{"title":"儿童接触预防法对青少年自杀的影响：一种消极控制方法。","authors":"Sean MacAllister, Matthew Miller, Sonja Swanson","doi":"10.1186/s40621-025-00577-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Recent publications on Child Access Prevention (CAP) laws suggest substantial protective effects on adolescent firearm suicide. However, these studies have also found comparable protective effect estimates on adolescent non-firearm suicide and adult firearm suicide, which may indicate residual confounding. Here we apply bias analysis techniques to assess the effects of CAP laws while accounting for potential unmeasured sources of bias using a negative control approach.</p><p><strong>Method: </strong>Using established bias formulas, we bias-adjust previously published point estimates and their 95% confidence intervals (CI) assuming that an arbitrary confounder biases all suicide-related effect estimates and that adolescent non-firearm suicide and adult firearm suicide are negative controls. Negative controls are outcomes or populations that prior subject matter suggests should not be meaningfully affected by the exposure and can be used to better understand and sometimes account for bias in the primary exposure-outcome relationship.</p><p><strong>Results: </strong>After bias adjustments, effect estimates were attenuated, with many of the confidence intervals including the null. Assuming that adolescent non-firearm suicide is a negative control outcome and taking a published point estimate as the bias parameter, the bias-adjusted effect estimate for adolescent firearm suicide decreased from an incidence rate ratio of 0.87 (95% CI: 0.78, 0.97) to 0.95 (95% CI: 0.85, 1.07). When adult firearm suicide was used as the negative control, the bias-adjusted estimate was 0.92 (95% CI: 0.82, 1.03).</p><p><strong>Conclusion: </strong>Our findings suggest that CAP laws may have had a smaller public health impact on adolescent suicide than previously estimated. Given the strong evidence that reducing access to firearms can prevent suicide deaths, and that secure storage helps reduce access for many children, our findings underscore the need to continue to identify and promote effective ways to motivate adults to make household firearms inaccessible to children.</p>","PeriodicalId":37379,"journal":{"name":"Injury Epidemiology","volume":"12 1","pages":"21"},"PeriodicalIF":2.4000,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020014/pdf/","citationCount":"0","resultStr":"{\"title\":\"The effect of child access prevention laws on adolescent suicide: a negative control approach.\",\"authors\":\"Sean MacAllister, Matthew Miller, Sonja Swanson\",\"doi\":\"10.1186/s40621-025-00577-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Recent publications on Child Access Prevention (CAP) laws suggest substantial protective effects on adolescent firearm suicide. However, these studies have also found comparable protective effect estimates on adolescent non-firearm suicide and adult firearm suicide, which may indicate residual confounding. Here we apply bias analysis techniques to assess the effects of CAP laws while accounting for potential unmeasured sources of bias using a negative control approach.</p><p><strong>Method: </strong>Using established bias formulas, we bias-adjust previously published point estimates and their 95% confidence intervals (CI) assuming that an arbitrary confounder biases all suicide-related effect estimates and that adolescent non-firearm suicide and adult firearm suicide are negative controls. Negative controls are outcomes or populations that prior subject matter suggests should not be meaningfully affected by the exposure and can be used to better understand and sometimes account for bias in the primary exposure-outcome relationship.</p><p><strong>Results: </strong>After bias adjustments, effect estimates were attenuated, with many of the confidence intervals including the null. Assuming that adolescent non-firearm suicide is a negative control outcome and taking a published point estimate as the bias parameter, the bias-adjusted effect estimate for adolescent firearm suicide decreased from an incidence rate ratio of 0.87 (95% CI: 0.78, 0.97) to 0.95 (95% CI: 0.85, 1.07). When adult firearm suicide was used as the negative control, the bias-adjusted estimate was 0.92 (95% CI: 0.82, 1.03).</p><p><strong>Conclusion: </strong>Our findings suggest that CAP laws may have had a smaller public health impact on adolescent suicide than previously estimated. Given the strong evidence that reducing access to firearms can prevent suicide deaths, and that secure storage helps reduce access for many children, our findings underscore the need to continue to identify and promote effective ways to motivate adults to make household firearms inaccessible to children.</p>\",\"PeriodicalId\":37379,\"journal\":{\"name\":\"Injury Epidemiology\",\"volume\":\"12 1\",\"pages\":\"21\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-04-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020014/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Injury Epidemiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s40621-025-00577-x\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Injury Epidemiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s40621-025-00577-x","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
The effect of child access prevention laws on adolescent suicide: a negative control approach.
Background: Recent publications on Child Access Prevention (CAP) laws suggest substantial protective effects on adolescent firearm suicide. However, these studies have also found comparable protective effect estimates on adolescent non-firearm suicide and adult firearm suicide, which may indicate residual confounding. Here we apply bias analysis techniques to assess the effects of CAP laws while accounting for potential unmeasured sources of bias using a negative control approach.
Method: Using established bias formulas, we bias-adjust previously published point estimates and their 95% confidence intervals (CI) assuming that an arbitrary confounder biases all suicide-related effect estimates and that adolescent non-firearm suicide and adult firearm suicide are negative controls. Negative controls are outcomes or populations that prior subject matter suggests should not be meaningfully affected by the exposure and can be used to better understand and sometimes account for bias in the primary exposure-outcome relationship.
Results: After bias adjustments, effect estimates were attenuated, with many of the confidence intervals including the null. Assuming that adolescent non-firearm suicide is a negative control outcome and taking a published point estimate as the bias parameter, the bias-adjusted effect estimate for adolescent firearm suicide decreased from an incidence rate ratio of 0.87 (95% CI: 0.78, 0.97) to 0.95 (95% CI: 0.85, 1.07). When adult firearm suicide was used as the negative control, the bias-adjusted estimate was 0.92 (95% CI: 0.82, 1.03).
Conclusion: Our findings suggest that CAP laws may have had a smaller public health impact on adolescent suicide than previously estimated. Given the strong evidence that reducing access to firearms can prevent suicide deaths, and that secure storage helps reduce access for many children, our findings underscore the need to continue to identify and promote effective ways to motivate adults to make household firearms inaccessible to children.
期刊介绍：
Injury Epidemiology is dedicated to advancing the scientific foundation for injury prevention and control through timely publication and dissemination of peer-reviewed research. Injury Epidemiology aims to be the premier venue for communicating epidemiologic studies of unintentional and intentional injuries, including, but not limited to, morbidity and mortality from motor vehicle crashes, drug overdose/poisoning, falls, drowning, fires/burns, iatrogenic injury, suicide, homicide, assaults, and abuse. We welcome investigations designed to understand the magnitude, distribution, determinants, causes, prevention, diagnosis, treatment, prognosis, and outcomes of injuries in specific population groups, geographic regions, and environmental settings (e.g., home, workplace, transport, recreation, sports, and urban/rural). Injury Epidemiology has a special focus on studies generating objective and practical knowledge that can be translated into interventions to reduce injury morbidity and mortality on a population level. Priority consideration will be given to manuscripts that feature contemporary theories and concepts, innovative methods, and novel techniques as applied to injury surveillance, risk assessment, development and implementation of effective interventions, and program and policy evaluation.
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