Additionally, with 50 separate legislatures, developing consistent countermeasures at the state level has proved difficult. The conditional funding mechanism for states to adopt federally endorsed injury prevention legislation has been effective when used, as in the case of the minimum age for the purchase of alcohol. Opportunities to increase use of this mechanism, rather than restrict its use, will be important to furthering progress.


Firearm discharges kill almost as many people each year in the United States as motor vehicle crashes, yet the response to this threat to public safety has been quite different from the response to motor vehicle crashes. In the case of motor vehicles, the public and policy makers have demanded safer vehicles, better highways, and more stringent regulation and law enforcement directed at drivers. Together with improved trauma care, these measures have been effective over several decades in reducing the fatality rate per occupant mile. Unfortunately, there has not been a similar comprehensive response—or similar progress—in reducing firearm injuries.

From 1962 to 1994, 992,388 people in the United States died from firearm-related injuries (Ikeda et al., 1997). Firearm deaths and death rates in the United States reached a 30-year high in 1993 (39,595 deaths) and declined in 1994 and 1995 (Fingerhut and Warner, 1997; Ikeda et al., 1997). Although a major cause of morbidity and mortality throughout the life span, firearm deaths particularly affect teens and young adults (mainly homicides) and the elderly (mainly suicides). In 1995, 35,957 people died as a result of firearm injuries; over half of these fatalities (18,003 deaths) were of persons 15–34 years old (Fingerhut and Warner, 1997). In 1995, a greater percentage of firearm deaths were due to suicide (51 percent) than homicide (43 percent) (Fingerhut and Warner, 1997). There were 1,225 unintentional firearm deaths in 1995 (3 percent of all firearm deaths) (Fingerhut and Warner, 1997). An international comparison of 26 industrialized countries found that the firearm death rate for U.S. children younger than 15 years was nearly 12 times higher than among children in the other 25 countries combined (CDC, 1997).

There are similarities in the high degree of lethality of both motor vehicles and firearms. Each product has the potential to produce serious injury or death in a matter of seconds. However, whereas most motor vehicle injuries are unintentional, most firearm injuries are intentional. This difference in intentionality creates complexities in dealing with the emotional, psychological, and behavioral antecedents and consequences of firearm injury. However, this further challenge does not preclude—but rather emphasizes—the need for a concerted effort to focus the full breadth of scientific expertise on preventing and reducing the health consequences of firearm injury.

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