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Firearm Availability and Unintentional Firearm Deaths, Suicide, and Homicide among 5–14 Year Olds

Miller, Mathew MD, MPH, ScD; Azrael, Deborah PhD; Hemenway, David PhD

The Journal of Trauma: Injury, Infection, and Critical Care: February 2002 - Volume 52 - Issue 2 - p 267-275
Original Articles

Background  In the United States, only motor vehicle crashes and cancer claim more lives among children than do firearms. This national study attempts to determine whether firearm prevalence is related to rates of unintentional firearm deaths, suicides, and homicides among children.

Methods  Pooled cross-sectional time-series data (1988–1997) were used to estimate the association between the rate of violent death among 5–14 year olds and four proxies of firearm availability, across states and regions.

Results  A statistically significant association exists between gun availability and the rates of unintentional firearm deaths, homicides, and suicides. The elevated rates of suicide and homicide among children living in states with more guns is not entirely explained by a state’s poverty, education, or urbanization and is driven by lethal firearm violence, not by lethal nonfirearm violence.

Conclusion  A disproportionately high number of 5–14 year olds died from suicide, homicide, and unintentional firearm deaths in states and regions where guns were more prevalent.

From the Harvard School of Public Health, Department of Health Policy and Management, Boston, Massachusetts.

Submitted for publication December 12, 2000.

Accepted for publication July 24, 2001.

This research was supported in part by grants from the Centers for Disease Control and Prevention, the Joyce Foundation, the Robert Wood Johnson Foundation, the Packard Foundation, and the Center on Crimes, Communities and Culture of the Open Society Institute.

Address for reprints: Matthew Miller, MD, MPH, ScD, Harvard School of Public Health, Department of Health Policy and Management, 677 Huntington Avenue, Boston, MA 02115; email:

© 2002 Lippincott Williams & Wilkins, Inc.