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State child access prevention (CAP) laws were linked with a 13% relative reduction in childhood firearm-related fatalities compared with states without such laws in the years 1991-2017, according to an analysis of CDC data.

So-called "negligence laws," in which caregivers are criminally liable if a child accesses and uses a firearm, were associated with a 13% reduction in all-intent firearm fatalities, a 15% reduction in firearm homicides, a 12% reduction in firearm suicides, and a 13% reduction in unintentional firearm fatalities among children ages 0 to 14 years, reported Eric Fleegler, MD, MPH, of Boston Children's Hospital, and colleagues.

The most stringent CAP laws, which hold parents responsible if a child has the ability to access firearms (but does not access or use them), were associated with a 28% relative reduction in all-intent firearm-related deaths, they wrote in .

However, recklessness laws, which hold firearm owners liable for directly providing guns to minors, were not associated with reductions in firearm fatalities among children ages 0-14, they added.

"I would argue there is not much value to recklessness laws, and states that pass them thinking they are making a difference in terms of protecting children's lives should think again," Fleegler told 乌鸦传媒. "If you want to make the biggest difference ... you should be aiming for these laws that say, 'If a child could access a gun, then that is a criminal act.'"

Twenty-seven U.S. states have CAP laws in place and although the nature of these laws varies across states.

These findings would be even more meaningful if the authors measured how CAP laws directly impact safe gun storage, particularly since prior research suggested up to 70% of firearm-owning homes failed to store guns unloaded, with a locking device, and separate from ammunition, wrote Megan Ranney, MD, MPH, of Brown University in Providence, Rhode Island, and colleagues, in an .

Notably, "confounding is likely at least partially responsible" for the association, and the data may also be subject to selection bias since states with stricter CAP laws are likely to have other strategies in place that prevent pediatric injury and death, Ranney's group noted.

"CAP laws may serve as a proxy for prioritization of a range of injury prevention efforts and broader social determinants of health," they wrote. "This finding does not obviate the potential consequence of CAP laws, but it highlights that laws do not exist in a cultural vacuum."

Ranney and colleagues advocated for "coalition building" between firearm owners and community groups to implement public health programs that aim to promote safe gun storage and reduce youth access.

"While nationally representative scientific opinion polls have found that most firearm-owning Americans support CAP laws, the passage of a law is only one element in successful injury prevention," they wrote. "Firearm owners must be leading and trusted voices in all aspects of firearm injury and mortality prevention, as illustrated in other studies."

For this study, morality data was collected from the for years 1991-2007 and the for years 2008-2016. The authors did not include adolescents, ages 15-19 years, because not all CAP laws apply to older teens, they noted.

Although this was "methodologically appropriate," future research should focus on states where CAP laws cover older adolescents, because youth from ages 15-19 are at the highest risk of firearm homicide and suicide, the editorialists noted.

There were 13,697 firearm-related deaths to occur in the study period, of which 56% were homicides, 22% were suicides, 19% were unintentional, and 3% were related to legal intervention or undetermined intent. Trends in firearm fatalities varied by states with a high of 7.1 per 100,000 children in Alaska in 2015 to a low of zero deaths in Connecticut and Delaware across many years, the authors reported.

If states without criminal liability for negligent gun storage were to apply negligence laws, 1,230 pediatric deaths could have been prevented, the authors calculated, adding that if these states were to apply the strictest negligence "could access" laws, 3,929 deaths could have been prevented, they added.

The authors cautioned against assuming causality based on the ecologic nature of the study, which was a limitation. It remains unclear how aware constituents of these states are of the CAP laws as well, which could influence safe gun storage practices, they said. Finally, some mortality data may have been misclassified and data on the perpetrators of homicides and unintentional fatalities in children were not available, they noted.

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