Strong Child Access Prevention Laws Reduced Pediatric Gun Deaths Interview with:
Hooman Azad
First author and a 3rd year medical student
Feinberg School of Medicine
Northwestern University

Eric Fleegler, MD MPH FAAP
Senior author and Pediatric Emergency Physician
Boston Children’s Hospital
Assistant Professor of Pediatrics and Emergency Medicine
Harvard Medical School What is the background for this study?

Response: Pediatric firearm violence is a public health crisis. The firearm fatality rate has increased by >50% over the past 10 years. Over our 26-year study period (1991-2016), 13,697 children under the age of 15 died at the hands of a firearm. Laws have been employed to try to reduce these deaths, and Child Access Prevention (CAP) laws, which aim to hold parents liable for the safe storage of their firearms, were passed in 25 states between 1989-2000. No new state passed a CAP laws after the year 2000.

Child Access Prevention laws come in two flavors – recklessness laws that hold firearm owners liable for directly providing firearms to a minor, and negligence laws that hold the firearm owner liable for the unsafe storage of firearms with variability in how storage is defined and what penalties are imposed. What are the main findings?

Response: We found significant reductions of firearm violence in states with negligence- Child Access Prevention laws, with overall 13% fewer firearm fatalities, and between 12-15% fewer firearm homicides, firearm suicides, and unintentional firearm deaths. These results control for other firearm laws, firearm ownership rates, and other factors associated with firearm fatality rates. Recklessness CAP laws were not associated with lower fatalities rates.

When looking at stronger forms of negligence laws, the reduction in firearm fatalities was even larger, with a >50% reduction in unintentional firearm fatalities in states with the strongest CAP laws. What should readers take away from your report?

Response: It is critical that research inform policy, and we aimed to determine what the impact of child-specific firearm laws might be. Our findings show that, in states with these laws, there is a significant reduction in pediatric  firearm deaths. Five hundred children die each year from firearm violence, and these deaths happen in much higher rates in certain states. Still, only 25 states have any form of CAP law, and only 16 states have CAP laws that our study found to be effective. What recommendations do you have for future research as a result of this work? 

Response: It is not well-understood where firearms are located and who owns the firearms that are used in pediatric firearm deaths. Understanding the situations surrounding pediatric firearm homicides is especially critical, as prior research has focused mostly on firearm suicides and unintentional firearm deaths. Finally, smart technologies that allow weapons use only by the individual who owns the firearm are exciting future avenues, but no firearm with such technology has ever been sold commercially in the United States.


Azad HA, Monuteaux MC, Rees CA, et al. Child Access Prevention Firearm Laws and Firearm Fatalities Among Children Aged 0 to 14 Years, 1991-2016. JAMA Pediatr. Published online March 02, 2020. doi:10.1001/jamapediatrics.2019.6227



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Last Updated on March 3, 2020 by Marie Benz MD FAAD