Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Variability of child access prevention laws and pediatric firearm injuries

Hamilton, Emma, C., MD; Miller, Charles, C., III, PhD; Cox, Charles, S., Jr., MD; Lally, Kevin, P., MD; Austin, Mary, T., MD, MPH

Journal of Trauma and Acute Care Surgery: April 2018 - Volume 84 - Issue 4 - p 613–619
doi: 10.1097/TA.0000000000001786
Original Articles

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.

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.

Submitted: June 20, 2017, Revised: November 24, 2017, Accepted: December 9, 2017, Published online: December 28, 2017.

The material included in this article was presented as a podium presentation at the American Pediatric Surgical Association Annual Meeting on May 5, 2017 in Hollywood, FL.

Address for reprints: Mary T Austin, MD, Department of Pediatric Surgery, University of Texas Medical School at Houston, 6431 Fannin St. MSB 5.253, Houston, TX 77030; email:

© 2018 Lippincott Williams & Wilkins, Inc.