'In the safety of your own home': results from a national survey on gun use at home

In the US, guns, particularly handguns, are typically brought into the home for protection. The wisdom of having a firearm in the home, however, is disputed. While guns appear to be a risk factor for family homicide, suicide and unintentional firearm fatality, no evidence has been available about gun use at home to intimidate family members and little about gun use to thwart crimes by intruders, or about the use of other weapons in home self-defense. Over the past decade, various private surveys have asked questions about the respondent's use of guns in self-defense. None, however, has asked detailed questions about the use of guns to threaten or intimidate the respondent. This study presents results from a national random digit dial telephone survey of 1906 US adults conducted in the spring of 1996. Respondents were asked about hostile gun displays and use of guns and other weapons in self-defense at home in the past five years. The objective of the survey was to assess the relative frequency and characteristics of weapons-related events at home. Thirteen respondents reported that a gun was displayed against them at home, two reported using a gun in self-defense at home, and 24 reported using another weapon (e.g. knife, baseball bat) in home self-defense. While we do not always know whose weapon was used in these incidents, most gun brandishings were by male intimates against women. A gun in the home can be used against family members or intruders and can be used not only to kill and wound, but to intimidate and frighten. This small study provides some evidence that guns may be used at least as often by family members to frighten intimates as to thwart crime, and that other weapons are far more commonly used against intruders than are guns.     

Private equity investment and nursing home care: is it a big deal?

Private equity investors have recently targeted nursing home chains as investment opportunities. Media attention has raised quality-of-care concerns, but little has been published in the research literature on the topic. Using a multivariate framework, we assessed how private equity purchases of nursing homes affected a range of outcomes. Although some transactions are quite recent, we found little evidence to suggest that nursing home quality worsens significantly following purchase by private equity companies. Nonetheless, recent nursing home ownership trends raise important questions about oversight and accountability, whose answers extend beyond private equity ownership.     

Validity of a household gun question in a telephone survey.

The validity of self-reported data on the presence of guns in the home obtained in a telephone survey was assessed in samples of households where a hunting license had been purchased or a handgun registered. The survey was conducted among a random sample of Ingham County, MI, residents who had purchased a hunting license between April 1990 and March 1991 and among those registering a handgun during 1990. A third study sample was selected from the county''s general adult population using a random digit dialing method. The interviews were conducted between November 1991 and January 1992. The proportion of respondents who reported that at least one gun was kept in their household was 87.3 percent among handgun registration households and 89.7 percent among hunting license households. In the survey of the general population of the county, approximately one-third of the respondents reported keeping a gun in the household, 67 percent of them for hunting and 23 percent for safety. Despite some limitations, the data indicate that a question on gun presence in a household can be used in a in a telephone survey.     

The Effect of State Gun Laws on the Supply of Guns and Gun Crimes: A Multilevel Modeling Analysis

Gun homicides alone cause 11 000 deaths each year. Numerous shootings in recent years, terrorist and otherwise, have sparked heated debates about gun control policy, particularly with regard to Second Amendment issues. Such discussions are more often than not driven by political and philosophical ideology, rather than empirical data. The self-imposed ban on the dissemination of gun-related statistics on the part of the Centers for Disease Control has created difficulty in obtaining data, particularly at the sub-state level. Furthermore, the majority of previous research has not examined the effect on crimes that are gun specific, that is, homicides or robberies committed using guns versus all homicides or robberies. The objective of this research is to examine the multiple relationships between gun ownership and gun crimes at the sub-state level and to then examine the effect of state-level gun laws on the sub-state relationships via multilevel modeling. This research involves two separate units of analysis, counties and states. Initial multivariate regression was conducted on a subset of counties in the United States examining the relationship between the percentage of all households with at least one gun, and both the gun homicide rate as well as the gun robbery rate. Data on gun ownership were obtained from the CDC's BRFSS SMART County-level data files from the mid-2000s. These data are sampled and weighted to be representative of the entire county. A total of 218 weighted, aggregated counties were used from two separate non-overlapping years combined. Gun crime data were obtained from the FBI Uniform Crime Reports, which provides total universe data on crimes, including the number committed with a gun. State gun law rankings were obtained from the Law Center to Prevent Gun Violence, which quantifies state gun laws into a numeric index. Standard county-level control variables such as race, income, poverty, region of the country, level of education, and population density were employed. Multilevel models were then run overlaying state gun laws with county-level data. The population studied included adults age 18 and older who responded to the Centers for Disease Control's BRFSS survey questions, as well as all gun crimes known to the police. In traditional multivariate analysis, a higher percentage of households with guns was associated with lower gun robbery rates as well as lower gun homicide rates. Multilevel modeling using state gun laws indicated that more restrictive gun laws were also associated with lower gun robbery and homicide rates. The percentage of households with guns remained negative and significant in the multilevel models. Moreover, restrictive state gun laws were associated with lower gun ownership rates at the county level. Both legal gun ownership and more restrictive state gun laws are associated with lower rates of violent gun crimes (robbery and homicide). The results unexpectedly provide support for both pro- and anti-gun positions. This suggests that causal patterns are more complex than either position might indicate, and public health policies on gun supply and restriction would be better informed by empirical analysis.     

Children and guns in a well child cohort

BACKGROUND: The purpose of this study was to estimate the extent of and to identify predictors of preadolescent gun use in a well child cohort with matched parent and child data. METHODS: We analyzed self-report questionnaires from children and their parents using conditional logistic regression models. Questionnaires were given to 3,145 ten- to twelve-year-old children and 3,145 parents enrolled by their pediatricians in a prevention cohort study. RESULTS: Thirty-two percent of the children lived in households with guns. Children and parents generally agreed about the presence of guns in their homes; 17% had access to unlocked guns in their homes; 22% had fired guns. In this preadolescent cohort, firing guns was associated with being male, having guns in the home, having friends who use guns, and initiation of alcohol use. CONCLUSIONS: In this well child cohort, significant numbers of preadolescent, healthy boys in white, middle-class U.S. homes have access to guns, are using guns, and have friends who use guns. These children are also early alcohol adopters. Safety interventions with parents of preadolescents about the risks for accidental injury, death, and suicide due to child gun use may prove beneficial.     

Adolescents and firearms: a California statewide survey

OBJECTIVES: We assessed the prevalence and correlates of adolescents' reports regarding firearms in their homes, of their own, of close friends, and of same-aged peers. METHODS: Random-digit-dialed interviews were conducted with 5801 adolescents as part of the California Health Interview Survey. RESULTS: One fifth (19.6%) of California adolescents reported having a firearm in their homes; few (3.0%) reported having their own gun. Characteristics associated with having one's own gun and with perceptions regarding others' guns generally were consistent with characteristics associated with having a firearm in the home. The 2 exceptions were related to socioeconomic status and to ethnicity. CONCLUSIONS: The source from which adolescents obtain guns, especially adolescents from less wealthy households, merits further investigation. Further research is needed to ascertain the accuracy of Black and Latino adolescents' perceptions regarding handguns among their peers.     

Guns in the home and risk of a violent death in the home: findings from a national study

Data from a US mortality follow-back survey were analyzed to determine whether having a firearm in the home increases the risk of a violent death in the home and whether risk varies by storage practice, type of gun, or number of guns in the home. Those persons with guns in the home were at greater risk than those without guns in the home of dying from a homicide in the home (adjusted odds ratio = 1.9, 95% confidence interval: 1.1, 3.4). They were also at greater risk of dying from a firearm homicide, but risk varied by age and whether the person was living with others at the time of death. The risk of dying from a suicide in the home was greater for males in homes with guns than for males without guns in the home (adjusted odds ratio = 10.4, 95% confidence interval: 5.8, 18.9). Persons with guns in the home were also more likely to have died from suicide committed with a firearm than from one committed by using a different method (adjusted odds ratio = 31.1, 95% confidence interval: 19.5, 49.6). Results show that regardless of storage practice, type of gun, or number of firearms in the home, having a gun in the home was associated with an increased risk of firearm homicide and firearm suicide in the home.     

The gender gap in reporting household gun ownership.

OBJECTIVES: This study examined errors in estimating household gun ownership that result from interviewing only 1 adult per household. METHODS: Data from 2 recent telephone surveys and a series of in-person surveys were used to compare reports of household gun ownership by husbands and wives. RESULTS: In the telephone surveys, the rate of household gun ownership reported by husbands exceeded wives' reports by an average of 12 percentage points; husbands' reports also implied 43.3 million more guns. The median "gender gap" in recent in-person surveys is 7 percentage points. CONCLUSIONS: Future research should focus on respondents' reports about personally owned guns.     

Firearm Storage in Gun-Owning Households with Children: Results of a 2015 National Survey

Data from a nationally representative probability-based online survey sample of US adults conducted in 2015 (n?=?3949, response rate 55%) were used to assess self-reported gun storage practices among gun owners with children. The presence of firearms and children in the home, along with other household and individual level characteristics, was ascertained from all respondents. Questions pertaining to household firearms (how guns are stored, number, type, etc.) were asked only of those respondents who reported that they personally owned a gun. We found that approximately one in three US households contains at least one firearm, regardless of whether children lived in the home (0.34 [0.29–0.39]) or not (0.35 [0.32–0.38]). Among gun-owning households with children, approximately two in ten gun owners store at least one gun in the least safe manner, i.e., loaded and unlocked (0.21 [0.17–0.26]); three in ten store all guns in the safest manner, i.e., unloaded and locked (0.29, [0.24–0.34]; and the remaining half (0.50 [0.45–0.55]) store firearms in some other way. Although firearm storage practices do not appear to vary across some demographic characteristics, including age, sex, and race, gun owners are more likely to store at least one gun loaded and unlocked if they are female (0.31 [0.23–0.41]) vs. male (0.17 [0.13–0.22]); own at least one handgun (0.27 [0.22–0.32] vs. no handguns (0.05 [0.02–0.15]); or own firearms for protection (0.29 [0.24–0.35]) vs. do not own for protection (0.03 [0.01–0.08]). Approximately 7% of US children (4.6 million) live in homes in which at least one firearm is stored loaded and unlocked, an estimate that is more than twice as high as estimates reported in 2002, the last time a nationally representative survey assessed this outcome. To the extent that the high prevalence of children exposed to unsafe storage that we observe reflects a secular change in public opinion towards the belief that having a gun in the home makes the home safer, rather than less safe, interventions that aim to make homes safer for children should address this misconception. Guidance alone, such as that offered by the American Academy of Pediatrics, has fallen short. Our findings underscore the need for more active and creative efforts to reduce children’s exposure to unsafely stored firearms.     

How can we remodel practices into medical homes without a blueprint or a bank account?

Medical homes are widely viewed as a solution to the problems with American medical care, despite lack of answers to many important questions. Review of articles from issues of 5 journals devoted to the medical home in 2010 provides few answers to those questions. However, with some exceptions, those answers seem more likely to come from real-life efforts to implement medical homes than from the research literature. In any other industry, that would be the case, especially the key questions about the financial viability of both the transformation of traditional practices and sustainability of the new care model.     

Measuring pain presence and intensity in nursing home residents

OBJECTIVES: To examine the extent of agreement between nursing home residents' (or their proxies') reports of pain presence and intensity as derived from an interview questionnaire and the Minimum Data Set (MDS) nearest to the interview date. DESIGN: Cross-sectional comparison of the 2 data sources on pain measurements. SETTING: Nursing homes included in evaluation projects of EverCare program and Minnesota Senior Health Options. PARTICIPANTS: Nursing home residents (n = 3100) were grouped based on the type of respondent answering the interview questionnaire: resident, family proxy, or staff proxy. MEASUREMENTS: We used kappa statistics and multinomial logit regression to examine agreement between the interview questionnaire and the MDS on pain presence and intensity. RESULTS: Presence of pain was reported 1.3 to 1.8 times more often on the questionnaire, depending on the respondent group. Agreement on the presence of pain was slight to fair (kappa = 0.17 to 0.28) between the MDS and the questionnaire. There was slight agreement on pain intensity (kappa = 0.13 to 0.18). The family proxy respondent group showed the largest discrepancy between questionnaire and the MDS in reporting of pain presence and intensity. The staff proxy respondent group had better agreement on pain intensity than did the other respondent groups, but it achieved only slight agreement (kappa = 0.18). CONCLUSIONS: Detecting and quantifying pain in nursing home residents is complex. Pain information is best obtained directly from residents; observations should be standardized. The MDS should be revised accordingly.     

Housing and health in Germany

STUDY OBJECTIVES: To examine the association between housing tenure and self rated health, controlling for socioeconomic measures and testing the mediating effects of physical features of the home, pollution in the local environment, and relationships with neighbours. DESIGN: Cross sectional panel study with people nested within households. Analyses were performed using multilevel methods. SETTING: Population based sample in Germany. PARTICIPANTS: People aged 16 or older were interviewed in the 1999 wave of the socio-economic panel study (n = 14 055) and nested within households (n = 7381). MAIN RESULTS: 44.0% of the population lived in homes that they owned. In bivariate analyses, women, people who live in apartment buildings, reside near cities, live in crowded homes, have homes in need of renovation, report higher pollution, and have distant contact with neighbours are more likely to live in rented homes. In multilevel analyses, renting a home was found to be associated with poor self rated health (OR 1.48, 95% CI 1.31 to 1.68). This relation persisted after controlling for education and income and was partially mediated by the need for household renovation, the perception of air and noise pollution in the local area, and distant relationship with neighbours, all of which were significantly associated with self rated health. CONCLUSIONS: This study provides evidence that home ownership is significantly associated with self rated health in Germany, and this relation may be, in part, mediated by physical and social features of home and neighbourhood.     

Gun Theft and Crime

Some law enforcement officials and other observers have asserted that theft is the primary source of guns to crime. In fact, the role of theft in supplying the guns used in robbery, assault, and murder is unknown, and current evidence provides little guidance about whether an effective program to reduce gun theft would reduce gun violence. The current article analyzes publicly available national data on gun theft together with a unique data set for Chicago. The results tend to support a conclusion that stolen guns play only a minor role in crime. First, publicly available data are used to calculate that thefts are only about 1% of all gun transactions nationwide. Second, an analysis of original data from Chicago demonstrates that less than 3% of crime guns recovered by the police have been reported stolen to the Chicago Police Department (CPD). If a gun is reported stolen, there is a 20% chance that it will be recovered, usually in conjunction with an arrest for illegal carrying. Less than half of those picked up with a stolen gun have a criminal record that includes violent offenses. Third, results from surveys of convicted criminals, both nationally and in Chicago, suggest that it is rare for respondents to have stolen the gun used in their most recent crime. The data on which these results are based have various shortcomings. A research agenda is proposed that would provide more certainty about the role of theft.     

Weapons in the lives of battered women

OBJECTIVES: We assessed weapon use in intimate partner violence and perspectives on hypothetical firearm policies. METHODS: We conducted structured in-person interviews with 417 women in 67 battered women's shelters. RESULTS: Words, hands/fists, and feet were the most common weapons used against and by battered women. About one third of the battered women had a firearm in the home. In two thirds of these households, the intimate partner used the gun(s) against the woman, usually threatening to shoot/kill her (71.4%) or to shoot at her (5.1%). Most battered women thought spousal notification/consultation regarding gun purchase would be useful and that a personalized firearm ("smart gun") in the home would make things worse. CONCLUSIONS: A wide range of objects are used as weapons against intimate partners. Firearms, especially handguns, are more common in the homes of battered women than in households in the general population.     

Losing homes through mortgage possession: a ‘new’ public health issue

During the last decade there has been an unprecedented growth in mortgage possessions in the UK, with 820 households a week losing their homes in 1996. The signs are that this trend is set to continue. This paper describes the processes involved in losing a home through mortgage possession. A number of features which characterize this experience are identified, these are: living with debt; uncertainty; and lack of control. Drawing on recent developments in the health inequalities literature, this paper argues that these experiences may be important psychosocial mechanisms which may help to explain the link between problematic home ownership and poor health. High levels of problematic home ownership and the possession of homes are relatively new sociostructural phenomena, and ones which must not go unnoticed by those who are keen to keep abreast of the changing dimensions of health inequalities, and those who are engaged with developing ‘healthy public policies’.     

Assessing views about gun violence reduction policy: A look at type of violence and expected effectiveness

ObjectivePublic opinion polling about gun policy is routinely conducted and often disregarded. The purpose of this research is to explore ways in which surveys can be made more useful to policy makers, researchers, and the general public.MethodsA stratified random sample of 1000 undergraduates at a private, urban university was recruited for an online survey about proposed gun policies. A total of 51.7% answered the questions analyzed herein. Including but going beyond typical assessments of agreement, the survey elicited respondent evaluations of the effectiveness of seven gun policies under two randomly assigned conditions: the type of gun violence (e.g., homicide, suicide, violent crime) and its magnitude. Participants were asked to estimate the effectiveness of each policy, including the possibility of making things worse.ResultsParticipants indicated strong support for all policies and expected each to be effective with one exception — a policy designed to increase the number of guns on the scene, that is, putting armed police in schools. Persons who did not support other policies, on average, did not expect them to make things worse. Telling participants about the scope of the violence did not but the type of gun violence did affect effectiveness ratings.ConclusionsAsking about expected effectiveness of (vs. general support for) a policy might identify some optimism: Even people who don't support a policy sometimes think it will be effective. Findings suggest that surveys about the effectiveness of gun violence policies likely assess views that exclude suicide, the most common form of gun-related mortality.     

Children and firearms in Turkish homes

Background Unintentional firearm injuries are an important cause of preventable deaths and disabilities among children. Keeping firearms at home and letting children to see or touch them increases the risk of injury. Methods This cross‐sectional study was conducted to estimate the extent of the firearm problem in an Anatolian province in Turkey. A random sample of families were approached and were asked to answer a series of questions completed by research assistants. Results In 974 randomly selected households, there were 2129 children aged less than 18 years, 11.1% of the fathers have a job in the firearms industry or in the security sector, and 12.3% of the households kept a firearm at home. Only 25.6% of the firearms were kept in a safe place, and 29.3% of the firearms and ammunition were kept separately. Overall, 70.9% of the children whose parents have firearms saw the firearm and 27.2% had handled it. Conclusions Results of this study pointed to the urgent need for preventive measures for the physical separation of guns from children. The establishment of effective firearms safety programmes requires an understanding of the culture and routine behaviours of the target population.     

Effects of a Gun Dealer's Change in Sales Practices on the Supply of Guns to Criminals

Licensed gun dealers are a major conduit for gun trafficking. Prior to May 1999, a single gun store sold more than half of the guns recovered from criminals in Milwaukee, WI, shortly following retail sale. On May 10, 1999, the store stopped selling small, inexpensive handguns popular with criminals, often called “Saturday night specials.” The purpose of this study was to estimate the effect of this gun store's changed sales practices on criminals' acquisition of new guns. We used an interrupted time-series design with comparisons to test for changes in the number of guns that police recovered from criminals within a year of retail sale following the gun dealer's new sales policy. The dealer's changed sales policy was associated with a 96% decrease in recently sold, small, inexpensive handguns use in crime in Milwaukee, a 73% decrease in crime guns recently sold by this dealer, and a 44% decrease in the flow of all new, trafficked guns to criminals in Milwaukee. The findings demonstrate the substantial impact that a single gun store's sales practices can have on the supply of new guns to criminals. Proposed anti-gun-trafficking efforts in other cities could benefit from targeting problem retail outlets.Webster, Vernick, and Bulzacchelli are with the Center for Gun Policy and Research, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Rm. 593, Baltimore, MD 21205, USA.