suicide rates, as efforts in other nations including Japan and Great Britain have shown. He discussed research findings on firearm access and suicide, cross-national data, and issues of data collection.

Dr. Hemenway explained that the U.S. has the highest rate of firearm suicide of all 27 developed nations, whereas we have the 16^th highest rate of suicide. Over 50 percent of all suicides are by firearm in the U.S., according to Dr. Hemenway. Some reasons for the high firearm suicide rate according to Dr. Hemenway are the high number of handguns and less regulation of firearms than in other developed nations. The U.S. lacks a national licensing or registration system, and there are no national storage laws. There is also a large secondary market of gun sales.

Dr. Hemenway pointed out that one problem in doing cross-national studies is that there is a lack of good measures, especially of gun prevalence. One report he described looked at 5–14 year olds in the U.S. and compared their suicide rate with that of other industrialized countries. Easy accessibility of guns was found to be a risk factor for suicides in the U.S., compared to other countries.

Dr. Hemenway discussed data from two types of studies, case-controlled and ecological studies. The case-controlled studies on gun prevalence and suicide risk have revealed significant increases in suicide in homes with guns, even when other factors such as education, arrests, and drug abuse were controlled for. Dr. Hemenway and the workshop participants discussed criticisms of these studies made by other researchers in the field. Case-controlled studies have been criticized for not looking at all suicides, just those occurring in the home. Workshop participants qualified this criticism, explaining that this was true of the largest study done by Kellerman and colleagues, but not of other studies done by Brent and colleagues. Another criticism is that the respondents are not telling the truth. Another criticism is that the respondents are not telling the truth. Dr. Hemenway described a survey study done by Kellerman and colleagues, finding that people do tell the truth, but indicated that this research was not definitive. There is some evidence that women underreport the presence of a gun in the home. Dr. Hemenway described a study of an HMO population in Seattle, that found 25% of the suicides had purchased a handgun from a licensed dealer in the state of Washington, as compared to only 15% of controls (those who did not commit suicide).

Front Matter (R1-R12)

Introduction & Design Choices and Analytical Strategies for Population-Based Programs: Implications for Suicide Prevention (1-3)

A Systems Approach to Youth Suicide Prevention (4-7)

Suicide Contagen (8-9)

Cognitive Approaches to Suicide (10-12)

Research and Usual Care Prevention Efforts Across Psychiatric Diagnoses (13-14)

The Role of the Primary Care Physician in Preventing Suicide (15-16)

Firearm Availability and Suicide (17-20)

Appendix A: Agenda (21-22)

Appendix B: Workshop Speakers (23-24)