By: Paul Nixon Re: Christoffel -1 This is posted for the edification of those who debate o

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By: Paul Nixon Re: Christoffel -1 This is posted for the edification of those who debate or discuss the gun control issue with antis and fence-sitters. Please note that I did not originate, nor do I agree with the conclusions in this series of posts. == Forwarded Message Follows ========================================= * Originally By: Wayne Dougherty * Originally To: All * Originally Re: Christoffel -1 * Original Date: 07 Feb 96 23:33 * Original Area: PR_NET * Forwarded by : Blue Wave/386 v2.21 Pediatrics Vol. 88 No. 2 August 1991 Toward Reducing Pediatric Injuries From Firearms: Charting a Legislative and Regulatory Course Katherine Kaufer Christoffel, MD, MPH From the Division of General and Emergency Pediatrics, Children's Memorial Hospital, Chicago, Illinois ABSTRACT. Each year in the United States, approximately 3000 children and adolescents younger than age 20 die as a result of homicides, suicides, and unintentional injuries from firearms. The young children, relatives, neighbors, and friends of the 30,000 adults killed by firearms each year in the United States are also affected by this uniquely American epidemic. It is estimated that half of all American homes contain 200 million firearms, including 60 million handguns. Increasingly, pediatricians are becoming involved in efforts to reduce the prevalence of injuries from firearms, as parent educators, experts on children and adolescents, and advocates in the political process. This commentary is intended to aid in the last of these roles. The advocacy goal is identified as reducing the accessibility of guns in the environments of children and adolescents. The pros and cons of 17 possible approaches--ranging from mandatory safety courses in schools to handgun bans--are presented. It is concluded that, while there is no perfect approach, many available approaches will help; there is every reason to be both bold and optimistic. Pediatrics 1991;88:294-305; firearms, injuries, legislation. Every day about 9 children and adolescents in the United States die of injuries from firearms; more are hurt. Table 1 summarizes sobering 1985 epidemiological data on deaths from firearms affecting US children and adolescents aged 0-19 years. In brief, close to 3000 of our youth die each year because of firearms. About 500 of these deaths are caused by unintentional injuries ("accidents"), and the majority of these are in children and adolescents younger than 15 years of age. The remaining 2500 are divided almost evenly between homicides and suicides, and the majority of these are in youths aged 15-19 years. Even the 30,000 deaths from firearms in American adults each year--80 a day--affect children: the victims' children, grandchildren, nieces and nephews, and the children of neighbors and friends. There is no other country in the world that has as many deaths caused by firearms in peacetime. Pediatricians in the United States are focusing increasing attention on the problem of injuries from firearms in children and adolescents. They are motivated by increasing alarm at the degree to which the epidemic of injuries from firearms intrudes into the child and adolescent population and by a sense that the time is right for our society to undertake initiatives to reduce the frequency of injuries and deaths caused by firearms. Pediatricians can play several important roles in this effort. These include the roles of (1) educator of parents about the dangers that firearms pose to children, (2) expert consultant to engineering efforts to render firearms more child resistant and to develop less deadly means of personal protection, and (3) advocate for children in the political process. Many factors contribute to morbidity and mortality from firearms, and, therefore, there are many approaches that are likely to help in reducing the frequency of these injuries. There is wide agreement that legislative and regulatory changes will be crucial. It is likely that the involvement of pediatricians and other child advocates in campaigns to reduce injuries from firearms will be important to the success of those campaigns. When deciding on their own involvement, child advocates will need to assess the political contexts in which initiatives bearing on firearm safety arise, as well as the logic of any particular initiative. The multiplicity of possible approaches[1] should not immobilize individuals or organizations. Every incremental step in the direction of reducing the availability of firearms in the environments of children and adolescents is a positive step toward reducing their risk of injury and mortality from firearms. This commentary is designed to aid child advocates as they undertake to develop firearm legislation and regulation and to make decisions about bills and regulations that have been developed by others. Prior to considering specific options, it is crucial to consider the larger question: Are laws that restrict ownership of firearms or their use constitutional? Well- informed legal scholars agree that such laws are indeed constitutional. This is reflected in the fact that there are now approximately 20 000 laws in the United States (at all levels of government) restricting possession and use of firearms, and none has been declared unconstitutional.[2] Indeed, when this matter has been brought before federal courts, including the U.S. Supreme Court, the decision has consistently been that the second amendment to the Constitution does not protect individual civilian ownership or use of firearms. The issue for child advocates is not whether to regulate possession and use of guns, but how best to do so. Our goal is to reduce the use of guns_and thereby, danger from guns_near and by children and adolescents. We have a number of options. They are discussed here, starting with those least restrictive on firearms, working toward those most restrictive on firearms, and finishing with some related issues (toy guns, plastic guns, and nonpowder firearms). The pros and cons of the options discussed are summarized in Table 2. ENFORCEMENT OF EXISTING LAWS It seems logical to start any effort to reduce the number of injuries from firearms with enforcement of existing laws. (These are summarized elsewhere.[2,3]) Efforts to enforce gun laws are likely to be most effective when the laws are uniform and apply to access and possession rather than to patterns of use. Unfortunately, because gun laws differ across jurisdictions, local enforcement has only a limited effect on regional patterns of firearm ownership and use. Further, to the extent that the laws affect use (rather than possession or access) and to the extent to which such use is private (eg, at home, concealed carrying), enforcement is likely to have a limited effect on the incidence of injuries. REGULATION UNDER CURRENT LEGISLATION Existing legislation allows for a variety of forms of regulation to restrict ownership and use of firearms. An example of this is the recent federal imposition of a ban on importation of "assault rifles," by means of an Executive Order carried out by the Treasury Department.[4] The Consumer Product Safety Commission has authority to regulate nonpowder firearms (air guns, air rifles, BB guns, dart guns, etc.) but has declined repeated petitions to do so.[5] The Consumer Product Safety Commission has no jurisdiction over powder firearms. New regulation under existing legislation is highly dependent on the political climate. In the recent past, and probably for the foreseeable future, reliance on the regulatory mechanism is an unreliable route to rapid increases in effective restriction of gun accessibility. HANDGUNS: OWNER LIABILITY FOR CHILD AND ADOLESCENT USE Existing laws prohibit the purchase of firearms by children and most adolescents,[2,3] in recognition of the need for maturity for responsible handling and securing of firearms. Parents of children who have died when playing with a loaded gun (or near one that discharged) cited the same need when they drafted legislation making gun owners criminally liable for any injury that results when children or adolescents gain access to weapons that have been inadequately secured. Such legislation is now law in Florida,[6] and is under consideration in other jurisdictions as well. Experience will clarify the efficacy of such laws. In advance of such experience, there are expected advantages and disadvantages to such legislation. The prime advantage is a clear statement of a societal expectation that gun owners will prevent their guns from coming into the hands of youngsters. A second advantage is political. This type of legislation is actively being promoted by citizens now, and the National Rifle Association has not consistently opposed it. Such legislation may help to build momentum toward meaningful change. The prime disadvantage is that the legislation relies on changing gun owners' behaviors (eg, by expecting them to unload and/or lock up their guns when not in direct control of them). It is known that strategies for injury prevention are least likely to be successful when they rely on behavioral rather than environmental change and are particularly unlikely to succeed when they require repeated behaviors rather than a single action.[7] Factors mitigating against daily actions to secure guns include the desire to have the gun available for self-protection, preoccupation with other concerns (eg, being late to work), and waning concern when injury does not occur. That knowledgeable owners do not reliably secure their unsupervised weapons is indicated by incidents in which children are injured when handling weapons owned by parents who are police officers. Another disadvantage to legislation creating a specific owner liability is that it is unlikely that judges or juries will convict grieving parents who owned a gun that killed their child. Indeed, even prosecution in such a context will be seen by some as cruel. Prosecutorial discretion can keep such cases out of court, but failing to take action would undermine the role of the law in setting social expectations. Finally, people keep loaded handguns because manufacturers, retailers, and some politicians say that guns promote home safety, and laws permit such use. If there is to be liability for misuse of guns in the home, it cannot reasonably rest solely on the individual gun owner. This objection has caused some advocates of gun injury prevention to actively oppose this type of legislation. In sum, the verdict is still out on "Florida Laws." HANDGUNS: EDUCATION There are an estimated 200 million firearms privately owned in the United States (including 60 million handguns). Firearms are present in half of all American homes. While promoting home possession of weapons, gun proponents recognize that firearms can endanger children and adolescents. They and others have proposed that education of gun owners can reduce dangerous access and that education of children can render them gun-safe. Some jurisdictions, including Dade County, Florida, and New York City, have instituted required gun safety curricula in their public schools.[8,9] There are several reasons for pessimism about this approach. First, there are no data to suggest that this strategy will work. Second, adult/owner education is likely to fail for the reasons discussed above: daily action will not happen reliably even if owners are knowledgeable. Third, young children are probably developmentally incapable of learning to consistently avoid handling guns. To do so, they would need to understand the danger and the required action (don't touch), remember both at the time of temptation (when they see a gun), resist the temptation, and correctly identify and contact someone to deal with the gun (someone who is not an adolescent, not intoxicated, and not likely to fire the gun by mistake). It is unlikely that all of these necessary steps will take place. Purporting to gun- proof young children might actually increase risk by lowering adult vigilance. Schoolchildren and preteenagers can surely learn the safety information, but they are typically lost in fantasy play (of the cops and robbers or Rambo type) when injury occurs. In fantasy, safety messages are lost along with the rest of reality. However, lessons learned before adolescence may be remembered later. Educating preteenagers about gun safety is probably worth a try, with care to avoid frightening children, which might be counter productive, and with appropriate evaluations of program efficacy and safety. Fourth, school-based lessons are likely to be diluted by contradictory lessons from the media. It may be a waste of time to teach children at school that they should not handle guns, only to send them home to watch television shows in which everyone does. Finally, even among children and adolescents, most deaths caused by firearms are intentional, ie, assaults or suicides. In these, unsafe use is not the problem. Individual safety education has not been successful in preventing other injuries, and educating gun owners about gun safety is unlikely to reduce the incidence of injuries from firearms. On the other hand, attendance at a course that compares the risks and benefits of keeping guns in the home could help to discourage some prospective purchasers. In contrast, public education concerning the dangers of firearms is a necessary component of any societal effort to reduce the frequency of injuries from firearms. Specific areas related to public education require particular attention. The effects of marketing techniques on patterns of gun ownership and use require evaluation. For example, it appears likely that the manufacturer promotion of handguns to mothers increases the accessibility of such guns to young children. Regulatory control, as for cigarette advertising, could be warranted. The effects of portrayals of gun use in the mass media also require ongoing evaluation. Actual and potential effects, both positive and negative, on public attitudes towards guns and on patterns of gun use must be assessed. Regulatory guidance of programming for children could be warranted. FIREARMS: SALES TAXES Many discretionary purchases are price sensitive. This fact has been put to use to reduce consumption of alcohol in England.[10] It is reasonable to consider taxes as an option for reducing the use of firearms in this country. Precedent exists in the history of munitions in Japan, as chronicled in the book, Giving Up the Gun.[11] Taxation of manufacturers and purchasers was a part of a pattern of government regulation that moved Japan over a several-hundred-year period from being the world's leading purveyor of firearms to being a virtually firearm-free society. Taxes on firearms are currently applied at the time of sale. Ammunition can be taxed. Taxes are not, and could not easily be, applied to firearms at the time of resale (unless resale is by a public retailer). Increased taxation is a proven approach to reducing private purchase of firearms, which probably would be both acceptable and effective in this country. FIREARM REGISTRATION AND LICENSURE Motor Vehicle crashes are the leading cause of injurious death in the United States. Motor vehicles must be registered and their operators licensed. Firearms are the second leading cause of injurious death in the United States. It is logical to explore the idea of requiring that firearms be registered and their operators licensed. This idea seems particularly meritorious when we realize how many things that are less deadly already commonly require registration and/or licensing, including dog ownership and fishing. Yet further consideration dampens enthusiasm for registration and licensure. There is already a requirement that purchasers of firearms fill out forms indicating that they can legally purchase the weapon (ie, are not felons or otherwise prohibited). This existing registration, which applies to purchases of new weapons, has obviously not sufficiently controlled the incidence of injuries from firearms. Part of the reason for this is that applications are required but are not checked unless misuse of the firearm occurs. Further, existing records systems have generally been foiled by simple misspellings of names as well as by inaccurate answers to eligibility questions on the registration form. These facts make it clear that it would require a monumental effort to make a registration system work. The federal government licenses individuals, who are not always eligible to own guns, as federally licensed dealers (Newsday. August 2, 1988;7:20-21; New York Times. January 20, 1990:1). This mail-order process is a documented source of firepower to gangs, among others. Licensure requirements for ownership are not enforceable for private activities, and most use of firearms is private. This limits the attractiveness of this option as well. Efforts toward the prevention of injuries from firearms are better applied in other directions. BACKGROUND CHECKS Because the current "almost-registration" system fails to effectively prevent the purchase of firearms by individuals who should not legally obtain them, including criminals and the mentally ill, it has been suggested that a waiting period with background check be instituted. The goal would be to reduce the likelihood that high-risk persons will acquire new guns. Such systems now in use in a few locales have prevented the acquisition and use of firearms by some such individuals. However, the net effect on injury and mortality from firearms is likely to be small for several reasons. First, most shootings are not committed by felons or mentally ill people, but are acts of passion that are committed using a handgun that is owned for home protection. Waiting periods and background checks will have no effect on these events. Second, there is no practical mechanism to identify the vast majority of those who are mentally ill_individuals who have mental illnesses but who have not been adjudicated mentally ill (ie, been declared to be so by a court). Therefore, the effect of background checks on acquisition of guns by mentally ill individuals would be small. Third, such provisions could not feasibly apply to private resale of guns in the absence of an effective registration system (which is unlikely, for the reasons outlined above). Fourth, there is question about whether an individual's background can be checked thoroughly within 7 days, given current capabilities for management of data on individuals who have been convicted of crimes. Waiting periods and background checks will help, but more will be needed. AMMUNITION MODIFICATION Because ammunition is a consumable product, modification of ammunition may have more promise as a rapid means to reduce the severity of injuries from firearms than modification of the weapons themselves. Some bullets that can be purchased for civilian use are so destructive that they are banned for use in war by international convention. The full-metal-jacketed bullets that are permitted in war are designed to either kill or leave the victim readily salvageable.[12] Some popular types of bullets actually maximize destructive power: magnum bullets contain as much gunpowder as possible; mushroom-tip bullets maximize tissue destruction. The destructiveness of available bullets could be reduced by regulating the amount of gunpowder, the shape of the tip, and/or jacketing. Such regulation might reduce the severity of nonfatal injury fairly quickly. This could substantially reduce medical costs associated with injuries from firearms (now an estimated $4 billion annually[13]). It probably would have less effect on the frequency of injury, inasmuch as it would not affect gun accessibility. HANDGUNS: BUILDING IN SAFETY Firearms are consumer products. There has been considerable success in reducing consumer product-related injuries by focusing on building safety into the products. This approach is illustrated by the efficacy of child-proof closures in reducing childhood poisonings[14] and by design changes to protect motor vehicle occupants_for example, regulatory requirements for passenger restraints, struts to prevent the crushing of occupant compartments during rollovers, and energy-absorbing steering columns.[15] Other notable successes include safety requirements for the design of common lawn mowers and toys. It is logical to consider ways in which handguns, the leading cause of injury from firearms in the home, can be made less deadly. There are several features that would be considered in such an effort. These include limits on muzzle velocity, higher pressures required to pull triggers, loading indicators that would enable an individual handling a gun to know whether it was loaded, and automatic safety locks on triggers that would make it impossible to fire a gun unless the lock is actively overridden. Such built-in safety features would be likely to prevent some unintentional injuries, particularly to infants and toddlers. They might also reduce homicides and suicides by requiring an additional instant before firing, which could allow some individuals to think again (about shooting), to escape, or to be discovered. There are, however, significant limitations to the safety margin that is likely to be acquired by gun modifications. First, significant gains can be expected only for unintentional injury to preschool children, a horrible but comparatively small proportion of all injuries from firearms. As built-in safety features could be overridden by all adults and all but the youngest children, they are not likely to provide much safety for the majority of injuries that are intentional, ie, related to assault and suicide. Second, unless there is a way to replace with safer weapons the 60 million handguns (and 140 million other firearms) that are already in American homes, the net result of marketing a "safer gun" could be to increase household arsenals and decrease vigilance about firearm safety, because people might have the impression that they now own "safe" guns. Ultimately, the problem with this approach is that handguns are constructed to be deadly weapons, and therefore they will always remain dangerous. ASSAULT WEAPONS: BANS There has been increasing awareness of the danger posed by so-called "assault weapons," semiautomatic military-style weapons that are favored by drug dealers, gangs, and some deranged individuals. Although some assault weapons are readily transformed into automatic weapons (which are banned for civilian use2,3), semiautomatics are accessible to the general public. Following a 1989 incident in a schoolyard in Stockton, California, during which 5 children were killed and 29 injured within seconds with an assault weapon, efforts to ban these weapons have arisen in a number of locales. The state of California passed legislation, which was signed into law, banning sales of assault weapons and requiring registration of previously purchased assault weapons.[16] Gun proponents' objections that "assault weapons" could not be defined in a way that distinguishes them from hunting rifles were dealt a blow by this legislation, as they were by the federal action defining these products in its importation ban. It may yet be feasible to pressure the Bureau of Alcohol, Tobacco and Firearms_or Congress_to logically expand the ban on assault rifles to include the majority that are domestically produced. Such a ban could also reduce exportation of US-made assault rifles to other countries (eg, to Colombia, where to the dismay of the local government, they apparently arm drug lords). The increasing use of assault weapons threatens to raise the body count unless access to these weapons of war is reduced. (Atlanta Constitution. May 21, 1989:A1, ff). Legislative and regulatory efforts to reduce the availability of assault rifles should minimize injury due to these particular firearms. In addition, as most Americans seem to agree that private individuals should not have assault rifles, efforts to control assault rifles are good contexts in which to discuss some of the arguments about civil liberties and questions about constitutional rights that arise more often in discussions about other types of firearms. However, assault weapons still account for a small percentage of all injuries and deaths from firearms. To significantly reduce the number of injuries and deaths from firearms, it will be necessary to address handguns. HANDGUNS: BANNING POSSESSION IN LOCATIONS WHERE CHILDREN LIVE AND VISIT To reduce the incidence of injuries from firearms among children, it would at first seem logical to focus on the leading cause of such injury_handguns_and on the leading site of such injury_homes where children live and visit. If handguns were forbidden in those locations, unintentional injury would presumably be reduced, as would adolescent suicide and the transporting of guns to school by children.[17,18] Such an approach would avoid privacy issues related to adults' choosing to arm themselves if they do not have children or child visitors. There are several problems with this approach. First, and probably foremost, it is unenforceable. The home is private. Confirmation of answers on questionnaires to crucial questions (such as "Do children live in or visit your home?") cannot be checked without invasion of privacy. As a result, it is likely that this requirement would be ineffective in reducing the presence of handguns in places that children frequent. A second objection is that this approach focuses all of the responsibility for injuries caused by firearms on owners of firearms, with none assigned to manufacturers and retailers. Manufacturers fail to build in safety devices, continue to promote their products as increasing household safety, and profit by the sales of these deadly weapons. Excusing them from responsibility seems unreasonable. Similar considerations apply to retailers. Finally, if we focus only on the places that children frequent and on direct injuries to children, we ignore the fact that injuries and deaths from firearms among adults affect the victims' children, grandchildren, young neighbors, nieces, nephews, and friends. If our goal is to reduce firearm-related morbidity among children and adolescents, injuries to adults must be our concern as well. HANDGUNS: BANS The many disadvantages of other approaches have led many advocates of injury prevention and some communities to favor a ban of handguns. However, this approach also remains controversial. Opponents and advocates of gun control who oppose handgun bans make several arguments. The first is that a ban would detrimentally affect handgun owners who do secure their guns responsibly as well as those who do not, and it would interfere with the legitimate sport of target shooting with handguns. The counterarguments to these points are as follows: many guns are not secured and the risk is excessive; target shooting can be conducted and enjoyed with other types of weapons, and exceptions may be desirable for licensed target ranges. Second, it is pointed out that it would be extremely difficult to effectively remove handguns from American households, because so many handguns are in so many homes. While there can be no disagreement about the difficulty of this task, various responses to this argument are possible. It is encouraging to consider the history of another public health campaign that has required widespread shifts in attitudes and changes in habit: a decade ago, few would have believed that the antismoking campaign could achieve the current ban on smoking on most US domestic airplane flights. The task of getting handguns out of homes will be difficult, but it is premature to conclude that it is impossible. Third, it is argued that banning handguns is not a politically feasible goal in the foreseeable future. Political analysts may well have agreed with this a few years ago, but the situation appears to be shifting dramatically as we enter the 1990s. Several facts support this conclusion. The gun lobby has begun to have difficulty getting its preferred legislation (state preemption of local firearm control ordinances) reported out of state legislative committees. Local organizations successfully overcame extremely well-funded opposition by the gun lobby to pass local ordinances banning all or some handguns in a number of communities and in the state of Maryland. Perhaps the most significant, two ban ordinances (in Oak Park, Illinois, and in Maryland) withstood referenda to repeal them.[19,20] Lobbyists around the country have begun to report that a wide variety of gun control laws are being reported out of state and national legislative committees for the first time and that although most are failing on final vote, the votes are increasingly close. In this political context, if the logic of the situation dictates a handgun ban, there is little reason to avoid stating that goal. Realistically, of course, it will probably be quite a few years before this goal can be achieved with any kind of uniformity across the United States. Specific laws banning handguns can be modeled on existing ordinances, most of which ban possession as well as purchase. Local political conditions and ongoing experience will clarify the advantages of allowing exceptions to handgun bans (eg, for collectors or gun clubs). The advantages of such exceptions are that they have withstood legal challenge and are politically expedient. The disadvantages might weakening of the "handguns are too dangerous" message and the permitting of arsenals and risks associated with them. WHAT ABOUT LONG GUNS? The majority of injuries and deaths caused by firearms are related to handguns, not because handguns are more deadly than long guns (which have higher muzzle velocities and often other more deadly features as well), but because of the way handguns are stored and are used. it would only make sense to focus current legislative and regulatory attention on long guns in local areas in which injuries from long guns predominate. It remains to be seen whether injuries from long guns would replace injuries from handguns in communities in which handguns began to disappear. Because of the differences in the handling characteristics of handguns and long guns, many believe that this is not likely. TOY GUNS Toy guns have been a concern to advocates of injury prevention for several reasons. First, some are needlessly dangerous in and of themselves.[21] Second, they have been mistaken for real weapons, with the unfortunate result that people have been shot by police while wielding toy guns (New York Times. August 5, 1988:22). Third, because of their verisimilitude, toy guns have been used successfully by criminals to commit crimes. Fourth, familiarity with realistic toy guns may contribute to children's handling real guns they encounter, believing them to be toys. Finally, there is concern among some pediatric and mental health experts that the use of realistic toy guns may train boys to be comfortable with firearms, a comfort that may contribute to later use of real guns and consequent injury. Concern about criminal use and the related risk to children playing with toy guns drove a number of recent local legislative efforts to regulate the appearance of toy guns. Discussions among those who were involved in initiating local legislation centered around whether it made sense to address toy guns alone or whether the issue of toy guns should be tied to the broader issue of firearms. Addressing the issue of toy guns in isolation is less likely to stir up opposition from the gun lobby. These relatively benign legislative efforts may raise public awareness about the dangers of firearms. A fear of proliferating and discordant local legislative rules led the toy industry to pressure Congress in 1989 to pass legislation establishing national standards for the appearance of toy guns. A weak standard was passed, requiring an orange plug in the muzzle of toy guns. Other color modifications intended to distinguish toys from real guns were added when the Department of Commerce wrote regulations to enforce the legislation (an orange band around the muzzle, brightly colored surfaces, white and brightly colored surfaces, or construction with transparent/translucent materials).[22] This was done without any data about visibility at night, ease of covering up the orange tip, ease of painting orange tips on real guns, or many other relevant factors. Advocates of child safety were initially skeptical that this legislation would bring about substantial changes. However, the majority of domestically produced toy guns now on the market are of bright plastic construction that makes them readily distinguishable from real guns, at least in a well-lit toy store. Unfortunately, tests done for the Department of Justice indicate that the new colorings do not prevent trained police officers from viewing the toy guns as potentially deadly weapons.[23] When confronted_at 15 and 30 feet_by "assailants" carrying guns in 2-second role-play situations, officers "fired," because they believed their lives were in danger, more than 95% of the time when they saw both unmarked replica guns and replica guns with orange muzzle plugs. They also fired 75% of the time when faced with a black plastic squirt gun with an orange band around the barrel, 75% of the time when faced with white and orange/purple squirt guns, and more than 30% of the time when faced with transparent green plastic squirt guns. While officers cited toy-like coloring as a factor in their decision when they did not fire, these results are not encouraging: they do not support the idea that more toy-like coloring of toy guns will ensure that children will be able to distinguish toy and real guns. It remains unclear whether the training effect of a chartreuse plastic toy gun will be less than that of a steel-gray, metal one. Future legislative initiatives (and/or regulations) could include toy gun weight, size, silhouette, and visibility at night. Real-life tests of the ability of children and adults to distinguish between toy and real guns without handling them are clearly necessary for any new standards that are proposed. It remains to be seen which problems associated with earlier toy guns persist with more toy-like models. Surely, dangerous confusion of toy and real guns is likely to increase if pastel handguns come on the market. Unfortunately, this possibility does exist. PLASTIC AND OTHER COLORFUL HANDGUNS Realistic toy guns are dangerous because they look real. Plastic handguns, for which a computer prototype exists,[24] are likely to be particularly dangerous because they look like toys. When a manufacturer first indicated its intent to produce light-weight, pastel plastic handguns for personal use, legislative concern focused on the possibility that the nonmetallic guns could thwart airport security. Federal legislation was passed requiring that any plastic gun produced must contain enough metal to set off metal detectors in airports. The uproar over the possibility of a plastic handgun seems to have persuaded the manufacturer to focus its efforts on developing plastic military weapons instead. If it ever again appears likely that pretty plastic guns may find their way into private homes, child advocates will need to explain again that children will not detect a small metal part on the inside and are likely to be fatally attracted to toy- like real guns. Legislation may yet be needed to ban such weapons, regardless of the outcome of attempts to ban all handguns. Other gun-recoloring schemes, such as the colorful silicon finishes now being promoted by one manufacturer, raise similar issues.[25] Among the advantages cited for colorful guns are that such finishes enhance "public image._[m]aking [guns] in attractive sporty colors is one way to `soften' the image of firearms" and "courtroom appeal._[I]t would be very difficult for a jury to feel infuriated when the prosecutor holds up a pink AK-47, or a baby blue Remington 870."25 The possibility that children may be lured to disaster is not mentioned. NOWPOWDER FIREARMS Nonpowder firearms are weapons of preadolescents and early adolescents. Resulting injuries are frequently in these groups,[26] including eye injuries that make nonpowder firearms a common cause of blindness for teenage boys.[27] The muzzle velocities of airguns have been rising in recent decades, with the result that some are now in the lethal firearm range (Newsweek. January 29, 1990:61). Regulatory options include restrictions on muzzle velocity, restrictions on age for use, labeling requirements, and requirements for sale with, and use of, goggles. Unfortunately, the Consumer Product Safety Commission, which has authority over nonpowder firearms, has repeatedly considered and declined petitions to regulate these consumer products. It therefore appears necessary for child advocates to consider introduction of legislation: at the local, state, and/or federal levels. Some examples of this approach are available.[28,29] The National Rifle Association is actively involved in teaching adolescents and preadolescents to shoot, often using nonpowder firearms. Strong opposition to legislation restricting manufacture, sale, possession, and/or use of nonpowder firearms would undoubtedly be forthcoming from the National Rifle Association. Such opposition is not a reason to avoid such legislation: it may be possible to turn it to great advantage by pointing out that by interfering with legislative initiatives to protect children from needless blindness and death as a result of injury from nonpowder firearms, the gun lobby would be placing a value on guns above the safety of children. This would eventually to be politically disadvantageous to the gun lobby. OMNIBUS CHILD FIREARM SAFETY BILL Consideration has been given to the merits of introducing a single bill that would cover all or most of the approaches outlined in this commentary. Such a bill would emphasize that reducing hazards to children caused by firearms requires a multifaceted approach. It has the additional advantage of leaving a great deal of room for negotiation in specific legislative contexts. On the other hand, omnibus bills are long, complicated, and unlikely to be passed in toto. Negotiations are therefore likely to result in a patchwork of laws with differing provisions. It remains to be seen whether the resulting legislation would increase understanding and clarity about the issues or would reduce injuries from firearms. CONCLUSION We can look forward to political failures as well as successes, and some ordinances that pass will prove to be less effective than hoped. We must take care to evaluate any preventive approaches that we implement. At the same time, we cannot wait for a perfect bill or conclusive study, because these are not available and the situation is urgent. Continuation of the current change in the political landscape is likely: we will see increasing intolerance of injury resulting from unregulated availability of handguns and other powerful firearms. This evolution can help us create a society in which children can play at their neighbors' homes without their parents worrying that they will find a gun. There is every reason to be both bold and optimistic. TABLE 1. Fatalities Caused by Firearms, Children and Adolescents, 1985* <1 y 1-4 y 5-9 y 10-14 y 15-19 y _________ ________ ________ _________ ________ No. Rate! No. Rate! No. Rate! No. Rate! No. Rate! Homicide@ 6 0.17 51 0.37 58 0.36 137 0.83 104 5.81 Male White 1 0.06 19 0.32 25 0.36 63 0.89 382 4.93 Black 1 0.35 12 1.11 6 0.46 40 2.97 506 36.38 Female White 3 0.20 13 0.23 15 0.23 26 0.39 88 1.18 Black 1 0.36 7 0.67 12 0.94 8 0.61 68 4.93 Suicide# 0 - 0 - 0 - 137 0.83 1083 6.02 Male White 0 - 0 - 0 - 103 1.45 850 10.97 Black 0 - 0 - 0 - 6 0.45 74 5.32 Female White 0 - 0 - 0 - 28 0.42 150 5.32 Black 0 - 0 - 0 - 0 - 9 0.65 Unintentional$ 2 0.06 41 0.30 54 0.33 174 1.06 233 1.30 Male White 0 - 15 0.25 33 0.47 145 2.04 166 2.14 Black 0 - 11 1.01 4 0.30 16 1.19 45 3.24 Female White 1 0.07 13 0.23 13 0.20 12 0.18 17 0.23 Black 1 0.36 2 0.19 4 0.31 1 0.08 5 0.36 Undetermined^ 0 - 2 0.01 4 0.02 13 0.08 52 0.29 Male White 0 - 1 0.02 3 0.04 8 0.11 36 0.46 Black 0 - 1 0.09 1 0.08 1 0.07 7 0.50 Female White 0 - 0 - 0 - 4 0.06 8 0.11 Black 0 - 0 - 0 - 0 - 1 0.07 All!@#$^+ 8 0.22 94 0.69 116 0.72 461 2.80 241 13.43 Male White 1 0.06 35 0.59 61 0.87 319 4.49 143 13.51 Black 1 0.35 24 2.22 11 0.84 63 4.68 632 45.43 Female White 4 0.27 26 0.46 28 0.42 70 1.04 263 3.53 Black 2 0.72 9 0.86 16 1.25 9 0.69 83 6.02 --------------------------------------------------------------------- - * Sources: number of deaths, National Center for Health Statistics,[30] population, US Bureau of the Census.[31] ! Per 100 000 population. @ International Classification of Diseases, 9th revision (ICD- 9) codes E965.0-965.4. # ICD-9 codes E955.0-955.4. $ ICD-9 codes E922.0-E922.9. ^ ICD-9 codes E985.0-E985.4. + Excludes nonblack, nonwhite (from numerator and denominator). TABLE 2. Pros and Cons of Possible Regulatory and Legislative Approaches to Reduce Firearm Injuries Affecting Children and Adolescents Approach Pros Cons 1. Enforce - No new laws - Private use limits existing laws needed effectiveness of laws addressing use (rather than ownership) 2. Regulation under - No new laws needed - Limited historical existing laws precedent - Especially dependent on political climate 3. Owner liability - Clear social - Requires repetitive for child use expectation set owner actions by new legislation - Entire burden on owner (none on - Gun promoters manufacturer, retailer) may support 4. Required gun - Easier to - Developmental safety education implement than characteristics of in schools most other options children make efficacy unlikely - Gun promoters - Could decrease support vigilance, increase risk - Safety message in school diluted by media portrayals of guns 5. Increased - Taxes already - Extent of effect could sales taxes exist, are be limited, particularly accepted for less expensive guns. - Taxes affect discretionary - Would not affect purchases private sales 6. Firearm registration - Other potentially - Current registration and and licensure deadly products licensure systems are so treated obviously have little (eg, motor effect. vehicles) - Effective tracking system could be extremely costly and difficult to enforce. 7. Background checks - Reduce - Most shootings do not impulse purchases involve new purchases, - Reduce purchases felons, or deranged by ineligible individuals. individuals - Impossible to identify all mentally ill - Local trials individuals. indicate systems - Would not affect can prevent some private sales sales 8. Ammunition - Consumable, so - Does not reduce gun modification changes will enter accessibility, so would market quickly not affect frequency of injuries - Likely to reduce injury severity - Current civilian bullets pack needlessly high power 9. Engineering - Precedent for - Efficacy would require modifications building safety trade-ins to replace of guns into consumer less safe guns products - Major effect would be on very young (which is - Guns are currently the smallest injury completely group) unregulated - Likely to have little - Candidate effect on homicide or modifications can suicide. be identified 10. Assault weapon - Rapid deadliness - A minority of deaths ban of these guns and injuries are due - Popular support due to these weapons for ban - Increasing use predicts increasing death and injury 11. Handgun bans - Focus on children - Unenforceable where there - Avoids adult - Entire burden on owner are children choice and (none on manufacturer, privacy issues retailer) - Would not protect against loss of parents and other loved ones 12. Handgun bans - Addresses cause - Wide popular support of most deaths must be built - Has been enacted - It will take a long in some locales time, because there are and upheld in so many handguns in federal courts homes now - Avoids most of - Not now politically the limitations of feasible in many places other approaches - Popular support appears to be growing - Work toward this goal will provide many opportunities for public education 13. Regulate long gun - Some deaths - Most deaths involve ownership and use involve long guns handguns - Hunting and target shooting are very popular 14. Regulate toy gun - Some toy gun - Few injuries involve gun construction injuries occur involve toy guns - Criminals can use - Possibility of toy- realistic toy colored real guns could guns undermine effectiveness - Adults and - Best approaches not clear children sometimes mistake real guns for toys and vice versa - Children may learn comfort with guns 15. Ban plastic - Toy-like real - Last debate on this handguns (and guns will further issue focused on metal other toy-like confuse children detectors, not children guns) - Prevent new - Not currently on hazards the market ACKNOWLEDGEMENTS The discussions and considerations summarized in this commentary are based, in large part, on policy discussions that occurred at the Forum on Children and Firearms, sponsored by the American Academy of Pediatrics (AAP) and the Henry J. Kaiser Family Foundation in August 1989; at the Symposium on Firearms and Children ("Little Hands, Deadly Guns") presented by the AAP Council on Government Affairs and the Department of Government Liaison at the AAP annual meeting, October 22, 1989; and within the Committee on Accident and Poison Prevention of the AAP during 1988 through 1990. Tom Christoffel, JD, Randolph Moore (of the AAP Office of Government Liaison), Robert Tanz, MD, Steven Teret, JD, MPH, Modena Wilson, MD, MPH, and Garen J. Wintemute, MD, MPH, made particularly helpful contributions to AAP discussions and the preparation of this manuscript. Thanks also go to Phia Van Guyse and Laura R. Gannott for secretarial assistance. REFERENCES _______________________________ 1. Baker SP, Teret SP, Dietz PE. Firearms and the public health. J. Public Health Policy. 1980;1:224-229 2. Zimring FE, Hawkins G. The Citizens Guide to Gun Control. New York, NY: Macmillan Publishing Co; 1987 3. State Laws and Published Ordinances_Firearms. 18th ed. Washington, DC: Dept. of the Treasury. Bureau of Alcohol, Tobacco and Firearms. Publication ATFP5300.5 (July 88) 4. Imported Assault Weapon Law. 18USC925d3 5. Christoffel T, Christoffel KK. Nonpowder firearm injuries: whose job is it to protect children? Am J Pub Health. 1987;77:735-738 6. FLA STAT 784.05 and 791.175. 1989 7. Haddon W, Baker SP. Injury control. In: Clark DW, MacMahon B, eds. Preventive and Community Medicare. Boston, MA: Little, Brown and Co; 1981: chap. 8 8. Don't Risk Your Education. No Guns in School. Teaching Strategies and Student Activity Sheets. New York, NY: New York City Board of Education; 1989 9. Handgun safety Awareness Program. Dade County, FL: Dade County Public Schools; 1989 10. Wagenaar AC, Farrell S. Alcohol beverage control policies: their role in preventing alcohol-impaired driving. In: Surgeon General's Workshop on Drunk Driving: Background Paper. Rockville, MD: US Dept of Health and Human Services; 1989:1-14 11. Perrin N. Giving Up the Gun: Japan's Reversion to the Sword. 1543-1879. Boston, MA: David R. Godine Publisher, Inc; 1979 12. Robertson LS. Injuries. Lexington, MA: Lexington Books; 1983;32 13. Martin JM, Hunt TK, Hulley SB. The cost of hospitalization for firearm injuries. JAMA. 1988;160:3048- 3050 14. Done AK. Aspirin overdosage: incidence, diagnosis and management. Pediatrics. 1978;62(suppl):890-897 15. Robertson LS. Control strategies: policies directed at agents and vehicles of injury. In: Injuries. Lexington, MA: Lexington Books; 1983:139-162 16. California SB No. 292, 1989 17. Florida Association of School Administrators and Florida School Boards Association, Inc. Survey Results. Weapons/Firearms on School Property. Tallahassee, FL: Florida School Boards Association, Inc; April 1988 18. Smith D. Across the USA: guns in schools. In: The Handgun Violence Report. Washington, DC: Center to Prevent Handgun Violence; 1988;1-2 19. Teret SP, Alexander GR, Bailey LA. The passage of Maryland's gun law: data and advocacy for injury prevention. J Public Health Policy. 1990:11 20. Christoffel T. A ban on handguns: they tried it and they liked it. J Public Health Policy. 1986;7:296-299 21. Tanz R, Christoffel KK, Sagerman S. Are toy guns too dangerous? Pediatrics. 1985;75:265-268 22. The Federal Point Gun Law (PL 100-615), Part of the Federal Energy Management Improvement Act of 1988 [NOTE: This note was switched with #23, and twice referenced in the document as "23" with no reference to #22 - transcriber] 23. Carlson K, Finn P. Test of the visibility of toy and replica handgun markings. Cambridge, MA: Abt Associates, Inc; August 1989. US Dept of Justice National Institute of Justice Contract OJP-86-C-002 24. Wintemute GJ, Teret SP, Krause JF. Plastic handguns that resemble toy guns: new technology creates a uniquely hazardous product. Pediatrics. 1988;81:316-317 25. Moritz, M. Technicolor guns. Hangunner. [sic] Mar/Apr 1990;69-70 26. Christoffel KK, Tanz R, Sagerman S, et al. Childhood injuries caused by nonpowder firearms. AJDC. 1984; 138:557- 561 27. Sternberg P Jr, DeJuan E Jr, Green WR, Hirst LW, Sommer A. Ocular bb injuries. Ophthalmology. 1984;91:1269-1277 28. BALTIMORE, MD, CODE art 19, Sec 111. 1966 29. Illinois HB3155. 1990 30. National Center for Health Statistics. Vital Statistics of the United States, 1985, Volume II, Mortality, Part A. Washington, DC: US Government Printing Office; 1988. US Dept of Health and Human Services publication (PHS)88- 1101. Tables 1-25 31. US Bureau of the Census. Current Population Reports, Series P-25, No. 1022, United States Population Estimate, by Age, Sex and Race: 1980-1987. Washington, DC: US Government Printing Office; 1988

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