versed, with handguns conveying a much higher risk than long guns (OR’s 5.6 vs. 1.3) (Brent et al., 1993).

While firearms counseling has gained acceptance as an important component of health supervision, in reality this often fails to occur (Grossman et al., 1995). Depressed adolescent patients and their parents are often non-compliant with physician recommendations to secure or remove firearms (Weil and Hemenway, 1992). Only two studies have examined the impact of firearms counseling on the removal of firearms with the parents of youth at risk for suicide. In one study, eight parents of suicide attempters with firearms in the home were counseled about the danger conveyed by firearms in the home, and five either removed the gun, or stored the gun in a more secure manner (Kruesi et al., 1999). In a study of depressed adolescents who entered a randomized psychotherapy clinical trial, only 27 percent of parents who reported having guns in the home at intake removed the guns on follow-up after being urged by the clinician to do so (Brent et al., 2000). Therefore, it is unwise to assume that providing recommendations on removal of firearms from the home will automatically result in compliance. An alternative recommendation to improve the security of gun storage is often more favorably received (Webster et al., 1992).

The firearms suicide rate and the overall suicide rate are related to the strictness of gun control laws and the prevalence of gun ownership (Boor and Bair, 1990; Killias, 1993; Lester, 1988; Lester and Murrell, 1986). Quasi-experimental studies suggest that greater restrictiveness in gun control laws is associated with declines in firearms suicide, sometimes without compensatory method substitution (Loftin et al., 1991). In a particularly elegant cross-country comparison, the suicide rates were compared in two similar cities, Seattle and Vancouver. Because gun control is more restrictive in Canada, it was assumed suicide rates in Vancouver would be lower (Sloan et al., 1990). Instead, the overall suicide rates were similar in the two cities, albeit with a 10-fold higher rate of firearms suicides in Seattle. This was almost entirely reflected in 40 percent higher rate of suicide among 15–24 year olds in Seattle. These results suggest that the greater availability of firearms is particularly deleterious for younger people.

In a well-designed quasi-experimental study, Loftin et al. (1991) examined the relationship between legislation enacted in 1976 in the District of Columbia and subsequent time trends in suicide and homicide during the years 1968 through 1987. This legislation mandated the registration of all firearms, required that new purchasers meet “fitness” and knowledge of safety standards, and necessitated that owners store guns unloaded and disassembled, with certain occupational exceptions, such as law enforcement. The unusual aspect of this study was that changes in the rates