percent with no substitution of method (Etzersdorfer and Sonneck, 1998; Etzersdorfer et al., 1992; Sonneck et al., 1994).

Universal measures can be used to reduce the availability of common tools for suicide. More restrictive legislation regarding firearms, barriers on bridges, or blister packs for medications are interventions that may be effective in reducing suicide or suicide attempts. This section focuses on the role of availability of methods of suicide, including the role that method availability and barrier restrictions may play in suicide by firearms, acetaminophen overdose, prescription drugs, jumping from buildings or bridges, domestic gas, automobile carbon monoxide, and railway suicides. Much of the research discussed has been done in Western societies, but suicide in rural Asian societies has been largely linked with availability of insecticides (Van der Hoek et al., 1998; Yip et al., 2000). Research is limited, but this underscores the need for implementing safe storage of agricultural poisons and using safety caps to reduce impulsive swallowing.

Epidemiological studies have consistently shown that firearms are most common method of suicide for all demographic groups in the United States (CDC, 1994). The association between suicide and firearms in the home is strong across all age groups, but is particularly high in the 24 and younger group (Odds Ratios³ [ORs] of 10.4 vs. 4.0–7.2 for those 25 and older) (Kellermann et al., 1992). The dramatic increase in the American youth suicide rate since 1960 is primarily attributable to an increase in suicide by firearms (see Figure 8-1a,b; Boyd, 1983; Boyd and Moscicki, 1986). In one study of youth suicide in Allegheny County from 1960–1983, the rate of suicide by firearms increased 330 percent, but the rate of suicide by other means increased only 150 percent (Brent et al., 1987b). The more recent increase in the suicide rate by African American males is also attributable primarily to an increase in suicide by firearms.