State Regulations Governing Firearms in Early Care and Education Settings in the US

This cross-sectional study documents existing US state regulations governing the presence and storage of firearms in early care and education settings and the extent to which these regulations align with national standards.


Introduction
Preventing firearm-related injuries in young children is a public health priority.Firearm fatalities are the third leading cause of injury-related deaths in US children, and firearms within the family home put children at risk. 1 Practices to mitigate this risk include storing firearms locked and unloaded, with ammunition also locked and stored separately.However, fewer than 50% of gun owners reported at least 1 safe storage practice, although households with children more often reported engaging in safe storage practices. 2Despite this, approximately 20% of gun-owning households with children stored firearms in an unsafe manner (ie, loaded and unlocked). 3cently, there has been a substantial increase in public support for policies requiring safer storage of firearms.Child access prevention (CAP) laws are 1 example, because they may reduce firearm-related injuries. 4Many US states have CAP laws that govern firearms within the family home. 4However, nearly two-thirds of children younger than 5 years spend substantial time in out-ofhome early care and education (ECE) settings. 5These settings are regulated by states and other jurisdictions, but to date these regulations have not been included in prior reviews of existing laws.
Moreover, to our knowledge, no data are available on firearm-related injuries in ECE settings.We sought to document existing regulations governing the presence and storage of firearms in ECE settings and the extent to which state regulations align with national standards.

Methods
Ethical approval was not required by the Johns Hopkins Bloomberg School of Public Health because human participants were not included in this regulations review.For this cross-sectional study, we reviewed ECE regulations for all 50 states, the District of Columbia, and the US territories (hereafter referred to as jurisdictions) through June 2019.We reviewed regulations for childcare centers (hereafter referred to as centers) and family childcare homes (hereafter referred to as homes), 2 primary types of ECE settings.Centers are typically located in dedicated buildings with more children and staff.Homes are most often located in the caregiver's own residence with fewer children and staff.We compared regulations with 3 firearm standards put forth by the American Academy of Pediatrics, the American Public Health Association, and the National Resource Center for Health and Safety in Child Care and Early Education, including no firearms within the premises; if firearms are present they should be unloaded, equipped with protective devices, kept under lock and key, and stored separately from ammunition; and parents should be notified if firearms are on the premises. 6o independent coders documented state regulations obtained from a US Department of Health and Human Services database.

Results
Thirty-three jurisdictions had regulations prohibiting firearms on the premises for centers (Table 1), but only 7 jurisdictions prohibited firearms for homes (Table 2).Instead, many jurisdictions had regulations governing firearm storage in homes.Few jurisdictions had regulations requiring that parents be notified of firearms on the premises (2 jurisdictions for centers and 8 jurisdictions for

Discussion
Although most jurisdictions did not allow firearms on the premises in centers, this was not the case for homes.Instead, these ECE settings had some regulations governing the safe storage of firearms.
Despite this, most jurisdictions did not require ECE staff to notify parents if firearms were present, which could undermine parents' ability to make informed decisions about childcare.Owners of family childcare homes, however, may own firearms for perceived safety reasons, which is a right that may be protected under the Second Amendment to the US Constitution.Additionally, nearly one-quarter of jurisdictions (13 jurisdictions) did not have any regulations governing firearms in ECE centers, and one-sixth (9 jurisdictions) did not have such regulations for homes.This raises concerns about the potential for firearm-related injuries in young children in these ECE settings.
This study has limitations.We assessed the existence but not enforcement of regulations.We also did not compare jurisdictions with CAP or other laws governing firearms with those with ECE regulations.Jurisdictions may have CAP or other laws 4 that would apply to family childcare homes as both a home-based business and a residence.Thus, jurisdictions may not reiterate CAP or other laws in their ECE regulations.Having ECE regulations could benefit both families and communities, including medical care practitioners who deal with the aftermath of firearm-related injuries.
Therefore, we recommend that US jurisdictions consider promulgating or strengthening regulations related to firearms to align with national standards.

Table 2 .
State Regulations Consistent With National Firearm Standards for Family Childcare Homes Through June 2019 Thirteen jurisdictions did not have any regulations related to firearms for centers, and 9 jurisdictions did not have any for homes.