Evaluation of Safe Firearm Storage Messaging in a Sample of Firearm-Owning US Military Service Members

Project Safe Guard: Challenges and opportunities of a universal rollout of peer-delivered lethal means safety counseling at a US military installation

INTRODUCTION

The US Department of Defense recommends lethal means safety counseling (LMSC) to promote firearm injury prevention via secure storage of personal firearms. We describe the rollout of a universal, peer-delivered adaptation of Project Safe Guard (PSG)-a brief, single-session LMSC discussion-at a US Space Force installation.

METHOD

Program evaluation data were collected via anonymous, voluntary, and online surveys. Of approximately 862 eligible active-duty service members and embedded civilians, 324 completed the preprogram survey and 68 and 37 completed the 1- and 2-month follow-ups, respectively.

RESULTS

At preprogram, 69.1% agreed that peer-delivered LMSC is appropriate. After rollout, 100% of the 222 firearm locking devices available to service members were requested from the on-base Violence Prevention Integrator. The effectiveness of PSG was indeterminable due to the low survey response rates.

CONCLUSIONS

Despite strong preprogram support for peer-delivered LMSC and behavioral indicators of secure firearm storage (e.g., firearm locking device requests), several challenges limited the uptake and evaluability of the PSG program in this naturalistic environment, including military survey fatigue and competing mission priorities. Additional work is needed to determine the effectiveness of peer-delivered LMSC in a military context. Sustained base support and military-civilian collaborations will be critical.

Determining who military service members deem credible to discuss firearm safety for suicide prevention

OBJECTIVES

To examine rankings of credible sources for discussing secure storage within a representative sample of firearm-owning service members, and examine how combinations of demographic variables impact the ranking of credible sources.

METHODS

The probability-based sample was collected with the help of Ipsos. Participants were US service members who owned a firearm at the time of the survey (n = 719).

RESULTS

The total sample ranked service members, Veterans, and members of law enforcement as the most credible sources and faith leaders, casual acquittances, and celebrities as the least credible sources. Black men ranked the NRA as a highly credible source whereas Black females ranked the NRA as one of the least preferred sources. Regardless of political preference, those who lived in non-metropolitan rural environments ranked members of law enforcement as highly credible sources. Those who lived in non-metropolitan rural and urban settings and identified as liberal ranked the National Shooting Sports Foundation as a highly credible source.

CONCLUSIONS

Law enforcement officers, military members, and Veterans are ranked as highly credible sources by most subgroups of firearm-owning service members. Leveraging these voices in firearm safety conversations is necessary, may increase adherence to secure storage recommendations, and ultimately reduce suicide.

Promoting Firearm Injury Prevention and Advocacy as Pediatric Surgeons: A Call to Action From the APSA/AAP Advocacy Committee

Firearm injuries have become the leading cause of death among American children. Here we review the scope of the problem, and the pivotal role pediatric surgeons have in preventing pediatric firearm injury. Specific methods for screening and counseling are reviewed, as well as how to overcome barriers. Community and hospital resources as well as organizational efforts are discussed. Finally, a path for surgeon advocacy is outlined as is a call to action for the pediatric surgeon, as we are uniquely poised to identify pediatric patients and deliver timely interventions to reduce the impact of firearm violence. LEVEL OF EVIDENCE: Level IV.

Firearm leadership: Development, analysis, and application of a novel concept to message secure storage of firearms in the military

Suicide remains a leading cause of death in the United States (U.S.) Armed Forces. Access to firearms increases the risk of death by suicide due to the high lethality of firearm-related injuries (~90% in suicide attempts) and the highly dynamic nature of suicide which includes rapid change from low- to high-risk states. Critical gaps remain in research, programming, and communication amongst scientists, Department of Defense (DoD) programmatic leaders, front-line commanders, and service members. To enhance communication and coordination, in June 2022, the first-ever national "Firearm Suicide Prevention in the Military: Messaging and Interventions Summit" was held, with discussion of Firearm Leadership, a concept that emphasizes the importance of communication about lethal means safety (LMS) among military leaders and service members. Through a discussion of scientific literature, the points identified during the Summit, as well as presenting illustrative case examples derived from suicide death reviews, we aim to provide a conceptual model for the benefits of Firearm Leadership and how some barriers can be overcome. Following the Summit, further discussions on "Firearm Leadership" led to the development of a Firearm Leadership Factsheet.

Law enforcement and firearms: understanding firearm ownership and storage habits

OBJECTIVE

This study seeks to better understand firearm ownership among law enforcement officers (LEO), with the goal of informing future firearm injury and suicide prevention efforts. We describe the frequency and sociodemographic correlates of firearm ownership and storage practices among, and examine the association between suicidal ideation and current firearm storage practices.

METHODS

The present study used data from a large online study (n=6410) and included data from individuals who were currently or previously being employed as an LEO (n=369; M (SD) age=39.2 y (15.8 y), 75.2% male, 66.7% white). Self-report measures were used to assess for firearm ownership, storage habits and suicidal ideation. Descriptive statistics were used to describe the frequency of firearm ownership and logistic regressions were used to examine the extent to which demographic characteristics and suicidal ideation were associated with firearm ownership.

RESULTS

Overall, 70.5% (n=261) of the sample reported firearm ownership. LEO who were older had significantly lower odds of reporting firearm ownership. Those who were married and those who reported lifetime suicidal ideation had significantly greater odds of reporting firearm ownership. Whereas firearm-owning LEO who reporting storing a firearm locked had significantly lower odds of reporting lifetime suicidal ideation, those who reported storing a firearm unloaded had significantly greater odds of reporting lifetime suicidal ideation.

CONCLUSION

Findings have important public health implications and can be used to increase adherence with secure storage recommendations. Increasing secure storage may help reduce suicide risk among LEO, a sample at heightened risk for suicide.

Emergency medical services (EMS) clinicians' views on EMS-delivered interventions to promote secure firearm storage practices

INTRODUCTION

Lethal means safety counseling (LMSC) to promote secure firearm storage may reduce the risk of firearm-involved deaths, including suicide. We examined if emergency medical services (EMS) clinicians, including emergency medical technicians and paramedics, may be suitable LMSC messengers.

METHOD

We conducted a web-based survey of 229 US EMS clinicians.

RESULTS

While few EMS clinicians supported EMS-delivered LMSC to all patients (17.0%), most supported EMS-delivered LMSC to patients in an acute suicidal crisis (64.2%) or with a known suicide attempt history (55.9%). Barriers to EMS-delivered LMSC included lack of training (73.4%), perceptions that LMSC is outside EMS clinicians' scope of practice (58.1%), and lack of standard operating procedures (56.3%). Most reported at least some interest in receiving training on EMS-delivered LMSC (67.7%). Participants holding more accurate beliefs about the link between firearm storage practices and suicide risk, as well as the efficacy of LMSC, were more likely to support EMS-delivered LMSC across patient scenarios (ORs = 2.18-5.21, ps <0.01) and express interest in receiving LMSC training (ORs = 3.78-5.43, ps <0.001).

CONCLUSION

Given that many EMS clinicians interface with patients at elevated suicide risk, targeted LMSC training may be strategic; however, research is needed to determine if and how EMS clinicians might be viable LMSC messengers.

Locked and loaded: correlates of in-home firearm storage beliefs and behaviours

OBJECTIVES

To understand how crime and victimisation fears and risks operate alongside social status threats and motivations to shape unsafe in-home firearm storage practices and beliefs.

METHODS

Using data from firearm owners identified in a nationwide sample surveyed in 2023, this study examined how in-home loaded firearm accessibility, firearm storage practice and firearm safety beliefs are associated with: fear of crime and victimisation; perceived and personal victimisation; racial resentment; cultural and status threats; and masculinity threats. Regression models also accounted for the role of gender, race, marital status, political affiliation, geographic region and protective motivation for firearm ownership.

RESULTS

Over 40% of firearm owners reported having a loaded firearm 'always accessible' at home, and almost half think homes with firearms are safer than those without. About one-third of owners reported storing firearms locked but still loaded. Crime and victimisation fears and threats were unrelated to firearm storage behaviours and beliefs; however, firearm owners who experience higher levels of sociocultural anxiety are more likely to always have a loaded firearm accessible at home, store firearms locked and loaded, and believe that firearms make homes safer.

CONCLUSIONS

Identifying the barriers to safer storage beliefs and behaviours is essential for refining and enhancing effective firearm injury prevention strategies. Sociocultural anxieties may not reflect concrete threats to physical safety, but they can be experienced as feelings of insecurity, instability and distress that-for some Americans-may be managed by knowing they have a (loaded) firearm within reach.

Perceptions of the utility of secure firearm storage methods as a suicide prevention tool among firearm owners who currently store their firearms loaded and unlocked

BACKGROUND

Although secure firearm storage can prevent firearm injury and death, secure storage is relatively rare. This tendency may be driven in part by a perceived lack of utility for secure storage in preventing suicide and other gun violence-related outcomes.

METHOD

We recruited a large (n = 3510) representative sample of residents from five US states and assessed the degree to which those who do and do not store their firearms securely perceive different utility in specific firearm storage practices for suicide prevention. To test for specificity, we examined if those differences hold when considering unintentional shooting and firearm theft prevention.

RESULTS

Those who currently store their firearms unsecured reported lower perceived utility in several firearm storage practices, particularly for suicide and theft prevention.

CONCLUSIONS

Our findings highlight that a lack of perceived utility in secure firearm storage may partially drive unsecure firearm storage. Efforts to promote secure storage must address this misperception.

Regional differences in firearm ownership, storage and use: results from a representative survey of five US states

BACKGROUND

Firearm access and storage practices influence risk for injury and death; however, prior research has considered only national and regional differences on these variables, overlooking state-level differences.

OBJECTIVES

To analyse and describe statewide differences in firearm ownership, storage and use in a representative sample of five US states.

DESIGN

Variables were assessed via an online self-report survey administered between 29 April 2022 and 15 May 2022.

SETTING

Surveys were completed online.

PARTICIPANTS

Participants (n=3510) were members of knowledge panel, a probability-based sample recruited to be representative of US adults. All participants were aged 18+ and resided in one of five states: Colorado, Minnesota, Mississippi, New Jersey or Texas.

MEASUREMENTS

We used χ2 tests to examine state differences in firearm ownership, childhood firearm experiences and purchasing. A series of analyses of covariance were then used to assess differences in firearm storage, firearms owned and carrying behaviours while adjusting for pertinent demographic characteristics.

RESULTS

We found significant differences in firearm ownership across states. There were significantly more first-time firearm purchasers during the firearm purchasing surge in New Jersey. Both Mississippi and Texas have elevated rates of unsecure storage practices and firearm carrying outside of the home.

LIMITATIONS

Results are cross-sectional and self-report. Findings may not generalise beyond the five states assessed in this survey.

CONCLUSIONS

Public health messaging around firearm safety should account for differences in key firearm behaviours related to ownership, storage and use to ensure effective communication and reduce the risk of gun injury and death across states.

'Whether it's your weapon or not, it's your home': US military spouse perspectives on personal firearm storage

INTRODUCTION

In the USA, an estimated 45% of veterans personally own firearms. Firearm access increases the risk of suicide, so suicide prevention efforts in the US Department of Defense (DoD) focus on lethal means safety, including reducing firearm access. Spouse input may enhance effective messaging and intervention delivery of lethal means safety. This study used qualitative methods to explore the perspectives of military spouses or partners on personal firearm storage, including at-home decisions, on-base storage and existing messaging from the DoD.

MATERIALS AND METHODS

Qualitative data were obtained using 1:1 interviews and focus groups with spouses/partners of US military service members (active duty, Reserve, National Guard, recently separated from the military) and representatives from military support organisations. Sessions focused on personal firearm storage (at home or on military installations) and military messaging around secure firearm storage and firearm suicide prevention. Data were analysed using a team-based, mixed deductive-inductive approach.

RESULTS

Across 56 participants (August 2022-March 2023), the themes were variability in current home firearm storage and spousal participation in decision-making; uncertainty about firearm storage protocols on military installations; mixed awareness of secure firearm storage messaging from the military; and uncertainty about procedures or protocols for removing firearm access for an at-risk person.

CONCLUSION

US military spouses are important messengers for firearm safety and suicide prevention, but they are currently underutilised. Tailored prevention campaigns should consider spousal dynamics and incorporate education about installation procedures.

Loneliness and firearm acquisition among low-income U.S. veterans: Findings from the National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study

RATIONALE

There are theoretical reasons to expect loneliness related to firearm purchasing. For instance, loneliness might amplify social isolation and feelings of insecurity, anxiety, perceived danger, and need for self-reliance. Purchasing a firearm might be seen as a way to bolster one's security and gain a sense of control when faced with potential threats, yet there is a lack of research assessing this possibility.

OBJECTIVE

This study aimed to examine the relationship between loneliness and purchasing a firearm among a sample of low-income U.S. military veterans.

METHODS

Data are from a national survey of 1,004 low-income U.S. veterans collected in December 2022 and January 2023. Firth logistic regression-a rare event logistic regression model to address small-sample bias stemming from rare outcomes through a penalized likelihood approach-was used to estimate the adjusted association between loneliness and purchasing a firearm in the past year.

RESULTS

Approximately 5.4% reported the purchase of a new firearm in the past year, and respondents reported an average loneliness score of 1.82 (standard deviation = 1.96; range = 0-6). Results of Firth Logit regression analyses found that net of control variables for demographic, socioeconomic, and household characteristics, loneliness was positively associated with purchasing a firearm in the past year (OR = 1.167, 95% CI = 1.006, 1.352).

CONCLUSION

The findings indicate that loneliness among U.S. military veterans is associated with firearm purchasing. Considering the risks posed by both loneliness and firearm ownership for veteran suicide, the findings suggest the need for greater focus and synergistic strategies to address loneliness and safe firearm practices among U.S. veterans.

Effect of a Gun Safety Video on Children's Behavior Around Real Guns: A Randomized Clinical Trial

Importance

Firearms are the leading cause of death for children in the US. It is therefore crucial to identify effective ways to reduce firearm injuries among children.

Objective

To test the effectiveness of a gun safety video vs a car safety video on decreasing unsafe behaviors around real guns after exposure to a violent movie with vs without guns.

Design, Setting, and Participants

Of 245 participants aged 8 to 12 years, 226 were tested (13 did not complete the laboratory portion, 4 had technical problems, and 2 did not respond to follow-up inquiries). Data were collected from February 2 to October 16, 2022. Participants were recruited via Facebook ads, ResearchMatch, and parent or guardian referrals. The study was conducted in 2 parts. Children watched a safety video at home 1 week before coming to the laboratory at The Ohio State University.

Interventions

Pairs of children were randomly assigned to watch a 1-minute gun or car safety video at home. In the laboratory, they were randomly assigned to watch a 20-minute clip from a violent PG-rated movie with or without guns. Next, they played with games and toys for 20 minutes in another room that contained 2 disabled 9-mm handguns hidden in a file cabinet drawer. Sessions were videotaped via a hidden camera.

Main Outcomes and Measures

Outcomes were whether children told an adult, touched a handgun, handled it, or pulled the trigger. Control variables were age, gender, race and ethnicity, trait aggressiveness, age-inappropriate media exposure, firearm attitude and interest, presence of firearms at home, and whether children had taken a firearm safety course.

Results

Of 226 children (mean [SD] age, 9.99 [1.38] years; 113 [52.3%] male), 216 (95.6%) found a gun and were included in analyses. Those who saw the gun (vs car) safety video were more likely to tell an adult about the gun they found (38 of 112 [33.9%] vs 11 of 104 [10.6%]), were less likely to touch the gun (44 of 112 [39.3%] vs 70 of 104 [67.3%]), held the gun fewer seconds if they did touch it (mean [SD], 42.04 [121.46] vs 98.96 [195.10]), were less likely to pull the trigger at all (10 of 112 [8.9%] vs 31 of 104 [29.8%]), and pulled the trigger fewer times (mean [SD], 4.20 [20.17] vs 7.23 [15.75]). Being male, exposure to age-inappropriate movies, and gun interest were related to unsafe behavior. Prior completion of a firearm safety course, having guns at home, and negative gun attitudes were related to safe behavior.

Conclusions

In this trial of children assigned to watch a gun or car safety video, watching a gun safety video reduced children's unsafe behavior around real guns. Children who had previously taken a gun safety course, had guns in the home, and had negative attitudes toward guns were less likely to engage in unsafe behavior around real guns. To encourage safe firearm behavior, children should be educated about gun safety and should not watch age-inappropriate media.

Trial Registration

ClinicalTrials.gov Identifier: NCT05257837.

Assessment of Firearm Storage Practices in the US, 2022

IMPORTANCE

Secure firearm storage may help reduce firearm injury and death. Broad implementation requires more granular assessments of firearm storage practices and greater clarity on circumstances that may prevent or promote the use of locking devices.

OBJECTIVE

To develop a more thorough understanding of firearm storage practices, obstacles to using locking devices, and circumstances in which firearm owners would consider locking unsecured firearms.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional, nationally representative survey of adults residing in 5 US states who owned firearms was administered online between July 28 and August 8, 2022. Participants were recruited via probability-based sampling.

MAIN OUTCOMES AND MEASURES

Firearm storage practices were assessed via a matrix provided to participants in which firearm-locking devices were described both via text and images. Locking mechanisms (key/personal identification number [PIN]/dial vs biometric) were specified for each type of device. Obstacles to the use of locking devices and circumstances in which firearm owners would consider locking unsecured firearms were assessed via self-report items developed by the study team.

RESULTS

The final weighted sample included 2152 adult (aged ≥18 years), English-speaking firearm owners residing in the US; the sample was predominantly male (66.7%). Among the 2152 firearm owners, 58.3% (95% CI, 55.9%-60.6%) reported storing at least 1 firearm unlocked and hidden, with 17.9% (95% CI, 16.2%-19.8%) reporting storing at least 1 firearm unlocked and unhidden. Gun safes were the most frequently used device both among participants who use keyed/PIN/dial locking mechanisms (32.4%; 95% CI, 30.2%-34.7%) and those who use biometric locking mechanisms (15.6%; 95% CI, 13.9%-17.5%). Those who do not store firearms locked most frequently noted a belief that locks are unnecessary (49.3%; 95% CI, 45.5%-53.1%) and a fear that locks would prevent quick access in an emergency (44.8%; 95% CI, 41.1%-48.7%) as obstacles to lock usage. Preventing access by children was the most often reported circumstance in which firearm owners would consider locking unsecured firearms (48.5%; 95% CI, 45.6%-51.4%).

CONCLUSIONS AND RELEVANCE

In this survey study of 2152 firearm owners, consistent with prior research, unsecure firearm storage was common. Firearm owners appeared to prefer gun safes relative to cable locks and trigger locks, indicating that locking device distribution programs may not match firearm owners' preferences. Broad implementation of secure firearm storage may require addressing disproportionate fears of home intruders and increasing awareness of the risks associated with household firearm access. Furthermore, implementation efforts may hinge on broader awareness of the risks of ready firearm access beyond unauthorized access by children.