Community based program to improve firearm storage practices in rural Alaska

Evaluation of a Firearm Safe Storage Device Distribution Program at a Break the Cycle of Violence Summit

This study assesses the feasibility and acceptability of a Firearm Safe Storage Device Distribution Program. The distribution took place at the Break the Cycle of Violence Summit hosted by the Johns Hopkins Medicine, the Break the Cycle Hospital Violence Intervention Program, and the Johns Hopkins Bloomberg School of Public Health Center for Gun Violence Solutions. The findings will guide future efforts to distribute safe storage devices in clinical settings. Attendees of the Break the Cycle of Violence Summit could choose from three types of safe storage devices to provide to their patients within their practice. Those attendees who participated were asked to participate in an electronic survey to assess the feasibility and acceptability of the safe firearm storage device distribution at the Summit. 24 participants received safe storage devices at the Break the Cycle of Violence Summit. Of the 24 participants, 15 participated in our evaluation. 86% of participants distributed most of the devices by the time of the survey and 57% of participants stated that by having safe storage devices to distribute, they were more likely to provide safe gun storage counseling. All participants would like to see continued safe gun storage distribution programs in their community. The provision of free safe storage devices allowed for open conversations about firearms and safe storage with patients and clients. This study can be used as a model to guide future efforts in safe storage device distribution in a hospital or clinic-based setting and showed feasibility, effectiveness, and efficacy.

Storage Practices, Devices, and Presence of Children Among Owners of Firearms: Informing Pediatric Firearm Safety

BACKGROUND

Firearm injury is the leading cause of death in children and prevention is the most effective method to reduce severe morbidity and mortality. Injury prevention programs have used community firearm lock giveaway events to promote safe firearm storage practices. The locks are generally simple and inexpensive devices suitable for mass distribution but may not possess the owner-desired attributes for use in the home. Because data on owner preferences for firearm lock type is lacking, we conducted a community survey to inform firearm safety outreach efforts.

METHODS

We performed an anonymous cross-sectional survey at a large community fair. We elicited responses regarding reasons for firearm ownership, current storage practices, and preferences for firearm storage devices. Participants were offered a choice of a free trigger lock or cable lock and education on its use.

RESULTS

Two-hundred and sixty-seven of 394 (67.7%) respondents reported firearm ownership, with 64.8% reporting children in the home regularly. Most (60.7%) owned handguns and cited personal protection as the main reason for ownership (88.4%). The ability to store the firearm loaded and the need for rapid access were identified as the main storage considerations. Respondents preferred trigger locks over cable locks at a rate of almost 2:1.

CONCLUSIONS

The majority of firearm owners had handguns for self-defense. Owners preferred simple locking mechanisms that allowed the firearm to remain loaded. The pragmatic pediatric injury prevention program will include firearm owners' preferences when considering which lock to purchase and distribute during firearm injury prevention programs.

LEVEL OF EVIDENCE

IV, Epidemiological.

When safe firearm storage isn't enough: Examining risk profiles among firearm suicide decedents

INTRODUCTION

Suicide is a leading cause of death in the United States, and firearms are the most frequently used suicide method. Research suggests risk for firearm suicide increases with greater access to firearms (e.g., storing loaded or unlocked). Although safe firearm storage is promoted as a means of risk reduction, no studies have explored factors differentiating firearm suicide decedents who stored firearms safely vs. those who stored unsafely prior to death.

METHODS

Utilizing data from the National Violent Death Reporting System, the current study aimed to determine which factors distinguish firearm suicide decedents who stored firearms safely vs. those who stored unsafely. The current sample included decedents for whom data were available on whether the firearm used in the suicide was stored loaded or unloaded (n = 4269) and unlocked or locked (n = 6273) prior to their death.

RESULTS

Results revealed using a long gun in the suicide (as opposed to a handgun) was associated with five times greater odds of storing unloaded prior to death, suggesting this safe firearm storage practice alone does not mitigate risk among all long gun owners.

CONCLUSION

These findings indicate a need to increase suicide prevention efforts within the long gun owning community.

Firearm locking device preferences among firearm owners in the USA: a systematic review

BACKGROUND

Preventing firearm-involved injuries is a critical public health priority. Firearm locking devices can prevent firearm injuries, such as suicide and unintentional shootings, as well as theft. Various firearm locking devices exist; however, little is known about firearm owners' preferred locking devices for secure firearm storage. In this systematic review, we examined existing literature on preferred locking devices for secure storage of personal firearms among United States (US) firearm owners with the purpose of understanding practical implications and needs for future research.

METHODS

We searched 8 major databases, as well as the grey literature, for English-language sources published on or before January 24, 2023, that empirically examined firearm locking device preferences. Following PRISMA guidelines, coders independently screened and reviewed 797 sources using pre-determined criteria. Overall, 38 records met inclusion criteria and were included in this review.

RESULTS

The majority of studies measure and report on participant use of various types of locking devices, but few go on to measure preference between device options and the attributes and features that may contribute to an individual's preference. Included studies suggest that a preference for larger devices, such as lockboxes and gun safes, may exist among US firearm owners.

CONCLUSIONS

Review of included studies suggests that current prevention efforts may not be aligned with firearm owners' preferences. Additionally, findings from this systematic review emphasize the need for additional methodological rigorous research to understand firearm locking device preferences. Expanded knowledge in this area will result in actionable data and foundational best practices for programming that encourages behavior change concerning secure storage of personal firearms to prevent injury and death.

Firearm-Related Injuries and Deaths in Children and Youth

Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States. In 2020, firearms resulted in 10,197 deaths (fatality rate 9.91/100,000 youth 0-24 years old). Firearms are the leading mechanism of death in pediatric suicides and homicides. Increased access to firearms is associated with increased rates of firearm deaths. Substantial disparities in firearm injuries and deaths exist by age, gender, race, ethnicity, and sexual orientation and gender identity and for deaths related to legal intervention. Barriers to firearm access can decrease the risk to youth for firearm suicide, homicide, or unintentional shooting injury and death. Given the high lethality of firearms and the impulsivity associated with suicidal ideation, removing firearms from the home or securely storing them-referred to as lethal means restriction of firearms-is critical, especially for youth at risk for suicide. Primary care-, emergency department-, mental health-, hospital-, and community-based intervention programs can effectively screen and intervene for individuals at risk for harming themselves or others. The delivery of anticipatory guidance coupled with safety equipment provision improves firearm safer storage. Strong state-level firearm legislation is associated with decreased rates of firearm injuries and death. This includes legislation focused on comprehensive firearm licensing strategies and extreme risk protection order laws. A firm commitment to confront this public health crisis with a multipronged approach engaging all stakeholders, including individuals, families, clinicians, health systems, communities, public health advocates, firearm owners and nonowners, and policy makers, is essential to address the worsening firearm crisis facing US youth today.

Comparison of cost and resource utilization between firearm injuries and motor vehicle collisions at pediatric hospitals

BACKGROUND/OBJECTIVES

Firearm injuries are converging with motor vehicle collisions (MVC) as the number one cause of death for children in the United States. Thus we examine differences in hospital cost and hospital resource utilization between motor vehicle and firearm injury.

METHODS

This retrospective, cross-sectional study compares hospital costs and resource utilization of motor vehicle and firearm-injured children aged 0 to 19 years of age over a 5-year time frame (January 1, 2013-December 31, 2017) in 35 freestanding children's hospitals that submitted data to the Pediatric Health Information System. The primary outcome was hospital-adjusted comparative cost per patient presentation. Generalized linear mixed models were used to quantify the relationship between the type of injury and each outcome, adjusting for patient characteristics and hospital.

RESULTS

There were 89,133 emergency department (ED) visits attributed to MVCs and 3,235 for firearm injury. Of the youths who presented for firearm injury, 49% were hospitalized versus 14% of youths presenting with MVC (adjusted odds ratio [aOR] = 6.6, 95% confidence interval [CI] = 6.1 to 7.2). Youths with firearm injury were more likely to be admitted to an intensive care unit (aOR = 6.7, 95% CI = 5.9 to 7.7) and had longer lengths of stays (aOR = 2.2, 95% CI = 1.9 to 2.6) compared to their MVC counterparts. Children admitted for firearm injury had more imaging and ED return visits, along with subsequent inpatient admission within 3 days (aOR = 3.4, 95% CI = 2.1 to 5.5) and 1 year (aOR = 2.5, 95% CI = 2.1 to 2.9). The mean relative per-patient costs were nearly fivefold higher for the firearm-injured group.

CONCLUSIONS

Hospital costs and markers of resource utilization were higher for youths with firearm injury compared to MVC. High medical resource utilization is one of several important reasons to advocate for a comparable national focus and funding on firearm-related injury prevention.

Firearm-related injuries and deaths in Ontario, Canada, 2002-2016: a population-based study

BACKGROUND

Firearm-related injury is an important and preventable cause of death and disability. We describe the burden, baseline characteristics and regional rates of firearm-related injury and death in Ontario.

METHODS

We conducted a population-based cross-sectional study using linked data from health administrative data sets held at ICES. We identified residents of Ontario of all ages who were injured or died as a result of a firearm discharge between Apr. 1, 2002, and Dec. 31, 2016. We included injuries classified as assault, unintentional, self-harm or undetermined intent secondary to handguns, rifles, shotguns and larger firearms. The primary outcome was the incidence of nonfatal and fatal injuries resulting in an emergency department visit, hospital admission or death. We also describe regional and temporal rates.

RESULTS

We identified 6483 firearm-related injuries (annualized injury rate 3.54 per 100 000 population), of which 2723 (42.3%) were fatal. Assault accounted for 40.2% (1494/3715) of nonfatal injuries and 25.5% (694/2723) of deaths. Young men, predominantly in urban neighbourhoods, within the lowest income quintile were overrepresented in this group. Injuries secondary to self-harm accounted for 68.0% (1366/2009) of injuries and occurred predominantly in older men living in rural Ontario across all income quintiles. The case fatality rate of injuries secondary to self-harm was 91.7%. Self-harm accounted for 1842 deaths (67.6%).

INTERPRETATION

We found that young urban men were most likely to be injured in firearm-related assaults and that more than two-thirds of self-harm-related injuries occurred in older rural-dwelling men, most of whom died from their injuries. This highlights a need for suicide-prevention strategies in rural areas targeted at men aged 45 or older.

Keeping Children Safe at Home: Parent Perspectives to Firearms Safety Education Delivered by Pediatric Providers

OBJECTIVES

The aims of this study were to assess parent acceptance of firearms education delivered by clinical providers, determine whether parents engage in firearms safety dialog with their children, and evaluate reasons for ownership and storage behaviors.

METHODS

The parents of children ages 0 to 18 years completed surveys while in a pediatric inpatient setting in Texas. Demographics, acceptability, current behaviors, and storage practices were queried. Responses between firearms owners and nonowners were analyzed using the Fisher exact and χ² tests.

RESULTS

Of the 115 parents who completed surveys, 41% reported owning firearms. Most parents were likely or highly likely to follow their pediatrician's gun safety advice (67%), were accepting of safety videos in waiting rooms (59%), and accepted firearms locks distributed by clinical providers (69%). Nonowners were less likely than owners to have spoken to their children about gun safety (P = 0.004). Parents owned firearms for self-protection and recreation (50%), self-protection only (38%), or recreation only (12%). Owners stored them unloaded (75%), used safety devices (95%), and stored them in the closet of the master bedroom (54%).

CONCLUSIONS

Talking about firearms safety in a healthcare setting was not a contentious issue in the majority of our sample. Parents were accepting of provider-led firearms guidance regardless of ownership status. This provides an opportunity for providers to focus on effective messaging and time-efficient delivery of firearms safety education.

Preferences for Firearm Locking Devices and Device Features Among Participants in a Firearm Safety Event

Introduction

Safe firearm storage is associated with a lower risk of firearm-related injury and death. Although providing firearm locking devices is a key component of firearm safety interventions, little is known about the types and characteristics of devices preferred by firearm users or others who make decisions about firearm storage. The aim of this study was to describe preferences for firearm locking devices and device features among firearm safety event participants.

Methods

We conducted a cross-sectional survey in the State of Washington in 2016 that assessed participants’ preferences for five firearm locking devices (eg, trigger lock) and seven device features (eg, quick access). We categorized respondents (n=401) as adults in households with 1) all firearms locked, 2) at least one unlocked firearm, and 3) no firearms. We analyzed data in 2017.

Results

Device ownership and feature preferences varied substantially but were similar across the three household categories. Of those residing with unlocked firearms, 84% reported they would consider using or definitely use a lock box, whereas 11% reported they would never use a trigger lock. Additionally, of those residing with unlocked firearms, 80% and 89% reported that the ability to lock a firearm while loaded and unlock it quickly were, respectively, “very important” or “absolutely essential.”

Conclusion

Participants had differing preferences for firearm locking devices and device features, although preferences were largely similar across households with locked, unlocked, or no firearms. At least eight in ten participants reported “great importance” regarding the ability to lock a firearm while loaded and unlock it quickly, which is likely related to perceptions about the utility of safely stored firearms for household protection. Designing firearm safety interventions to match the needs and preferences of those who make firearm storage decisions may improve their effectiveness.

Acceptability and Use of Evidence-Based Practices for Firearm Storage in Pediatric Primary Care

OBJECTIVE

Promoting safe firearm storage in pediatric primary care is one way to address youth suicide by firearm. The study objective was to determine the perspectives of primary care physicians (PCPs) and leaders of primary care practices regarding the acceptability and use of screening, counseling, and firearm locks-all components of an adapted evidence-based intervention known as the Firearm Safety Check.

METHODS

In 2016, an online survey was conducted in two large US health systems. PCPs (n = 204) and leaders (n = 57) from 83 clinics were invited to participate. Respondents included 71 clinics (86%), 103 PCPs (50%), and 40 leaders (70%). Main outcomes included acceptability (6-point Likert scale, with higher scores indicating better acceptability) and use of the 3 intervention components (4-point Likert scale, with higher scores indicating greater use), as measured by an adapted validated instrument.

RESULTS

Analyses were conducted in 2017. PCP acceptability of screening (mean = 4.28; standard deviation [SD] = 1.12) and counseling (mean = 4.56; SD = 0.89) were high, but acceptability for firearm lock provision was more neutral (mean = 3.78; SD = 1.16). Most PCPs endorsed sometimes screening (85%) and counseling (80%). Few PCPs offered firearm locks to caregivers (15%). Leaders reported consistent information.

CONCLUSION

The acceptability of screening for firearms and safe storage counseling was high; both components were used commonly but not routinely. The acceptability of providing firearm locks was neutral, and use was rarely endorsed. This study provides important insights about areas of focus for future implementation efforts from policy and research perspectives.

Firearm Storage Practices Among American Veterans

INTRODUCTION

Interventions that reduce access to highly lethal and commonly used methods of suicide (e.g., limiting firearm access) are considered essential elements of effective suicide prevention programs. Scant epidemiologic data are available to inform such efforts among Veterans. The aim of this study is to describe firearm storage practices and correlates of those practices among a nationally representative sample of U.S. Veteran firearm owners.

METHODS

The authors used a probability-based online survey of Veteran firearm owners in 2015 (data analyzed in 2017; 54.6% response rate). The primary outcome was firearm storage practices. Additional items assessed individual and household-level sociodemographic characteristics, firearm-related characteristics, and risk perceptions related to firearm ownership.

RESULTS

One in three (33.3%, 95% CI=28.6%, 38.4%) Veteran firearm owners stores at least one firearm loaded and unlocked. The prevalence of this practice ranges substantially (9%-65%) across individual, household, and firearm ownership characteristics, and is strongly related to other firearm-related behaviors (e.g., carrying handguns); reasons for firearm ownership (e.g., protection versus other); number of firearms owned; and perceptions about the utility of guns stored safely and whether guns make homes safer.

CONCLUSIONS

Storing a firearm loaded and unlocked is common among Veterans. Storage practices are strongly related to reasons for ownership and potentially malleable perceptions including beliefs about firearm-related risks. Suicide prevention initiatives among Veterans should incorporate communication strategies that address common misperceptions about household firearm risk and whether safe storage practices may better align with reasons most Veterans own firearms (i.e., safety)-especially when someone in their home is at increased risk for suicide.

Evaluation of a community-based safe firearm and ammunition storage intervention

BACKGROUND

Safe firearm storage practices are associated with a lower risk of unintentional and self-inflicted firearm injuries among household members, though many firearms remain unlocked and/or loaded.

OBJECTIVES

Conduct a preliminary evaluation of a community-based firearm safety intervention and assess participants' preferences for firearm locking devices and their comfort with potential firearm safety counsellors.

DESIGN/METHODS

Baseline event and follow-up surveys among adult participants to assess changes in firearm storage practices, including whether all household firearms were stored locked, all were unloaded, all ammunition was locked, and a composite measure assessing whether all firearms were locked and unloaded and all ammunition was stored locked.

RESULTS

A total of 206 out of 415 participants completed both surveys and were included. Nearly 9 in 10 respondents preferred the firearm lock box rather than a trigger lock. At follow-up, a significantly greater proportion reported that all household firearms were locked (+13.7%) and unloaded (+8.5%) and a non-significantly greater proportion reported that all ammunition was locked (+6.3%). A significantly greater proportion reported practising all three safe firearm and ammunition storage practices at follow-up (+12.6%). A majority reported they would be comfortable or very comfortable discussing firearm safety with various safety counsellors, though women were less likely to do so than men.

CONCLUSION

This intervention that included distribution of a free, participant-selected locking device improved safe firearm storage practices among participants. Differences in participant preferences for devices and safety counsellors suggest that a 'one size fits all' approach may be inadequate in affecting population-level storage practices.

Effectiveness of Interventions to Promote Safe Firearm Storage

Despite supportive evidence for an association between safe firearm storage and lower risk of firearm injury, the effectiveness of interventions that promote such practices remains unclear. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, we conducted a systematic review of randomized and quasi-experimental controlled studies of safe firearm storage interventions using a prespecified search of 9 electronic databases with no restrictions on language, year, or location from inception through May 27, 2015. Study selection and data extraction were independently performed by 2 investigators. The Cochrane Collaboration's domain-specific tool for assessing risk of bias was used to evaluate the quality of included studies. Seven clinic- and community-based studies published in 2000-2012 using counseling with or without safety device provision met the inclusion criteria. All 3 studies that provided a safety device significantly improved firearm storage practices, while 3 of 4 studies that provided no safety device failed to show an effect. Heterogeneity of studies precluded conducting a meta-analysis. We discuss methodological considerations, gaps in the literature, and recommendations for conducting future studies. Although additional studies are needed, the totality of evidence suggests that counseling augmented by device provision can effectively encourage individuals to store their firearms safely.

Uncovering a missing demographic in trauma registries: epidemiology of trauma among American Indians and Alaska Natives in Washington State

BACKGROUND

The objectives of this study were to evaluate racial misclassification in a statewide trauma registry and to describe the epidemiology of trauma among the Washington American Indian and Alaska Native (AI/AN) population.

METHODS

We performed probabilistic record linkage between the Washington Trauma Registry (2005-2009) and Northwest Tribal Registry, a dataset of known AI/AN. AI/AN patients were compared with caucasians on demographic, injury and clinical outcome factors. A multivariable model estimated odds of mortality.

RESULTS

Record linkage increased ascertainment of AI/AN cases in the trauma registry 71%, from 1777 to 3039 cases. Compared with caucasians, AI/AN trauma patients were younger (mean age=36 vs 47 years, p<0.001) and more commonly male (66.5% vs 61.2%, p<0.001). AI/AN experienced more intentional injuries (suicide or homicide: 20.1% vs 6.7%, p<0.001), a higher proportion of severe traumatic brain injury (20.7% vs 16.8%, p=0.004) and were less likely than caucasians to use safety equipment such as seat belts/airbags (53.9% vs 76.7%, p<0.001). ISSs were similar (ISS >15: 21.4% vs 20.5%, p=0.63), and no difference was observed in mortality after adjustment for covariates (p=0.58).

CONCLUSIONS

Linkage to a state trauma registry improved data quality by correcting racial misclassification, allowing for a comprehensive description of injury patterns for the AI/AN population. AI/AN sustained more severe injuries with similar postinjury outcomes to caucasians. Future efforts should focus on primary prevention for this population, including increased use of seat belts and child safety seats and reduction of interpersonal violence and suicide.

Improving firearm storage in Alaska native villages: a randomized trial of household gun cabinets

OBJECTIVES

We determined if the installation of gun cabinets improved household firearm storage practices.

METHODS

We used a wait list, randomized trial design with 2 groups. The "early" group received the intervention at baseline, and the "late" group received it at 12 months. Up to 2 gun cabinets were installed in each enrolled home, along with safety messages. In-person surveys were conducted at 12 and 18 months to determine the proportion of households reporting unlocked guns or ammunition. Direct observations of unlocked guns were also compared.

RESULTS

At baseline, 93% of homes reported having at least 1 unlocked gun in the home, and 89% reported unlocked ammunition. At 12 months, 35% of homes in the early group reported unlocked guns compared with 89% in the late group (P < .001). Thirty-six percent of the early homes reported unlocked ammunition compared with 84% of late homes (P < .001). The prevalence of these storage practices was maintained at 18 months. Observations of unlocked guns decreased significantly (from 20% to 8%) between groups (P < .03).

CONCLUSIONS

Gun cabinet installation in rural Alaskan households improved the storage of guns and ammunition. If these gains are sustained over time, it may lead to a reduction in gun-related injuries and deaths in this population.

Storage of household firearms: an examination of the attitudes and beliefs of married women with children

Although safe firearm storage is a promising injury prevention strategy, many parents do not keep their firearms unloaded and locked up. Using the theory of planned behavior as a guiding conceptual framework, this study examines factors associated with safe storage among married women with children and who have firearms in their homes. Data come from a national telephone survey (n=185). We examined beliefs about defensive firearm use, subjective norms, perceived behavioral control and firearm storage practices. A Wilcoxon-Mann-Whitney test was conducted to assess associations between psychosocial factors and firearm storage practices. Women were highly motivated to keep firearms stored safely. Those reporting safe storage practices had more favorable attitudes, more supportive subjective norms and higher perceptions of behavioral control than those without safe storage. One-fourth believed a firearm would prevent a family member from being hurt in case of a break-in, 58% believed a firearm could scare off a burglar. Some 63% said they leave decisions about firearm storage to their husbands. Women were highly motivated to store firearms safely as evidenced by favorable attitudes, supportive subjective norms and high perceptions of behavioral control. This was especially true for those reporting safer storage practices.

Correlates of Alaska Native fatal and nonfatal suicidal behaviors 1990-2001

Factors correlated with suicidal behavior in a predominately Alaska Native region of Alaska are described, and the correlates relating to fatal and nonfatal suicide behaviors in this indigenous population are distinguished. Suicide data from the region (1990-2001) were aggregated and compared to 2000 U.S. Census Data using chi-squared tests. Multivariable logistic regression was used to identify predictors of suicide behaviors. Suicidal behaviors were significantly more common among single, unemployed Alaska Natives who had not completed high school. In multivariable analysis, male sex, age > or = 25 years, firearms, and substance abuse history were each associated with suicide death.

Twenty-year trends in fatal injuries to very young children: the persistence of racial disparities

OBJECTIVE

Mortality trends across modifiable injury mechanisms may reflect how well effective injury prevention efforts are penetrating high-risk populations. This study examined all-cause, unintentional, and intentional injury-related mortality in children who were aged 0 to 4 years for evidence of and to quantify racial disparities by injury mechanism.

METHODS

Injury analyses used national vital statistics data from January 1, 1981, to December 31, 2003, that were available from the Centers for Disease Control and Prevention. Rate calculations and chi2 test for trends (Mantel extension) used data that were collapsed into 3-year intervals to produce cell sizes with stable estimates. Percentage change for mortality rate ratios used the earliest (1981-1983) and the latest (2001-2003) study period for black, American Indian/Alaskan Native, and Asian/Pacific Islander children, with white children as the comparison group.

RESULTS

All-cause injury rates declined during the study period, but current mortality ratios for all-cause injury remained higher in black and American Indian/Alaskan Native children and lower in Asian/Pacific Islander children compared with white children. Trend analyses within racial groups demonstrate significant improvements in all groups for unintentional but not intentional injury. Black and American Indian/Alaskan Native children had higher injury risk as a result of residential fire, suffocation, poisoning, falls, motor vehicle traffic, and firearms. Disparities narrowed for residential fire, pedestrian, and poisoning and widened for motor vehicle occupant, unspecified motor vehicle, and suffocation for black and American Indian/Alaskan Native children.

CONCLUSIONS

These findings identify injury areas in which disparities narrowed, improvement occurred with maintenance or widening of disparities, and little or no progress was evident. This study further suggests specific mechanisms whereby new strategies and approaches to address areas that are recalcitrant to improvement in absolute rates and/or narrowing of disparities are needed and where increased dissemination of proven efficacious injury prevention efforts to high-risk populations are indicated.

Are household firearms stored less safely in homes with adolescents?: Analysis of a national random sample of parents

OBJECTIVE

To examine whether firearms are more frequently stored loaded, unlocked, or both in households with adolescents only (aged 13-17 years) compared with households with younger children only (aged 0-12 years).

DESIGN

Random-digit-dial survey on firearms (n = 2770). We computed bivariate associations between the presence of adolescents and firearm storage practices. Statistical significance was assessed using prevalence ratios with 95% confidence intervals.

SETTING

United States.

PARTICIPANTS

Survey respondents with children (aged <18 years) who reported the presence of a household firearm.

MAIN OUTCOME MEASURES

Prevalence of firearms in the home stored loaded and/or unlocked.

RESULTS

Of the 392 respondents, 22% had a loaded firearm, 32% had an unlocked firearm, and 8% had a firearm stored loaded and unlocked. Compared with households with younger children, households with adolescents only were somewhat more likely to store a firearm unlocked (42% vs 29%; prevalence ratio, 1.48; 95% confidence interval, 1.04-2.02), loaded (26% vs 20%; prevalence ratio, 1.25; 95% confidence interval, 0.82-1.91), or both (10% vs 8%; prevalence ratio, 1.43; 95% confidence interval, 0.64-3.19).

CONCLUSIONS

Parents of adolescents appear to be more likely to keep household firearms stored unsafely, especially with regard to keeping firearms unlocked. This is of concern because most youth firearm injuries happen to adolescents. Firearm injury prevention programs should directly target parents of adolescents to promote safe firearm storage.

Prevalence of household firearms and firearm-storage practices in the 50 states and the District of Columbia: findings from the Behavioral Risk Factor Surveillance System, 2002

OBJECTIVES

To examine the prevalence of household firearms and firearm-storage practices in the 50 states and the District of Columbia and estimate the number of children exposed to unsafe storage practices.

METHODS

We analyzed data from the 2002 cross-sectional Behavioral Risk Factor Surveillance System survey of 240735 adults from randomly selected households with telephones in the 50 states and the District of Columbia.

RESULTS

Nationally, 32.6% of adults reported that firearms were kept in or around their home. The prevalence of adults with household firearms ranged from 5.2% in the District of Columbia to 62.8% in Wyoming (median: 40.8%). The prevalence of adults with loaded household firearms ranged from 1.6% in Hawaii, Massachusetts, and New Jersey to 19.2% in Alabama (median: 7.0%), and the prevalence of adults with loaded and unlocked household firearms ranged from 0.4% in Massachusetts to 12.7% in Alabama (median: 4.2%). Among adults with children and youth <18 years old, the prevalence of loaded household firearms ranged from 1.0% to 13.4% (median: 5.3%), and the prevalence of loaded and unlocked household firearms ranged from 0.3% to 7.3% (median: 2.3%); in each instance, Massachusetts had the lowest prevalence and Alabama had the highest. Findings indicate that approximately 1.69 million (95% confidence interval: 1.57-1.82 million) children and youth in the United States <18 years old are living with loaded and unlocked household firearms.

CONCLUSIONS

Substantial state variations exist in the prevalence of household firearms and firearm-storage practices. It is vital that surveillance systems such as the Behavioral Risk Factor Surveillance System continue to monitor the prevalence of household firearms and firearm-storage practices so that future interventions to promote safe storage of firearms can be evaluated and more widely implemented based on their efficacy.

Evaluation of a community-based handgun safe-storage campaign

OBJECTIVE

Safe storage of firearms has been recommended as a means of preventing gun-related pediatric injuries, yet few interventions have led to significant improvements in storage practices. This study examined a multifaceted community education campaign to promote safe handgun storage and the campaign's impact on firearm locking and loading practices in households with children.

METHODS

Beginning in 1997, a safe-storage campaign consisting of television and radio announcements, educational materials, billboards, and discount coupons for lock boxes was conducted in King County, Washington. The campaign evaluation used a quasi-experimental design and compared the intervention site with 9 control counties outside Washington State and west of the Mississippi River. Cross-sectional, random-digit-dial telephone surveys of handgun-owning households with children were conducted in all study counties both before the intervention in 1996 (n = 302) and again in 2001 (n = 255). The main analyses assessed whether greater improvements in household firearm-storage practices occurred between 1996 and 2001 in the intervention, compared with the control, counties. Primary outcomes were based on up to 3 handguns per household and included (1) all stored with trigger locks, lock boxes, or gun safes (formal locking devices), (2) all stored in lock boxes or gun safes, (3) any stored loaded, (4) any stored loaded without a formal locking device, and (5) any stored loaded and not in a lock box or gun safe. Data were also collected on up to 1 long gun per household; long-gun outcomes included (1) stored with a trigger lock or gun safe and (2) stored loaded.

RESULTS

Overall, handguns and long guns were generally more likely to be stored locked and less likely to be loaded in 2001 compared with 1996, with these trends seeming to be more consistent in the intervention county. Even so, more than one quarter of households with children and handguns in 2001 failed to store all of their handguns with a formal locking device, and up to 8% continued to possess at least 1 loaded handgun that was not stored with a formal device. The majority of households that stored their handguns with formal devices used lock boxes or gun safes. Storage of handguns in lock boxes or gun safes became more common in both the intervention (adjusted odds ratio [aOR]: 1.71; 95% confidence interval [CI]: 1.03-2.84) and control households (aOR: 1.66; 95% CI: 1.01-2.72) between 1996 and 2001. None of the other measured changes reached statistical significance, such as storing any household handgun loaded (aOR: 0.71; 95% CI: 0.35-1.42 [intervention]; aOR: 1.08; 95% CI: 0.58-2.00 [control]) or keeping any household handgun loaded and not stored in a lock box or gun safe (aOR: 0.59; 95% CI: 0.22-1.55 [intervention]; aOR: 0.67; 95% CI: 0.30-1.49 [control]). Moreover, the intervention county did not experience significantly greater overall improvements in household storage practices for handguns or long guns than did control counties.

CONCLUSIONS

In both the intervention and control counties, households were more likely to lock all handguns in 2001 compared with 1996. After accounting for temporal trends, this educational campaign, combined with economic incentives to purchase lock boxes, did not seem to significantly change safe storage practices in households with handguns and children. Even if the campaign did result in small improvements in firearm safe storage, simultaneous national and state-specific gun-safety activities or legislative efforts may have drawn increasing attention to gun-related issues in the control counties, thereby making it more difficult to identify effects of our specific handgun storage intervention.

Safer storage of firearms at home and risk of suicide: a study of protective factors in a nationally representative sample

OBJECTIVE

To estimate the protective effect of storing firearms locked or unloaded, or both, on the risk of suicide by firearms among people with relatively low intention to die.

DESIGN AND SETTING

Cross sectional survey. The 1993 National Mortality Followback Survey of 22 957 deaths in the United States, representing 2.2 million people, conducted by the National Center for Health Statistics.

PARTICIPANTS

Decedent's next of kin answered questions regarding various aspects of decedent's life to supplement information from death certificates.

MAIN RESULTS

Compared with decedents who stored their firearm unlocked or loaded, those who stored their firearms locked or unloaded, or both, were less likely to commit suicide by firearms (locked: OR = 0.39, 95% CI = 0.24 to 0.66; unloaded OR = 0.30, 95% CI = 0.18 to 0.49).

CONCLUSIONS

This study further supports the utility of devices and practices intended to reduce the likelihood of unauthorised or impulsive use of firearms.