidemic of pediatric gun violence a critical public health issue. Child Access Prevention (CAP) laws are a proposed solution to curbing gun deaths and injuries, as they impose criminal liability on adults who leave firearms accessible to children and teens. Prior studies have shown safe storage practices have a protective effect on pediatric injury and death; few, however, have investigated the effect of CAP laws on youth suicides exclusively. The primary objective was to compare the rate of firearm suicides in children 0-19 years between states with and without CAP laws. The secondary objective was to evaluate the relationship between CAP law strictness and rate of youth firearm suicides.

Methods: A cross-sectional study was performed using the CDC’s Web-based Injury Statistics Query and Reporting System (WISQARS) and household firearm ownership rates (HFR) from the RAND Corporation to estimate suicide rates by CAP law in a pediatric population age 0-19 years. Upon merging the WISQARS suicide data with the RAND HFR data, analysis was completed for 50 states from 1981 to 2016. To estimate relative rates of firearm suicides, the number of suicides and average HFR per state were examined for each two-year period. CAP laws were examined as three categories (Recklessness Laws, Negligence Laws, No CAP Law) and as two categories (CAP Law, No CAP Law).

Results: Firearm suicide rates adjusting for period were statistically significantly associated with CAP laws (p < 0.0007). Firearm suicides were 0.42 times lower in states with Negligence Laws than in states with No Law Enacted (RR = 0.58, 95% adjusted CI: 0.35 to 0.95). No significant difference was observed in firearm suicide rates between states with Recklessness Laws and states with No Law Enacted. Upon adjusting for both period and HFR, firearm suicide rates were no longer significantly associated with CAP laws. Firearm suicide rates were significantly associated with both period (p < 0.0001) and HFR (p < 0.0001). Results for firearm and non-firearm suicide rates in states with CAP laws compared with those without, adjusting for period and HFR, were not significantly associated. No significant differences in firearm suicide rates were observed between states with and without CAP laws, but were observed among periods (p < 0.0001) and by HFR (p < 0.0001).

Conclusion: Negligence Laws were associated with a lower firearm suicide rate in children ages 0-19 when not accounting for HFR. The less strict Recklessness Laws, however, were not associated with pediatric firearm suicides. Since CAP laws and HFR were closely related variables, after adjusting for HFR, CAP laws were no longer associated with pediatric firearm suicides. As a control, non-firearm suicides were not associated with either CAP laws or HFR.