Introduction: Firearm-related injuries are the second leading cause of pediatric death in the US. We sought to evaluate the effectiveness of state child-access prevention (CAP) laws and gun regulations on pediatric firearm mortality (PFM). We hypothesized that states with more stringent firearm legislation had lower PFM. Methods: We used 2014-2015 PFM data from the Web-Based Injury Statistics Query and Reporting System, 2014 Brady scores (used to quantify stringency of state gun regulations), and 2014 CAP laws (indexed by the Law Center to Prevent Gun Violence). Spearman rank correlations and linear regression were used to determine the relationship between PFM and gun regulations. Results: Annually, there were approximately 2,715 pediatric firearm fatalities; 62.1% were homicides and 31.4% were suicides. There was a significant negative correlation between states’ firearm legislation stringency and PFM (ρ = -0.66), and between presence of CAP laws and firearm suicide rates (ρ = -0.56). There was a positive correlation between unemployment rate and firearm homicide rate (ρ = 0.55), and between teen tobacco use and firearm suicide rate (ρ = 0.50). After controlling for poverty, unemployment, and substance abuse, the association between firearm legislation stringency and PFM remained significant (p < 0.01). There was an association between CAP laws and firearm suicide rate after controlling for socioeconomic factors and other firearm legislation (p < 0.01). Conclusion: Strict gun legislation was associated with fewer pediatric firearm fatalities. CAP laws were associated with fewer firearm suicides. State-level legislation could play an important role in reducing pediatric firearm-related deaths.

Figure 1

Relationship between 2014 Brady score (higher score signifies greater regulation) and 2014-2015 firearm-related mortality rate

Figure 1

Relationship between 2014 Brady score (higher score signifies greater regulation) and 2014-2015 firearm-related mortality rate

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