Additionally, there is ongoing discussion and study of the extent to which gun ownership, gun availability, or the expense and time required to acquire a firearm influences the likelihood that it will be used in a violent or suicidal act. Issues of access include studies on the effects of the presence of a firearm in a specific location (e.g., home or vehicle); gun commerce, including black markets for firearm purchase; and the effects of regulations on carrying concealed weapons.

Child and Adolescent Vulnerability

Another important issue involves the relative importance of child and adolescent vulnerability on the one hand and adult freedom on the other. Because they live in environments that are generally controlled by adults, children and adolescents are vulnerable to risks that result from adult decisions, including decisions to keep and use guns and decisions on gun storage, particularly in the home. When children and adolescents encounter a gun, they have a reduced capacity to make safe decisions because of their lack of experience, immaturity of judgment, and impulsivity. Their decisions can result in increased risk of injury related to play, assault, or suicidal behavior.

Goals and Priorities for Action

As noted above, a workable political consensus has not yet developed on the balance that should be struck between the prerogatives of firearm ownership and the reduction of firearm-related injuries, especially in a social context in which about 192 million firearms, including 65 million handguns, are in circulation (Cook and Ludwig, 1996). In the committee's view, a workable consensus is most likely to emerge if the discussion is focused less on ownership issues and more on the steps that can be taken to reduce the adverse health consequences of firearm use and to strengthen the scientific basis of policy making. In short, the points of departure for national firearms policy should be harm reduction and better science.

Within the overall framework, initial priority should be given to measures that reduce the risk of harm to the most vulnerable segments of the population, particularly children and adolescents and that curtail the risk of firearm injury caused by children and adolescents. Even in the absence of a broad consensus about the aims of national policy, few people are likely to contest the ethical legitimacy of aggressive measures designed to reduce gun-related injuries to and by youths.

In 1995, firearms were the second leading cause of death among children ages 10–14 years (48 percent of those deaths were homicides; Fingerhut and Warner [1997]). In 1994, 185 children, ages 0–14 years, and 327 adolescents, ages 15–19 years, died from unintentional firearm injuries (Ikeda et al., 1997).

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