Firearm injuries in children and adolescents: epidemiology and preventive approaches.

Firearm injury, now a leading cause of death in childhood and adolescence, had jointed the ranks of pediatric conditions that threaten child health and development. This paper reviews articles on epidemiology (of firearm injuries and the firearms themselves) and prevention. Epidemiology of injuries: 5356 Americans under 20 years of age died of firearm injuries in 1991; most of these were homicides, and most involved 15 to 19 years olds. The same year, firearm deaths exceeded motor vehicle deaths in seven states and the District of Columbia. Case-control studies showed that handguns in the home raised the risk of homicide threefold, and that handguns raised the risk of suicide ninefold; for suicide, the risk was greatest (13-fold) in those without psychiatric problems. In Iowa, handguns were used disproportionately often in suicides (as compared with other firearms). Hospitalized pediatric shooting victims often had social as well as medical problems. Epidemiology of firearms: gun ownership was higher among incarcerated youths than in community controls (83% vs 22%), but the patterns of gun acquisition were similar: mainly handguns for self-protection, most often from a friend or family member, or "off the street," cost under $100 per gun. Among 5000 families attending pediatric offices, 32% owned handguns or rifles; 13% of handguns and 1% of rifles were stored unlocked and loaded. In a school survey, three-fourths of first and second graders who knew there was a gun at home knew where it was. Gun sales are very loosely under the jurisdiction of the Bureau of Alcohol, Tobacco, and Firearms; no regulations affect gun design, and oversight of commerce is extremely lax.(ABSTRACT TRUNCATED AT 250 WORDS)