Emma C Hamilton1, Charles C Miller, Charles S Cox, Kevin P Lally, Mary T Austin. 1. From the Department of Pediatric Surgery (E.C.H., C.S.C., K.P.L., M.T.A.), Center for Surgical Trials and Evidence-Based Practice (E.C.H., K.P.L, M.T.A.), Department of Cardiothoracic and Vascular Surgery (C.C.M.), McGovern Medical School at The University of Texas Health Science Center at Houston; Children's Memorial Hermann Hospital (C.S.C., K.P.L., M.T.A.); and Department of Surgical Oncology (M.T.A.), The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Abstract
BACKGROUND: State-level child access prevention (CAP) laws impose criminal liability on adults who negligently allow children access to firearms. The CAP laws can be further divided into strong CAP laws which impose criminal liability for negligently stored firearms and weak CAP laws that prohibit adults from intentionally, knowingly, and/or recklessly providing firearms to a minor. We hypothesized that strong CAP laws would be associated with a greater reduction in pediatric firearm injuries than weak CAP laws. METHODS: We constructed a cross-sectional national study using the Healthcare Cost and Utilization Project-Kids Inpatient Database from 2006 and 2009 using weighted counts of firearm-related admissions among children younger than 18 years. Poisson regression was used to estimate the association of CAP laws with pediatric firearm injuries. RESULTS: After adjusting for race, sex, age, and socioeconomic income quartile, strong CAP laws were associated with a significant reduction in all (incidence rate ratio, 0.70; 95% confidence interval, 0.52-0.93), self-inflicted (incidence rate ratio, 0.46; 95% confidence interval, 0.26-0.79), and unintentional (incidence rate ratio, 0.56; 95% confidence interval, 0.43-0.74) pediatric firearm injuries. Weak CAP laws, which only impose liability for reckless endangerment, were associated with an increased risk of all pediatric firearm injuries. CONCLUSION: The association of CAP laws on hospitalizations for pediatric firearm injuries differed greatly depending on whether a state had adopted a strong CAP law or a weak CAP law. Implementation of strong CAP laws by each state, which require safe storage of firearms, has the potential to significantly reduce pediatric firearm injuries. LEVEL OF EVIDENCE: Prognostic and epidemiology study, level III.
BACKGROUND: State-level child access prevention (CAP) laws impose criminal liability on adults who negligently allow children access to firearms. The CAP laws can be further divided into strong CAP laws which impose criminal liability for negligently stored firearms and weak CAP laws that prohibit adults from intentionally, knowingly, and/or recklessly providing firearms to a minor. We hypothesized that strong CAP laws would be associated with a greater reduction in pediatric firearm injuries than weak CAP laws. METHODS: We constructed a cross-sectional national study using the Healthcare Cost and Utilization Project-Kids Inpatient Database from 2006 and 2009 using weighted counts of firearm-related admissions among children younger than 18 years. Poisson regression was used to estimate the association of CAP laws with pediatric firearm injuries. RESULTS: After adjusting for race, sex, age, and socioeconomic income quartile, strong CAP laws were associated with a significant reduction in all (incidence rate ratio, 0.70; 95% confidence interval, 0.52-0.93), self-inflicted (incidence rate ratio, 0.46; 95% confidence interval, 0.26-0.79), and unintentional (incidence rate ratio, 0.56; 95% confidence interval, 0.43-0.74) pediatric firearm injuries. Weak CAP laws, which only impose liability for reckless endangerment, were associated with an increased risk of all pediatric firearm injuries. CONCLUSION: The association of CAP laws on hospitalizations for pediatric firearm injuries differed greatly depending on whether a state had adopted a strong CAP law or a weak CAP law. Implementation of strong CAP laws by each state, which require safe storage of firearms, has the potential to significantly reduce pediatric firearm injuries. LEVEL OF EVIDENCE: Prognostic and epidemiology study, level III.
Authors: Byron D Hughes; Claire B Cummins; Yong Shan; Hemalkumar B Mehta; Ravi S Radhakrishnan; Kanika A Bowen-Jallow Journal: J Pediatr Surg Date: 2020-02-20 Impact factor: 2.545
Authors: Rebecca M Cunningham; Patrick M Carter; Megan L Ranney; Maureen Walton; April M Zeoli; Elizabeth R Alpern; Charles Branas; Rinad S Beidas; Peter F Ehrlich; Monika K Goyal; Jason E Goldstick; David Hemenway; Stephen W Hargarten; Cheryl A King; Lynn Massey; Quyen Ngo; Jesenia Pizarro; Lisa Prosser; Ali Rowhani-Rahbar; Fredrick Rivara; Laney A Rupp; Eric Sigel; Jukka Savolainen; Marc A Zimmerman Journal: JAMA Pediatr Date: 2019-08-01 Impact factor: 16.193