Child Access Prevention Research Articles

Confronting the Global Crisis of Youth and Firearms in the Wake of Serbia’s First School Shooting

Abstract Issue School shootings reflect crucial systemic flaws, notably the ease of firearm access and training for children, despite rigorous firearm regulations. Description In May 2023, Serbia was rocked by its first school shooting in Belgrade, where a 13-year-old boy, armed with guns and Molotov cocktails, killed 9 and injured 6.His actions were amplified by his proficiency with firearms, a skill honed under his father’s guidance at shooting ranges. This tragic event ignited a nationwide debate on gun control. Our study seeks to attain an in-depth analysis on regulations on minimum age for firearm training in context of school shootings in Serbia and USA as countries with highest rates of civilian gun ownership globally. Results Serbian regulations lack a definitive minimum age for firearm training at shooting ranges, mirroring a situation in the USA, where 17 states do not have child access prevention laws, and 43 states lack mandated safe storage requirements. A worrying trend is the escalation in mass shootings by individuals aged 21 or younger, deviating from the earlier trend of middle-aged perpetrators. This younger demographic often seeks fame, inspired by previous mass shooters, contributing to the rise in both deliberate and accidental shootings by young people. Lessons We need to consider the implementation of regulations on minimum age for children firearm training at shooting ranges, as well as stricter control of the ranges. This problem extends beyond national boundaries, reflecting a global issue. The accessibility of firearms to youth, coupled with their developmental susceptibility to impulsive and aggressive behavior, raises significant concerns. Key messages • To increase global awareness and stricter regulations on youth firearm access, emphasizing the stricter regulations on shooting ranges and the integration of firearm safety education into curricula. • Firearm control and children safety is a collective international duty, crucial for addressing a concern that impacts public safety and youth welfare.

Are Child Access Prevention Laws Associated With Fewer Pediatric Firearm Injuries?

Firearm injuries are the leading cause of death for children in the United States. Child access prevention (CAP) laws have been passed in some states. This study examines characteristics of children with firearm injuries in states with different types of CAP laws. The Pediatric Health Information System database was reviewed to identify all pediatric firearm injury patients between 2016 and 2021. Hospital data were categorized based on state laws as (1) no CAP laws (2) some CAP laws or (3) strict CAP laws. CAP laws that specifically outlined criminal liability for the negligent storage of firearms were considered a strict restriction, whereas any other form of CAP law was considered some restriction. χ-squared and independent-samples median testing were performed to compare restriction levels. Between 2016 and 2021, 12 853 firearm injuries were recorded in the Pediatric Health Information System database. In states with strict CAP laws, patients were significantly older (P < .001) and had a significantly higher household income (P < .001) compared with patients in states with no CAP laws. Gender, race, and the number of firearm injuries differed between the 3 restriction levels. There were less firearm injuries observed than expected in cities with strict CAP laws. CAP laws are associated with a higher age and household income of pediatric firearm injury patients. Given the disparities seen between cities, a federal CAP law may best protect children nationwide.

State Policies Regulating Firearms and Changes in Firearm Mortality

Despite high social and public health costs of firearm violence in the United States, the effects of many policies designed to reduce firearm mortality remain uncertain. To estimate the individual and joint effect sizes of state firearm policies on firearm-related mortality. In this comparative effectiveness study, bayesian methods were used to model panel data of annual, state-level mortality rates (1979-2019) for all US firearm decedents, with analyses conducted in October 2023. Six classes of firearms policies: background checks, minimum age, waiting periods, child access, concealed carry, and stand-your-ground laws. Primary outcomes (total firearm deaths, firearm homicide deaths, and firearm suicide deaths) were assessed using the National Vital Statistics System. Bayesian estimation was used to estimate the partial association of changes in firearms policies with subsequent changes in firearm mortality. The estimated effect sizes of individual policies 5 or more years after implementation were generally small in magnitude and had considerable uncertainty. The policy class with the highest probability of reducing firearm deaths was child-access prevention laws, estimated to reduce overall firearm mortality by 6% (80% credible interval [CrI], -2% to -9%). The policy class with the highest probability of increasing firearm deaths was stand-your-ground laws, estimated to increase firearm homicides by 6% (80% CrI, 0% to 13% increase). Estimates of association of implementing multiple firearm restrictions with subsequent changes in firearm mortality yielded larger effect sizes. Moving from the most permissive to most restrictive set of firearm policies was associated with an estimated 20% reduction in firearm deaths (80% CrI, 10% to 28% reduction), with a 0.99 probability of any reductions in firearm death rates. In this comparative effectiveness study of state firearm policies, the joint effect estimates of combinations of firearm laws were calculated, showing that restrictive firearm policies were associated with substantial reductions in firearm mortality. Although policymakers would benefit from knowing the effects of individual policies, the estimated changes in firearm mortality following implementation of individual policies were often small and uncertain.

Knowledge Gaps Identified in a Survey of Maine Physicians' Firearm Safety Counseling Practices.

Numerous medical associations have identified firearm injuries as a public health issue, calling on physicians to provide firearm safety counseling. Data suggest that while many physicians agree with this, few routinely screen and provide counseling. We aimed to survey Maine physicians to assess their current firearm safety counseling practices and knowledge of a new state child access prevention (CAP) law. We conducted an anonymous cross-sectional survey of Maine primary care and psychiatry physicians. We recruited multiple statewide medical organizations, residency programs, and two major health systems to distribute the survey to their membership. Group differences were compared by physician rurality and years in practice using Fisher's Exact and Chi Squared tests. Ninety-five surveys were completed. Though most participants agreed that firearm injury is an important public health issue that physicians can positively affect (92%), few had received prior firearm safety counseling education (27%). There were significant differences in firearm screening frequency, with rural physicians screening more often. More rural physicians and physicians with > 10 years of clinical practice felt they had adequate knowledge to provide meaningful counseling, compared with non-rural and early career physicians, respectively. Overall, 62% of participants were unaware of the 2021 Maine CAP law. This study highlights significant differences in firearm safety counseling practices among Maine physicians based on rurality and years of experience. Participants also reported a significant gap in knowledge of a recent state child access prevention law. Next steps include development of firearm safety counseling education tailored to Maine physicians.

Access denied: Reducing pediatric firearm mortality with smart gun technology

AbstractIn 2020, firearm‐related injuries became the leading cause of death in American children. Ensuring the safe storage of household firearms is one way to reduce those deaths. Since the 1990s, states have sought to accomplish that goal through child access prevention (CAP) laws, which sanction gun owners for unsafe firearm storage. However, recent survey data suggests that these laws are not effective, as they suffer from low compliance. To compensate for these shortcomings, legislators should repeal CAP laws and devise legislation requiring gun owners residing with children to retrofit their household firearms with smart gun technology.

Child Firearm-Related Homicide and Suicide by State Legislation in the US (2009-2020).

Firearms are the leading cause of death among U.S. children and adolescents. This study evaluates whether state gun laws are associated with firearm suicides and homicides in children. This is a cross-sectional database study comparing childhood firearm mortality with 36 state firearm laws using data from CDC WONDER and the RAND state firearm law database. Primary outcomes were firearm-related suicide and homicide mortalities per 100,000 persons. We examined suicide deaths by all firearms, including intentional self-harm by handguns only, intentional self-harm by rifles, shotguns, or large firearms only, and intentional self-harm by other or unspecified firearms, as well as homicide deaths for the same firearm types in each state. Welch's t-tests compared mean rates of suicide and homicide mortalities between states with and without these laws. States that either enacted or rescinded firearm legislation during this period were excluded. From 2009-2020, there were 6,735 suicides and 10,278 homicides by firearm totaling 17,013 child deaths (<18) by firearm. States with "child access prevention- negligent storage" laws demonstrated lower suicide mortality rates across all firearm types (handguns) N=13, M (mean per 100,000)=0.68, SD=0.27, p<0.001; (long guns) N=12, M=0.65, SD=0.25, p<0.001). There were no significant differences in mean suicide death rates across all firearm types when comparing states with or without firearm laws related to "minimum age youth possession", "minimum age youth purchase and sale", or "child access prevention - intentional." Comparing homicide mortality rates for all firearm types revealed no notable distinctions between states with and without the identified laws. Firearm legislation is associated with decreased suicide rates for individuals under 18, but its influence on homicides is less certain. Comprehensive research and thoughtful policy formulation are essential for addressing this pressing public health concern.

Child Access Prevention Laws and Pediatric Firearm Injury: A Rapid Review.

US child firearm fatality rates have risen since 2013. Child Access Prevention (CAP) laws aimed at reducing minors' access to firearms have existed since the 1980s. However, specific requirements for safe storage of firearms, standards of negligence, and penalties for offenders vary significantly by state, yielding a heterogeneous body of CAP legislation. A few studies have investigated the relative impacts of these laws on child firearm injury rates, with sometimes conflicting results. Here, we present a rapid review of the existing literature on CAP laws and their apparent impact on firearm-related injuries among US children, to assess whether CAP laws are an effective tool for reducing child firearm injuries. We conducted a rapid review of published reports that evaluated the impact of CAP laws on pediatric firearm injuries and/or deaths in the United States. We extracted target population data and outcomes of each study. The data are presented narratively. A total of 14 articles met criteria for evaluation. Taken together, these studies showed that implementation of CAP legislation was associated with reduced pediatric firearm injuries and fatalities. Moreover, longitudinal or time-series studies that examined changes in pediatric firearm injuries pre/post-CAP legislation yielded the most consistent and robust findings. CAP laws were found to be associated with reduced pediatric firearm injuries and deaths, with the magnitude of effect being proportional to CAP law stringency.

Bullet holes: A novel model to identify the most impactful gaps in the firearm homicide prevention laws of each state.

Firearm homicides (FH) are a major cause of mortality in the United States. Firearm law implementation is variable across states, and legislative gaps may represent opportunities for FH prevention. For each state, we sought to identify which firearm law category would have been most effective if implemented and how effective it would have been. We conducted a retrospective cohort study examining the effects of firearm laws on FH rates in the 48 contiguous US states 2010 to 2019. Data were obtained from the CDC WONDER and FBI UCR databases, State Firearm Law Database, and US Census. Firearm laws were grouped into 14 categories. We assessed the association between the presence of each law category and FH rate as an incidence rate ratio (IRR) using a Poisson regression accounting for state population characteristics and laws of surrounding states. We estimated the IRR for each state that did not have a given law category present and determined which of these missing law categories would have been associated with the greatest reduction in FH rate. FH rates varied widely across states and increased from a mean of 3.2 (SD = 1.7) to 4.2 (SD = 2.9) FH per 100,000. All law categories were significantly associated with decreased FH rate ( p < 0.05), with IRR ranging from 0.25 to 0.85. The most effective missing law category differed between states but was most commonly child access prevention (34.09% of states), assault weapons and large-capacity magazines (15.91%), preemption (15.91%), and concealed carry permitting (13.64%). In total across 2010 to 2019, we estimated that 129,599 fewer FH would have occurred with enactment of the most effective missing law category in each state. Modeling firearm law prevention of FH with regard to state legislative and population characteristics can identify the highest impact missing law categories in each state. These results can be used to inform efforts to reduce FH. Prognostic and Epidemiological; Level IV.

Examining media reports of pediatric unintentional firearm injury deaths for prevention messaging concerning secured storage of firearms: U.S., 2021–2022

BackgroundMedia outlets that report on firearm injuries and deaths may provide an important role in emphasizing safe storage practices, particularly when unintentional firearm injuries and deaths occur among young children. There has been a scarcity of research on aspects of media reports on injuries, particularly concerning prevention messaging. The objective of the present study was to examine prevention messaging on the safe storage of firearms among media outlets when reporting on unintentional firearm injury deaths among children aged 0–11.MethodsThe Gun Violence Archive collects information from media sources regarding firearm injuries and deaths. We analyzed data from 2021 to 2022 to analyze prevention messaging incorporated into the media reports. We then examined if media reporting of events that occurred in States with child access prevention (CAP) laws had a higher likelihood of including prevention messaging compared to those events occurring in States without CAP laws.ResultsThere were 223 deaths reported that were attributed to unintentional firearm discharge among children aged 0–11. Prevention messages were delivered in 61 of the 223 incidents. Specific messages which included the word “lock” when referring to firearm storage were included in 21.9% of all incidents. An analysis examining State CAP laws and the presence of any prevention message per event did not yield any discernable relationship.ConclusionInclusion of prevention messaging stating that firearms should be stored locked and unloaded when reporting on unintentional firearm injury deaths among children is lacking. When specific prevention messaging was included, the source was often law enforcement. Public health officials may play an important role in educating the journalistic and law enforcement communities about the inclusion of safe storage messages when reporting on firearm deaths.

Fatal Firearm Violence Among American Indians and Alaska Natives.

There is a dearth of population-based studies regarding firearm-related deaths and years of potential life lost among American Indians and Alaska Natives (AI/AN). Using the Centers for Disease Control and Prevention's (CDC) We Based Injury Statistics Query and Reporting System (WISQARS) data for the three most recent years (2018-2020), we analyzed the demographic characteristics of AI/ANs who succumbed to firearm violence. AI/ANs averaged almost 500 firearm-related deaths per year. The majority of these deaths were observed among individuals 20-39 years of age (53%), males (84.4%), and in the West (55.3%). A plurality of these firearm-related deaths were suicides (48.9%) followed by homicides (43.5%). During the 3-year study period, the age-adjusted firearm death rate increased almost 5 times the growth of the AI/AN population. Also, a staggering 67,050 years of potential life were lost before the age of 80 years (YPLL80) during this period. Firearm suicides were responsible for the largest proportion of YPLL80s (48.5%). Traditional legal interventions [e.g., child access prevention (CAP) laws and extreme risk protection orders (ERPO)], if expanded to more states could potentially help reduce AI/AN firearm mortality. None of the 10 states with the highest firearm mortality of AI/AN have ERPOs and 8 of the 10 do not have CAP laws. Also, a renewed focus on cultural continuity and indigenous protective factors is essential to ameliorate the level of firearm violence in AI/ANs.

Modeling the Relationship Between Firearm Restrictions, Medicaid Expansion, and Political Partisanship with Pediatric Firearm Mortality Costs

IntroductionFirearms are now the leading cause of pediatric mortality in the U.S., but few studies have investigated the economic impact of these deaths. Thus, this study determined whether multiple different gun-related measures, political partisanship and Medicaid expansion were related to the costs of pediatric gun deaths. MethodsEach states’ medical costs, years of potential life lost (YPLL), and value of statistical life (VSL) lost due to pediatric gun deaths were extracted from the WISQARS database from 2015 to 2020. Seven firearm laws or restrictiveness measures (assault weapons bans, child access prevention laws, firearm registration and permit to purchase requirements, safe storage laws, Giffords Law Center ranking, and the number of firearm provisions), the Cook Partisan Voting Index (PVI), and Medicaid expansion status were determined across states. Unadjusted analyses compared each measure and (1) medical costs, (2) VSL, and (3) YPLL for each state. These were repeated using adjusted analyses, controlling for poverty, educational attainment, poor mental health, and race. ResultsOf the 9 variables assessed, unadjusted analyses revealed that 8 variables were significantly associated with increased medical costs, all 9 were associated with higher VSL and 8 were associated with higher YPLL due to pediatric firearm-related mortality. Multivariable analyses revealed that 7 variables were associated with medical costs, 7 were associated with VSL and 6 were associated with YPLL. ConclusionStates with fewer gun laws and those which have not adopted Medicaid expansion were more likely to experience a higher economic burden due to pediatric gun deaths. Quantifying the costs of these deaths can demonstrate the social toll of gun violence to policymakers and the general public. Level of EvidenceIII.

An epidemiological study of unintentional pediatric firearm fatalities in the USA, 2009–2018

BackgroundFirearm injuries are the leading cause of mortality among children and adolescents 1–19 years old in the USA. Many prior studies on this topic lack detailed information about the circumstances of the firearm fatalities and include decedents and shooters of all ages. This study characterizes firearm fatalities in the USA in which children < 15 years old unintentionally killed themselves or another child.MethodsTen years of data from the National Violent Death Reporting System were analyzed. Unintentional firearm fatalities among children were reviewed to identify characteristics of decedents and the children who inflicted the deaths, their relationship, and circumstances of the deaths. There were 279 firearm fatalities during the study period involving children < 15 years old who unintentionally killed themselves or another child < 15 years old.ResultsMost victims were male (81.4%), and 40.9% were 2–4 years old. Most incidents (64.0%) occurred at the victim’s residence, and in 80.9% of cases the firearm owner was a relative of the shooter. In the < 5-year age group, 80.3% of injuries were self-inflicted, and in the 10–14-year age group, 32.3% of shooters were a friend of the victim.ConclusionThis study highlights that children in the USA are shooting themselves and each other in their own homes, and often accessing firearms owned by family members. These findings can be used to guide prevention efforts, such as child access prevention laws, to reduce the number of pediatric firearm fatalities in the future.

Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach.

Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach.

Advocacy training tool for pediatric residents to strengthen firearm safety laws.

Firearm injury is the leading cause of death in children and adolescents in the US, surpassing motor vehicle crashes. There is a need for greater legislative advocacy around firearm injury prevention, specifically around safer storage of firearms. A national medical trainee-based program convened in 2021 with the goal of increasing advocacy efforts around common causes of pediatric injury. A focus was to create a set of advocacy training tools that could be utilized by a wide variety of stakeholders. The subgroup sought to design policy-based training tools; one focused on general firearm injury prevention principles and another specifically focused on Child Access Prevention (CAP) laws. We explicate the utility of these documents and the need for greater advocacy around pediatric firearm injuries.

Firearm Mortality Among Pre-school Age Children, 2010-2020.

Firearms are a substantial cause of death for pre-school children (ages 0-5 years). The purpose of this study was to characterize fatal firearm violence in this age group. The Web-Based Injury Statistics Query and Reporting System (WISQARS) data from the Centers for Disease Control and Prevention (CDC) were analyzed for the years 2010-2020. There were 1,220 firearm deaths during the study period with a 75% increase in the rate of deaths per 100,000 population. Most deaths (two-thirds) were among males. Non-Hispanic Blacks comprised 56.4% of all deaths in 2020, a 172% increase from 2010 and the rate for non-Hispanic Whites increased by 15.4% from 2010 to 2020. The majority of the deaths occurred in the South. Almost two-thirds (65.9%) of all firearm deaths were homicides, 30% were unintentional, and 4.1% were undetermined. Homicides were also the majority of deaths for non-Hispanic Blacks (64.9%), non-Hispanic Whites (60.8%), and Hispanics (81.3%). The years of potential life lost before 80 years of age were 94,105, with a plurality (43.3%) of losses occurring among non-Hispanic Black children. Sustained awareness campaigns should be implemented to make parents and guardians aware of the profound dangers of unlocked and loaded or unsafely stored firearms in the home. Child healthcare providers should counsel parents and guardians on firearm safety in households. Public health professionals should advocate for laws that can help protect children from firearm violence (e.g., Domestic Violence Restraining Orders, Child Access Prevention laws, and Extreme Risk Protection Order laws).

Child Access Prevention Laws and Non-Hispanic Black Youth Firearm Mortality.

Firearm injuries are the leading cause of death for youths 19 and younger in general and the third leading cause of death for non-Hispanic Black youths. Child Access Prevention (CAP) laws have been explored concerning their impact on firearm mortality reduction among heterogenous groups of youth, but not specifically among non-Hispanic Black youths. We analyzed data related to non-Hispanic Black youth firearm mortality, non-Hispanic Black poverty rates, firearm dealer density, and CAP laws for each state to ascertain the impact of CAP laws from 2015 to 2019. During the study period, a total of 6778 non-Hispanic Black youths died due to firearm trauma with the leading causes of death being homicides (85.8%); mostly seen among males (96%), and in the South (53.2%). When compared by CAP laws, the states with the strongest laws had statistically significantly lower rates of firearm mortality than states with the weakest laws. After adjusting for state poverty and firearm dealer density, the differences were not statistically significant but still, stronger CAP laws were associated with lower rates of firearm mortality among non-Hispanic Black youth. CAP laws alone can have a modest impact on non-Hispanic Black youth firearm mortality. To adequately reduce firearm mortality among non-Hispanic Black youths, the state and local governments should, along with CAP laws, enact policies to reduce poverty, crime, access to firearms by criminals, and neighborhood dysfunction among non-Hispanic Black communities.

Association Between Child Access Prevention and State Firearm Laws With Pediatric Firearm-Related Deaths

IntroductionWe aim to study the association between state child access prevention (CAP) and overall firearm laws with pediatric firearm-related mortality. MethodsThe Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System was queried for pediatric (aged < 18 y) all-intent (accidental, suicide, and homicide) firearm-related crude death rates (CDRs) among the 50 states from 1999 to 2019. States were into three groups: Always CAP (throughout the 20-year period), Never CAP, and New CAP (enacted CAP during study period). We used the Giffords Law Center Annual Gun Law Scorecard (A, B, C, D, F) to group states into strict (A, B) and lenient (C, D, F) firearm laws. A scatter plot was constructed to display state CDR based on CAP laws by year. The top 10 states by CDR per year were tabulated based on CAP law status. Wilcoxon rank-sum was used to compare CDR between strict and lenient scorecard states in 2019. ResultsThere were 12 Always CAP, 21 Never CAP, and 17 New CAP states from 1999 to 2019. No states changed from CAP laws to no CAP laws. Never CAP and New CAP states dominated the high outliers in CDR compared to Always CAP. The top 10 states with the highest CDR per year were most commonly Never CAP. Strict firearm laws states had lower median CDR in 2019 than lenient states (0.79 [0-1.67] versus 2.59 [1.66-3.53], P = 0.007). ConclusionsStricter overall gun laws are associated with three-fold lower all-intent pediatric firearm-related deaths. For 2 decades, the 10 states with the highest CDR were almost universally those without CAP laws. Our findings support the RAND Gun Policy in America initiative's claims on the importance of CAP laws in reducing suicide, unintentional deaths, and violent crime among children, but more research is needed.

Policy pathways to address American youth firearm injury and death.

Context: The burden of firearm violence and death are uniquely American problems. Over 90% of firearm deaths among children and adolescents in high income countries occur in the United States. Despite similar overall crime rates, the gun homicide rate is about 25 times higher in the U.S. than other Western democracies, and 49 times higher for those aged 15-24 years. Firearm-related injuries are a leading cause of child and adolescent deaths, second only to motor vehicle crashes. Approximately 4.6 million children are living in U.S. homes with at least one loaded, unlocked firearm. Reducing gun violence injuries and deaths is imperative and requires a multifaceted approach. Objectives: Review the impact of gun violence on youth across the U.S.; articulate the evidence base for gun safety policies; describe the current landscape of federal and state firearm laws. Study Design: Policy analysis and literature review. Results: The history of U.S. firearm policy demonstrates laws in evolution from 1791-2021, regulating both gun owner rights and restrictions. These firearm policies, existing in a variety of forms in states and nationally, reveal evidence that gun safety legislation saves lives: Child Access Prevention; Safe Storage; Universal Background Checks; Permit to Purchase; Extended Waiting Periods; Extreme Risk Protection Orders; Assault Weapon and High Capacity Magazine Ban. The dearth of federal law has resulted in more extensive state legislation but with variability and inconsistencies. No single law or policy reduces all forms of gun violence, but states with a variety of firearm policies have a cumulative impact on reducing injuries and death. Conclusions: We aim to promote education, physical safety, and behavioral health so that children can achieve their highest potential. Decreasing firearm injury and death is achievable with education, collaboration, research, and policies. To protect children and youth from firearm injury and death, we must: strengthen federal laws building on evidence from state policies; protect current evidence-based state laws from dismantling efforts; invest in public health firearms research; overcome the inequities suffered by disproportionately affected populations.

Firearm Injury and Mortality Prevention in Pediatric Health-care Settings.

Firearm Injury and Mortality Prevention in Pediatric Health-care Settings.

Child Access Prevention Laws and Firearm Storage: Results From a National Survey

Child Access Prevention Negligent Storage (CAP-NS) laws seek to reduce pediatric firearm injury by imposing sanctions on gun owners if children gain access to unlocked guns. Whether these laws affect the storage behavior they aim to encourage is not known because historical panel data on firearm storage do not exist. As a result, assessing how much, if at all, firearm storage changed because of CAP-NS laws requires an indirect approach. Data for this study came from a web-based survey conducted by the research firm Ipsos from July 30, 2019 to August 11, 2019. Respondents were adult gun owners drawn from an online sampling frame comprising approximately 55,000 U.S. adults recruited using address-based sampling methods to be representative of the U.S. The primary outcome was the proportion of gun owners in CAP-NS versus non-CAP-NS states who had ≥1 unlocked firearm. Estimates are presented by CAP-NS status, for gun owners overall and for those who live with children, before and after adjusting for potential confounders. Data were analyzed in 2021. In adjusted analyses, gun owners in CAP-NS states were no more likely to lock firearms than were those in states without these laws. In addition, most gun owners reported not knowing whether they lived in a state with a CAP-NS law. CAP-NS laws have at best modest effects on firearm storage. If the storage effect is as small as this study indicates, the mortality benefits previously attributed to CAP-NS laws are overstated. As such, developing interventions that effectively reduce firearm mortality by reducing access to firearms remains an urgent clinical and public policy priority.