1. Why Vermont Should be the 29 th State Preventing Child and Youth Gun Injuries and Deaths 5/13/2015 Eliot Nelson, MD November, 2010

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4. Objectives Review the epidemiology of child and youth firearm injuries – dimensions and risk factors Explain how these injuries and deaths are preventable Show how a Child Access Prevention (CAP) Law can help 5/13/2015

5. Unintentional Firearm Death Rates 5/13/2015

6. Youth Firearm Suicide Death Rates Youth Firearm Suicide Death Rates 2 nd Leading Cause of Death in Vermont Teens 5/13/2015

9. In a Typical Year in Vermont since 2000…

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11. Unintentional and Suicide Firearm Deaths in Vermont 1999-2007

12. 5/13/2015 94 Unintentional and Suicide Firearm Deaths in Vermont 1983-2007

13. How do these Tragedies Happen to Children? 5/13/2015

14. Developmental Vulnerabilities  In Young Children: Curiosity Lack of Judgment, “Wishful Thinking” Ability to Pull a Trigger by age 3-4 Poor retention of training/rules – so teaching children not to handle guns doesn’t work! Irresistible urge to play with a gun (e.g., boys age 8-12 yrs) 5/13/2015 ~Himle MB et al. Pediatrics 2004 ~Naurekas SM et al. Arch Ped Adol Med 1995 ~Hardy MS. J Dev Behav Ped 2002 ~Jackman GA et al. Pediatrics 2001

15. Developmental Vulnerabilities  Older Children and Adolescents:  Protracted development, with late maturation of gray matter in the dorsolateral pre-frontal cortex 5/13/2015 ~Allstate Foundation: Chronic: State of teen driving report 2005 ~Giedd J. Ann NY Acad Sci 2004

16. The Teen Brain  Powerful Strengths Intelligence, Quickness, Motor Skills  Immature judgment/Limited experience Risk propensity: novelty and danger attractive Poor recognition of specific risks + Overconfidence Experimentation with risky behaviors  High susceptibility to social influences/crises  High impulsivity 5/13/2015 ~Steinberg L. Ann. NY Acad Sci. 2004 ~Hatfield J and Fernandes R. Accid. Anal. and Prev. 2009

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18. Unintentional Firearm Deaths  Occur when children are unsupervised in homes – at victim’s OR shooter’s home  Male>>Female  Most often when playing with the gun (older age too)  Victims most often shot by family member or friend  Higher rates in teens than in younger children!  Safe storage of firearms decreases risk: by 74% if locked, by 81% if unloaded 5/13/2015 ~Wintemute GT et al. JAMA 1987 ~Hemenway D et al. Acc Anal Prev 2010 ~WISQARS data base, CDC.gov/ncipc/ ~Himle MB et al. Pediatrics 2004 ~Grossman D et al. JAMA 2005

19. Youth Suicide 2 nd Leading Cause of Death in Vermont Teens  Risk Factors include: Male gender (~8 times the rate for females) Depression or other mental illness Drug or Alcohol abuse Exposure to Suicidal behavior (family or other) Stressful life events – legal trouble, bullying Sexual identity struggles History of previous suicide attempts Hopelessness, rage, mood swings, other behavior Easy Access to Lethal Methods 5/13/2015

24. Youth Firearm Suicide  Firearms used in ~50% of all youth suicide  up to 60-70% in Vermont!  associated with ~85-90% fatality rate  Guns in the home  increased risk of suicide – even more if no prior psychiatric illness  ~85% of victims used a family member’s gun  33% had short-duration same-day crisis – suicidal act often impulsive 5/13/2015 ~HICRC. Means Matter: Suicide, Guns and Public Health. www.meansmatter.orgwww.meansmatter.org ~Brent DA et al. Am J Dis Child 1993 ~HICRC, NVISS 2001.

25. Means Matter Youth Firearm Suicide Means Matter  Household firearm storage in U.S. strongly associated with increased suicide risk  Substitution of less lethal method decreases risk of suicide  90% of survivors of near lethal suicide attempts do NOT commit suicide later  Safe storage of firearms (locked up) reduces risk of suicide by > 70% 5/13/2015 ~Miller M et al. J Trauma 2007 ~Owens D et al. Brit J Psychiatry 2002 ~Grossman D et al. JAMA 2005

26. These deaths are Preventable 5/13/2015

27. Injury Prevention Principles 5/13/2015 Host AgentEnvironment

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29. Injury Prevention Principles 5/13/2015 Host AgentEnvironment

30. Safe Storage of Firearms in homes with children Advocated by: NRA  AAP » Public Health Agencies 5/13/2015 NSSF etc., etc., etc.

31. A CAP Law Aims to Increase the Likelihood of Safe Firearm Storage in Homes with Young People 5/13/2015

32. Child Access Prevention (CAP) Laws Codify adult gun-owner responsibility to store firearms securely in presence of children Impose criminal liability on adult owners for negligent and unsafe storage; specific provisions vary in different states Allow exceptions and consideration of personal losses in enforcement DO NOT DO NOT restrict adults from owning or keeping firearms 5/13/2015

33. CAP Laws in Other States 27 States and the District of Columbia Effectiveness: – Decrease unintentional deaths (if strong laws) – Significantly though modestly reduce suicides – Significantly reduce non-fatal gun injuries All New England states except Vermont and Maine have some form of CAP Law 5/13/2015 ~Cummings P et al. JAMA 1997 ~Webster DW et al. Pediatrics 2000 ~Webster DW et al. JAMA 2004 ~DeSimone J et al. Nat Bureau of Econ Research Working Paper N. 11613. Online at www.nber.orgwww.nber.org

34. Vermont CAP Law Proposal  Adult liable if a child under age 18 yrs obtains access to a firearm without permission and uses it to cause injury, or discharges it or commits a crime with it  Does not apply if: Gun is locked/secured Gun is obtained by illegal means Gun is carried on person of adult Gun belongs to law officer or member of military, engaged in activities of official duty Gun is obtained in course of defense of self or other A child would not be expected to be on premises 5/13/2015

35. But do we Really Need a Law? Can’t we just teach safer gun storage? 5/13/2015

36. Safe Storage of Firearms in homes with children Advocated by: NRA  AAP » Public Health Agencies 5/13/2015 NSSF etc., etc., etc.

37. How Safely are Firearms Stored in Homes with Children? Multiple Studies Over Two Decades 5/13/2015  Optimal Safety (locked, unloaded, ammunition locked/stored separately):  6% to 41.5% of households Less likely in rural homes, more likely for handguns  Most UNSAFE manner (unlocked and loaded or stored with ammo):  ~9-13% of households somewhat lower rates in more recent studies higher rates if only teens at home vs. only young children Vermont and Maine have worst rates in New England ~references available in notes page

38. “Public health traditionally has relied on the law to enforce standards and promote behavior change…. [The law]…communicates social expectations and provides a model of moral authority that can influence behavior.” 5/13/2015 ~T. Christoffel and S. Gallagher, Injury Prevention and Public Health, 1999 How do Public Health Laws Work?

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41. Vermont CAP Law Proposal Vermont CAP Law Proposal Further Provisions Business – Firearm dealers shall: Inform customers of law’s provisions at point of sale Provide written information

42. Legislative Strategies Can mandate changes in agents or the environment Can overcome the “attitude-practice gap” – just because most people are willing to obey the law! “Public safety” laws traditionally respected “Pros” 5/13/2015

44. Legislative Strategies Less easily accepted by some – Restrict personal freedom – May impose costs Legislative process often slow – Politics “Cons” 5/13/2015

45. Poly tics  many many blood-sucking animals 5/13/2015

46. Legislative Strategies Less easily accepted by some – Restrict personal freedom – May impose costs Legislative process often slow – Politics “Cons” Require enforcement and/or public education to be effective 5/13/2015

48. Summary  Vermont DOES have a firearm injury problem  Safe Storage of Firearms is PROVEN to prevent suicides and unintentional injuries  CAP laws are one way to increase safe storage – working together with education!  Aaron’s Law will save lives 5/13/2015