Evaluation of the United States' Permitless Concealed Carry Laws and Child Health in the ECHO Cohort

Firearms are the leading cause of death among children in the United States (US). As of 2023, half of US states had enacted laws allowing permitless concealed carry of firearms. Our cross-sectional study evaluated the association between permitless concealed carry laws and child general health using data from the nationwide Environmental influences on Child Health Outcomes (ECHO) Cohort collected between 2003 and 2023. Children aged 1-21 years with caregiver- or self-reported general health status were included. Secondary outcomes included child internalizing and externalizing behaviors and child stress. Regression models estimated the association of exposure to state-level permitless concealed carry laws six months prior to each outcome, adjusted for individual- and area-level covariates. One-fifth (20.9%) of the sample (n = 11,325) lived in states allowing permitless concealed carry of a handgun. Children living in these states were 25% less likely (OR: 0.75, 95% CI: 0.60, 0.95) to report excellent/very good general health and had psychological stress scores 0.21 standard deviations higher (β = 0.21, 95% CI: 0.10, 0.31) than children in other states. There was no statistically significant association with internalizing or externalizing behavior scores. Our study found that children living in states that allow permitless concealed carry of firearms had worse general health and higher stress, suggesting the need for policy changes to address gun violence as a public health and human rights crisis.