Compared with U.S. states with the strictest gun control legislation, gun deaths among children and teenagers are twice as common in states with the most lax gun laws, a study from the Stanford University School of Medicine has found.

In addition, states with laws that restrict children's access to guns have lower rates of firearm-related suicides among youth, even after controlling for other factors, the study said.

The research will be presented in a scientific talk Nov. 5 at the American Academy of Pediatrics 2018 National Conference & Exhibition in Orlando, Florida.

The title of the presentation is "Strict Firearm Legislation Is Associated With Lower Firearm-Related Fatalities Among Children and Teens in the United States."

"A child is 82 times more likely to die in our country of a firearm injury than in any other developed nation," said senior author Stephanie Chao, MD, assistant professor of surgery at Stanford. "We focus a lot on the federal government and the things they can do to protect our children from firearms. But our study shows that what states do at the state level really does have an impact."

The lead authors of the study are former graduate student Sriraman Madhavan and postdoctoral scholar Jordan Taylor, MD.

Chao, a pediatric surgeon, is the medical director of trauma care at Lucile Packard Children's Hospital Stanford, where her role includes investigating how to prevent serious childhood injuries. "If you look at what causes injury deaths in U.S. children, sadly, firearms are always in the top five," she said.

Gun death data

Chao's team used 2014 and 2015 data on firearm deaths of individuals 0 to 19 years old from the National Vital Statistics System, which is maintained by the Centers for Disease Control's National Center for Health Statistics. About 2,715 children died of firearm injuries each year. Of those deaths, 62.1 percent were homicides, 31.4 percent were suicides and the remaining deaths were accidental, of undetermined intent or the result of legal interventions.

The researchers examined the firearm laws of all 50 states. They rated the overall stringency of each state's gun laws as of 2014 using a metric called the Brady score, which ranged from -39 in the least strict state, Arizona, to +76 in the strictest state, California. (The score is named for James Brady, who has advocated for gun control since being permanently disabled in the 1981 assassination attempt on Ronald Reagan.) The researchers also evaluated whether each state had child access prevention laws, which were classified in two groups: legislation that requires storing guns safely (locked or unloaded, or both), and laws that impose liability for failing to prevent minors from gaining access to guns.

Analyses of the relationship between gun deaths and gun laws were controlled for many socioeconomic and demographic factors, including unemployment rates, poverty, urbanization, alcohol dependence, tobacco and marijuana use, and high school graduation rates. The analyses also accounted for the strictness of gun laws in each state's neighboring states and the number of registered firearms per 100,000 children in each state.

The researchers grouped the states by Brady score. Before adjusting for socioeconomic and demographic factors, the states in the highest quartile -- with the strictest laws -- had an annual youth firearm mortality rate of 2.6 per 100,000, while states in the lowest quartile, with the least strict laws, had nearly twice that mortality rate, at 5.0 per 100,000. States' Brady scores were still significantly correlated with pediatric gun deaths after controlling for other factors.

States with both types of child access prevention laws had pediatric firearm suicide rates of 0.63 per year per 100,000 children, while states that had no CAP laws had 2.57 pediatric firearm suicides per year per 100,000 children. The relationship was significant even after controlling for other factors, the study found.

Chao hopes the work will inform state-level legislators. "If you put more regulations on firearms, it does make a difference," she said. "It does end up saving children's lives."

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Other Stanford co-authors of the study are Julia Chandler, MD, resident in surgery and graduate student in health policy; and Kristan Staudenmayer, MD, associate professor of surgery.

Stanford's Department of Surgery supported the work.

The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://med. stanford. edu/ school. html . The medical school is part of Stanford Medicine, which includes Stanford Health Care and Stanford Children's Health. For information about all three, please visit http://med. stanford. edu .

Print media contact: Erin Digitale at 650-724-9175, digitale@stanford.edu

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