Why Vermont Should be the 29th State

Preventing Child and Youth Gun Injuries and Deaths

04/19/23

Eliot Nelson, MDNovember, 2010

04/19/23

04/19/23

ObjectivesObjectives

• Review the epidemiology of child and youth firearm injuries – dimensions and risk factors

• Explain how these injuries and deaths are preventable

• Show how a Child Access Prevention (CAP) Law can help

04/19/23

Unintentional FirearmUnintentional FirearmDeath RatesDeath Rates

0

0.1

0.2

0.3

0.4

0.5

CT ME MA NH NJ NY PA RI VT U.S. Total

0.17 0.200.05 0.06 0.13 0.16 0.22

0.04

0.28

0.46

Rate

per

100

,000

State

Northeast States, 1987-2006, 0-19 yr-oldscrude rates

04/19/23

Youth Firearm Suicide Death Youth Firearm Suicide Death RatesRates

2nd Leading Cause of Death in Vermont Teens

0

0.5

1

1.5

2

2.5

CT ME MA NH NJ NY PA RI VT U.S total

0.73

2.10

0.42

1.71

0.41 0.691.43

0.54

2.111.69

Rate

per

100

,000

State

Northeast States, 1987-2006, 0-19 yr-oldscrude rates

04/19/23

04/19/23

04/19/23

04/19/23

In a Typical Year in

Vermont since 2000…

04/19/23

04/19/23

Unintentional and Suicide Firearm Deaths in Vermont

1999-2007

04/19/23

94

Unintentional and Suicide Firearm Deaths in Vermont

1983-2007

How do these How do these Tragedies Happen Tragedies Happen

to Children?to Children?

04/19/23

Developmental Vulnerabilities

In Young Children:• Curiosity• Lack of Judgment, “Wishful Thinking”• Ability to Pull a Trigger by age 3-4• Poor retention of training/rules – so teaching

children not to handle guns doesn’t work!

• Irresistible urge to play with a gun (e.g., boys age 8-12 yrs)

04/19/23

~Himle MB et al. Pediatrics 2004~Naurekas SM et al. Arch Ped Adol Med 1995~Hardy MS. J Dev Behav Ped 2002~Jackman GA et al. Pediatrics 2001

Developmental Vulnerabilities

Older Children and Adolescents: Protracted development, with late

maturation of gray matter in the dorsolateral pre-frontal cortex

04/19/23

~Allstate Foundation: Chronic: State of teen driving

report 2005~Giedd J. Ann NY Acad Sci

2004

The Teen BrainPowerful Strengths

• Intelligence, Quickness, Motor SkillsImmature judgment/Limited experience

• Risk propensity: novelty and danger attractive• Poor recognition of specific risks +

Overconfidence• Experimentation with risky behaviors

High susceptibility to social influences/crises

High impulsivityHigh impulsivity04/19/23

~Steinberg L. Ann. NY Acad Sci. 2004~Hatfield J and Fernandes R. Accid. Anal. and Prev. 2009

04/19/23

Unintentional Firearm Deaths

Occur when children are unsupervised in homes – at victim’s OR shooter’s home

Male>>Female Most often when playing with the gun (older age

too)

Victims most often shot by family member or friend

Higher rates in teens than in younger children! Safe storage of firearms decreases risk: by Safe storage of firearms decreases risk: by

74% if locked, by 81% if unloaded74% if locked, by 81% if unloaded

04/19/23

~Wintemute GT et al. JAMA 1987~Hemenway D et al. Acc Anal Prev 2010~WISQARS data base, CDC.gov/ncipc/ ~Himle MB et al. Pediatrics 2004~Grossman D et al. JAMA 2005

Youth Suicide2nd Leading Cause of Death in Vermont Teens

Risk Factors include:• Male gender (~8 times the rate for females)• Depression or other mental illness• Drug or Alcohol abuse• Exposure to Suicidal behavior (family or other)• Stressful life events – legal trouble, bullying• Sexual identity struggles• History of previous suicide attempts• Hopelessness, rage, mood swings, other behavior• Easy Access to Lethal Methods

04/19/23

04/19/23

04/19/23

04/19/23

04/19/23

Youth Firearm Suicide

Firearms used in ~50% of all youth suicide up to 60-70% in Vermont!associated with ~85-90% fatality rate

Guns in the home increased risk of suicide – even more if no prior psychiatric illness

~85% of victims used a family member’s gun

33% had short-duration same-day crisis –suicidal act often impulsive

04/19/23

~HICRC. Means Matter: Suicide, Guns and Public Health . www.meansmatter.org~Brent DA et al. Am J Dis Child 1993~HICRC, NVISS 2001.

Youth Firearm SuicideMeans MatterMeans Matter

Household firearm storage in U.S. strongly associated with increased suicide risk

Substitution of less lethal method decreases risk of suicide

90% of survivors of near lethal suicide attempts do NOT commit suicide later

Safe storage of firearms (locked up) Safe storage of firearms (locked up) reduces risk of suicide by > 70% reduces risk of suicide by > 70%

04/19/23

~Miller M et al. J Trauma 2007~Owens D et al. Brit J Psychiatry 2002~Grossman D et al. JAMA 2005

These deaths are These deaths are

PreventablePreventable

04/19/23

Injury Prevention Principles

04/19/23

Host

Agent Environment

04/19/23

Injury Prevention Principles

04/19/23

Host

Agent Environment

Safe Storage of FirearmsSafe Storage of Firearmsin homes with childrenin homes with children

• Advocated by:

NRA

AAP

» Public Health Agencies

04/19/23

NSSFetc., etc., etc.

A CAP Law Aims to A CAP Law Aims to Increase the Increase the

LikelihoodLikelihood of Safe of Safe Firearm Storage in Firearm Storage in Homes with Young Homes with Young

PeoplePeople

04/19/23

Child Access Prevention Child Access Prevention (CAP) Laws(CAP) Laws

• Codify adult gun-owner responsibility to store firearms securely in presence of children

• Impose criminal liability on adult owners for negligent and unsafe storage; specific provisions vary in different states

• Allow exceptions and consideration of personal losses in enforcement

• DO NOT DO NOT restrict adults from owning or keeping firearms

04/19/23

CAP Laws in Other StatesCAP Laws in Other States• 27 States and the District of Columbia

• Effectiveness:– Decrease unintentional deaths (if strong laws) – Significantly though modestly reduce suicides– Significantly reduce non-fatal gun injuries

• All New England states except Vermont and Maine have some form of CAP Law

04/19/23

~Cummings P et al. JAMA 1997~Webster DW et al. Pediatrics 2000~Webster DW et al. JAMA 2004~DeSimone J et al. Nat Bureau of Econ Research Working Paper N. 11613. Online at www.nber.org

Vermont CAP Law ProposalVermont CAP Law ProposalAdult liable if a child under age 18 yrs

obtains access to a firearm without permission and uses it to cause injury, or discharges it or commits a crime with it

Does not apply if:• Gun is locked/secured• Gun is obtained by illegal means• Gun is carried on person of adult• Gun belongs to law officer or member of military,

engaged in activities of official duty• Gun is obtained in course of defense of self or other• A child would not be expected to be on premises

04/19/23

But do we Really But do we Really Need a Law?Need a Law?

Can’t we just teach Can’t we just teach safer gun storage?safer gun storage?

04/19/23

Safe Storage of FirearmsSafe Storage of Firearmsin homes with childrenin homes with children

• Advocated by:

NRA

AAP

» Public Health Agencies

04/19/23

NSSFetc., etc., etc.

How Safely are Firearms How Safely are Firearms Stored in Homes with Stored in Homes with

Children?Children?Multiple Studies Over Two Decades

04/19/23

Optimal Safety (locked, unloaded, ammunition locked/stored separately):

6% to 41.5% of households•Less likely in rural homes, more likely for handguns

Most UNSAFE manner (unlocked and loaded or stored with ammo):

~9-13% of households •somewhat lower rates in more recent studies•higher rates if only teens at home vs. only young children•Vermont and Maine have worst rates in New England

~references available in notes page

“Public health traditionally has relied on the law to enforce standards and

promote behavior change…. [The law]…communicates social

expectations and provides a model of moral authority that can influence

behavior.”

04/19/23

~T. Christoffel and S. Gallagher, Injury Prevention and Public Health, 1999

How do Public Health Laws How do Public Health Laws Work?Work?

04/19/23

04/19/23

Vermont CAP Law ProposalVermont CAP Law ProposalFurther Provisions

• Business

– Firearm dealers shall:• Inform customers of law’s provisions

at point of sale• Provide written information

Legislative Strategies

• Can mandate changes in agents or the environment

• Can overcome the “attitude-practice gap” –just because most people are willing to obey the law!

• “Public safety” laws traditionally respected

““Pros”Pros”

04/19/23

04/19/23

Legislative Strategies

• Less easily accepted by some– Restrict personal freedom– May impose costs

• Legislative process often slow– Politics

““Cons”Cons”

04/19/23

Poly • ticsPoly • tics

manymany blood-sucking animalsblood-sucking animals

04/19/23

Legislative Strategies

• Less easily accepted by some– Restrict personal freedom– May impose costs

• Legislative process often slow– Politics

““Cons”Cons”

• Require enforcement and/or public education to be effective

04/19/23

04/19/23

SummarySummary

Vermont DOES have a firearm injury problem

Safe Storage of Firearms is PROVEN to prevent suicides and unintentional injuries

CAP laws are one way to increase safe storage – working together with education!

Aaron’s Law will save livesAaron’s Law will save lives04/19/23