Firearm storage patterns in US homes with children

OBJECTIVES: This study determined the prevalence and storage patterns of firearms in US homes with children. METHODS: We analyzed data from the 1994 National Health Interview Survey and Year 2000 objectives supplement. A multistage sample design was used to represent the civilian noninstitutionalized US population. RESULTS: Respondents from 35% of the homes with children younger than 18 years (representing more than 22 million children in more than 11 million homes) reported having at least 1 firearm. Among homes with children and firearms, 43% had at least 1 unlocked firearm (i.e., not in a locked place and not locked with a trigger lock or other locking mechanism). Overall, 9% kept firearms unlocked and loaded, and 4% kept them unlocked, unloaded, and stored with ammunition; thus, a total of 13% of the homes with children and firearms--1.4 million homes with 2.6 million children--stored firearms in a manner most accessible to children. In contrast, 39% of these families kept firearms locked, unloaded, and separate from ammunition. CONCLUSIONS: Many children live in homes with firearms that are stored in an accessible manner. Efforts to prevent children's access to firearms are needed.     

Adolescent suicide and household access to firearms in Colorado: results of a case-control study.

PURPOSE: To determine whether, compared with age- and sex-matched controls who did not commit suicide, adolescents who committed suicide by firearms were more likely to have had household access to firearms (after adjusting for significant risk factors for adolescent suicide). METHODS: A case-control study design was used; case subjects were Colorado adolescents who committed suicide between 1991 and 1993; controls were sex- and age-matched adolescents who were randomly selected from the same school the subjects had attended. Interviews were conducted with the parent or guardian of cases and controls. RESULTS: Of the 36 case subjects in this study, 67% committed suicide using a gun obtained from their home. Adolescent suicide victims who committed suicide by firearms were significantly more likely to have a firearm in their home (72%) than age- and sex-matched community controls (50%), after adjusting for significant risk factors. Conduct disorder and previous mental health treatment were also found to be independent risk factors for adolescent firearm suicide. CONCLUSIONS: Two types of public health interventions to prevent adolescent firearm suicides are likely to be successful: (a) limiting household access to firearms, and (b) identifying adolescents at high risk of firearm suicide.     

The epidemiology of firearm suicide in the United States

Context Little attention has been given to the role of firearms in suicide. In 1998, firearms were the leading method of committing suicide for both men and women, responsible for three times the number of suicides compared to the next leading method. Understanding the epidemiology of firearm suicide will increase awareness of firearm suicide as a major public health problem. Results Rates of firearm suicide have changed little over the past two decades and have consistently exceeded rates of firearm homicide. the firearm suicide rate among men is approximately six times that of women. While firearm suicide rates are highest among the elderly, the majority (66%) of firearm suicides are among persons under 55 years of age. Firearm suicide rates among women of all ages have dropped modestly, while rates among elderly men have risen considerably. Whites have roughly twice the rate of firearm suicide as do blacks and other race/ethnicity groups. Individual-level empirical studies have consistently indicated that keeping firearms in the home is associated with an increased risk of suicide. Conclusions For suicide prevention to be effective, the availability and use of firearms in suicides must be addressed.     

Firearm ownership and health care workers.

OBJECTIVE. Health professionals have increasingly become aware of the public health hazards caused by firearms. This study was designed to determine the firearm ownership and storage practices of a group of health care workers. METHODS. All 6436 nonphysician employees of a large health maintenance organization were surveyed as part of an ongoing effort to enhance the organization''s effectiveness. Two questions regarding firearm ownership and storage practices were included in the 85-question survey instrument. A total of 4999 surveys were returned, for a response rate of 78%. RESULTS. Forty-two percent of the health workers surveyed reported keeping a firearm in their home, and 35% of firearm owners stored that firearm loaded. Men were more likely than women to report having a firearm in the home. Firearm ownership and storage of a loaded firearm decreased with higher levels of education in both sexes. A measure of increased alcohol consumption was related to higher rates of firearm ownership and storage of loaded firearms in men. CONCLUSIONS. A substantial number of health care workers had firearms in their homes and did not store them safely. Counseling regarding the risks associated with easy access to firearms should be considered for inclusion in employee health programs as well as in employee assistance and alcohol treatment programs.     

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.     

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.     

Storage of poisonous substances and firearms in homes with young children visitors and older adults

BACKGROUND: Most unintentional childhood poisonings and firearm injuries occur in residential environments. Therefore, a preventive strategy includes limiting children's access to poisons and firearms through safe storage. This study examines storage of poisons and firearms among households with older adults, and households where young children reside compared to those where they visit only. METHODS: Sample is from a 2002 national random-digit-dial survey of 1003 households. Analyses were weighted to reflect the national population. RESULTS: There were 637 households with children residents or visitors aged <6 years. Seventy-five percent of the households (n =480) had children aged <6 as visitors only, and 15% had older adult residents (aged >/=70 years). Poisons and firearms were stored less securely in homes with young children as visitors as compared to those homes with resident young children. In 55% of homes where young children lived, and 74% of homes where young children were only visitors, household chemicals were reportedly stored unlocked. Although firearm ownership was comparable between the two categories of households (33% vs 34%), homes in which children were only visitors were more likely to store firearms unlocked (56%), than homes in which children resided (33%). Homes with older adult residents had more firearms present. CONCLUSIONS: Children are at risk from improperly stored poisonous substances and firearms in their own homes and homes they visit. Strategies are needed to improve the storage practices of both poisons and firearms to minimize in-home hazards to young children, particularly raising awareness of these hazards to young visitors.     

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.     

Clinical Psychologists’ Firearm Risk Management Perceptions and Practices

The purpose of this study was to investigate the current perceptions and practices of discussing firearm risk management with patients diagnosed with selected mental health problems. A three-wave survey was mailed to a national random sample of clinical psychologists and 339 responded (62%). The majority (78.5%) believed firearm safety issues were greater among those with mental health problems. However, the majority of clinical psychologists did not have a routine system for identifying patients with access to firearms (78.2%). Additionally, the majority (78.8%) reported they did not routinely chart or keep a record of whether patients owned or had access to firearms. About one-half (51.6%) of the clinical psychologists reported they would initiate firearm safety counseling if the patients were assessed as at risk for self-harm or harm to others. Almost half (46%) of clinical psychologists reported not receiving any information on firearm safety issues. Thus, the findings of this study suggest that a more formal role regarding anticipatory guidance on firearms is needed in the professional training of clinical psychologists.     

Household firearm storage practices: Do responses differ by whether or not individuals ever use firearms?

INTRODUCTION: The prevalence with which firearms are stored loaded or unlocked has been measured in previous surveys. Our purpose was to compare household firearm storage practices reported by firearm users and nonusers. METHODS: We analyzed telephone survey data from the 1992 and 1993 Oregon Behavioral Risk Factor Surveillance System on 2454 randomly selected adults in households with firearms. We compared reported firearm storage practices among persons who ever used firearms with persons who had never used firearms by demographics and type of firearm. RESULTS: Nonusers of firearms were much less likely than firearm users to report that household firearms were always or sometimes stored loaded [odds ratio (OR) = 0.45, 95% confidence interval (CI):0.36-0.54] or stored loaded and unlocked (OR = 0.46, 95% CI: 0.36-0.57). Except for persons aged 18 to 34 years and persons in handgun-only households, differences in reported firearm storage practices between nonusers and users varied little by demographic characteristics or by type of firearm. Nonusers of household firearms may be unaware that firearms are stored loaded or stored loaded and unlocked in their homes. CONCLUSIONS: Surveys that do not consider firearm use status may underestimate household exposure to loaded firearms or to loaded and unlocked firearms.     

Psychiatrists' practices and perceptions regarding anticipatory guidance on firearms

BACKGROUND: Most suicides (60%) and homicides (67%) are committed with firearms. Additionally, 90% of homicide offenders and 80% of individuals reporting suicide behaviors meet diagnostic criteria for mental illness. Medical society guidelines support the counseling of patients regarding firearms. This study assessed psychiatrists' anticipatory guidance on firearms and their perceived roles on this topic. METHOD: A four-wave mail survey of adult psychiatrists in Ohio was conducted and analyzed. The outcome measures were the portion of psychiatrists involved in anticipatory guidance on firearm safety issues and their self-efficacy and perceived barriers regarding firearm counseling. RESULTS: Two hundred and five psychiatrists of a possible 340 (60%) responded. Almost half (45%) had never thought seriously about discussing firearm safety issues with patients. They perceived firearm safety issues to be much greater (32%) or slightly greater (37%) for mental health patients than for the general population. Psychiatrists with high efficacy expectations were twice as likely (56.5% vs 28.0%) as those with low efficacy expectations to provide firearm anticipatory guidance. Those who counseled their patients were 15 times more likely to have high outcome expectations compared to those who did not counsel their patients (93.7% vs 6.3%, respectively). CONCLUSIONS: When psychiatrists are provided with firearm information, they were significantly more likely to be involved in anticipatory guidance regarding firearms. This implies that professional societies and journals should attempt to increase the information they provide to their members regarding this topic. Psychiatrists may be in a unique position to help reduce firearm morbidity and mortality for mentally ill patients.     

Validating survey responses to questions about gun ownership among owners of registered handguns

While survey-based data on firearm ownership are essential for epidemiologic studies of the relation between gun ownership and injuries, the validity of respondent answers to questions about gun ownership has not been confirmed. In order to assess the accuracy of interview data about firearms, in June to August 1987, the authors attempted to contact residents of 75 homes in the cities of Memphis, Tennessee and Seattle, Washington listed as the address of the owner of a recently registered handgun. Despite problems with inaccurate registration data, contact was ultimately made with 55 households, 35 of which consented to a general interview that included a series of questions about gun ownership. Respondents in 31 of these 35 households (88.6%) readily acknowledged that one or more guns were kept in their home. Respondents in three of the remaining four households (8.6%) stated that guns were recently kept in their homes but were no longer kept there. Only one respondent (2.9%) denied categorically that guns of any kind were kept in her home. The authors conclude that, at least among registered gun owners, respondent answers to questions about gun ownership are generally valid and that survey data of this type can be utilized with confidence.     

State-level homicide victimization rates in the US in relation to survey measures of household firearm ownership, 2001-2003

Two of every three American homicide victims are killed with firearms, yet little is known about the role played by household firearms in homicide victimization. The present study is the first to examine the cross sectional association between household firearm ownership and homicide victimization across the 50 US states, by age and gender, using nationally representative state-level survey-based estimates of household firearm ownership. Household firearm prevalence for each of the 50 states was obtained from the 2001 Behavioral Risk Factor Surveillance System. Homicide mortality data for each state were aggregated over the three-year study period, 2001-2003. Analyses controlled for state-level rates of aggravated assault, robbery, unemployment, urbanization, per capita alcohol consumption, and a resource deprivation index (a construct that includes median family income, the percentage of families living beneath the poverty line, the Gini index of family income inequality, the percentage of the population that is black and the percentage of families headed by a single female parent). Multivariate analyses found that states with higher rates of household firearm ownership had significantly higher homicide victimization rates of men, women and children. The association between firearm prevalence and homicide victimization in our study was driven by gun-related homicide victimization rates; non-gun-related victimization rates were not significantly associated with rates of firearm ownership. Although causal inference is not warranted on the basis of the present study alone, our findings suggest that the household may be an important source of firearms used to kill men, women and children in the United States.     

Firearm homicide and firearm suicide: opposite but equal

OBJECTIVE: Homicide and suicide are intentional acts of violence that disproportionately involve firearms. Much more effort has been devoted to the ecological study of homicide; methods that have been developed to better understand and subsequently prevent homicide may be applicable to suicide. The purpose of the present study was to compare the occurrence of firearm homicide and firearm suicide using routine activity theory as a framework for analysis. METHODS: Detailed mortality data pertaining to decedents, their neighborhoods, and use of firearms were collected from 1994 to 1998 for the counties containing and surrounding three small to medium-sized U.S. cities. Data from a total of 468 neighborhoods that collectively experienced 1,025 intentional deaths from firearms (396 firearm homicides and 629 firearm suicides) were analyzed. RESULTS: Firearm homicide was consistently associated with out-of-home, nighttime activity in neighborhoods where many people were likely to be coming and going. In an opposite-but-equal fashion, firearm suicide was consistently associated with in-home, daytime activity in out-of-the-way neighborhoods. CONCLUSIONS: Firearm homicide and firearm suicide were found to be consistently associated with markers of routine activity in all three cities, albeit in an opposite-but-equal manner. Because firearm suicides very often occur as lonely events in lonely neighborhoods, they may go under-noticed relative to firearm homicides. More awareness and additional public health studies of firearm suicide, in tandem with firearm homicide, should be pursued to better identify individuals and neighborhoods that are at greatest risk of experiencing each event.     

State Firearm Laws,Firearm Ownership,and Safety Practices Among Families of Preschool-Aged Children

Objectives. We investigated how state-level firearms legislation is associated with firearm ownership and storage among families with preschool-aged children.Methods. Using 2005 nationally representative data from the Early Childhood Longitudinal Study-Birth Cohort (n = 8100), we conducted multinomial regression models to examine the associations between state-level firearms legislation generally, child access prevention (CAP) firearms legislation specifically, and parental firearm ownership and storage safety practices.Results. Overall, 8% of families with children aged 4 years living in states with stronger firearm laws and CAP laws owned firearms compared with 24% of families in states with weaker firearm laws and no CAP laws. Storage behaviors of firearm owners differed minimally across legislative contexts. When we controlled for family- and state-level characteristics, we found that firearm legislation and CAP laws interacted to predict ownership and storage behaviors, with unsafe storage least likely among families in states with both CAP laws and stronger firearm legislation.Conclusions. Broader firearm legislation is linked with the efficacy of child-specific legislation in promoting responsible firearm ownership.Family firearm safety practices are a major public health concern, with firearm-related deaths being one of the leading causes of injury-related fatalities among young children.1 Recent media attention on accidental shootings involving young children has heightened public and policy debate over the role of government in restricting access to firearms and the effectiveness of firearm laws.2,3 Some states have implemented laws—often referred to generally as child access prevention (CAP) laws—that legislate safe firearm storage practices among families with children and make adults criminally liable for children’s unsupervised use of firearms. Studies examining the effects of CAP laws, however, report mixed findings, suggesting that they have a greater effect on child morbidity and mortality when instituted in states with higher levels of pediatric firearm incidents and when the penalties associated with firearm usage are more stringent.4–8 One explanation for the lack of consistent findings is that most studies have not directly measured the behavior CAP laws intend to regulate. That is, little is known about how these access laws are associated with factors beyond mortality and morbidity, such as firearm storage behaviors. We addressed this gap by empirically testing the relationship between CAP laws and firearm storage behaviors in a nationally representative sample.Currently, limitations of this literature constrain the ability to draw strong conclusions about the effects of state-level policies on firearm ownership and storage practices.4,9 For example, because person-level data on firearm-related behavior is scarce, many studies that rely on macrolevel statistics (e.g., state firearm ownership, firearm-related mortality) run the risk of creating ecological fallacies, whereby associations at the aggregate level are erroneously extrapolated to the individual level.10 Similarly, aggregate-level data do not allow the examination of the specific populations that the policies address and, hence, may not be sufficiently sensitive to directly test these policies’ effects. A lack of data that can be used to compare ownership and specific aspects of that ownership, such as safety practices, also makes it difficult to determine if stronger laws generally affect firearm ownership or laws directed at specific unsafe behaviors work. Furthermore, the potential for state policies to be a product of the selectivity of the residents of the state complicates disentangling the effects of state-level firearm laws.11 Lawmakers in states with a high proportion of firearm owners may be more reluctant to pass laws that regulate firearm practices; consequently, observed correlations between laws and state-level firearm ownership may reflect state population characteristics or state “gun culture” to a greater extent than states’ firearm policy (or lack thereof).In line with the American Academy of Pediatrics’ recommendation that parents who own firearms store them locked and unloaded, with ammunition locked and stored separately,12 we examined how laws aimed at firearm storage practices—along with general state-level firearm laws—are associated with firearm ownership and storage behaviors among families with preschool-aged children. Previous research has suggested a theoretical framework emphasizing the importance of both situational and individual characteristics in understanding patterns of firearm ownership.13 For example, studies link higher socioeconomic status, being White, and having a man in the house with higher levels of firearm ownership.14,15 We anticipated that (1) families in states with stronger general and child-specific firearm legislation would have the lowest rates of firearm ownership and the highest rates of safe firearm storage, (2) families in states with weaker firearm legislation would report the highest levels of ownership and the lowest levels of storage safety, and (3) families in states with a relatively strong set of laws in one domain but not in the other would fall between these 2 groups, with higher levels of ownership and safer storage practices in states with CAP laws but weaker general laws than in states with the opposite combination of laws.     

The choice of weapons in firearm suicides.

We report on the firearms used in 235 suicides in Sacramento County, California, during 1983-85. Handguns were used in 69 per cent of firearm suicides--65 per cent for males, 88 per cent for females--and in all such deaths among women ages 35 and older. We tested the hypothesis that the choice of firearms by persons committing suicide at home would passively reflect the reported prevalence of firearms by type in households in the region. Handguns were used more frequently (rate ratio 2.00; 95% CI = 1.68, 2.39), and rifles and shotguns less frequently than expected.     

High school students’ attitudes about firearms policies

PURPOSE: To examine high school students' attitudes about firearm policies and to compare their attitudes with those of adults. METHODS: The Hamilton Youth and Guns Poll is the first national survey of high school students about their attitudes concerning firearm policies. Questions were asked of 1005 sophomores, juniors, and seniors about their actual (i.e., direct) exposure (e.g., presence of a gun in the home) and about their social (i.e., indirect) exposure (e.g., whether the student could get a gun) to firearms and related violence. Population weights were applied, and multivariate logistic regression was used to examine the relationship between demographic and exposure variables and opinions about firearm policies. RESULTS: Most high school students supported more restrictive firearm policies. Opinions varied little by demographic variables with the exception of gender. Females were significantly more supportive of most firearm policies. Actual exposure was a more consistent predictor than social exposure. Students living in a home with a gun, particularly a handgun, were less likely to support most restrictive gun policies. CONCLUSIONS: Most high school students in the United States favor stringent policies governing firearms. Adolescents' attitudes about firearm policies parallel those of adults.     

State firearm laws and rates of suicide in men and women

BACKGROUND: To evaluate the associations of state laws restricting firearms and incidence rates of suicide in men and women using a cross-sectional design. METHODS: States were divided into three categories based on the restrictiveness of their firearm laws: restrictive (n =8); modest (n =22); and unrestrictive (n =20). State suicide incidence rates stratified by gender were compared using Poisson regression analyses that controlled for measures of race/ethnicity, income, and urbanization. Analyses were based on 2000 census data and state suicide data from 1999 and 2000. RESULTS: In the analysis of women, compared to states with restrictive firearm laws, there were higher suicide incidence rate ratios (IRR) in states with modest (IRR=1.64; 95% confidence interval [CI], 1.34-2.01) and unrestrictive laws (IRR=1.55; 95% CI, 1.23-1.95). The analysis of men showed comparable results: modest firearm laws (IRR=1.51; 95% CI, 1.27-1.79); unrestrictive firearm laws (IRR=1.49; 95% CI, 1.23-1.82). CONCLUSIONS: Results support the hypothesis that state restrictions on firearms have the potential to reduce the suicide rate. Findings do not support a hypothesis that greater firearm restrictions are associated with the substitution of alternative methods of suicide. Firearms appear to be a comparable exposure for suicide in men and women. Although men are more likely to use firearms in suicide than women, this difference may merely reflect more frequent gun ownership among men.     

Parents’ Depressive Symptoms and Gun,Fire, and Motor Vehicle Safety Practices

Objective This study examined associations between mothers’ and fathers’ depressive symptoms and their parenting practices relating to gun, fire, and motor vehicle safety. Methods Using data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a nationally representative sample of children birth to age five, linear probability models were used to examine associations between measures of parents’ depressive symptoms and their use of firearms, smoke detectors, and motor vehicle restraints. Parents reported use of smoke detectors, motor vehicle restraints, and firearm ownership and storage. Results Results suggest mothers with moderate or severe depressive symptoms were 2 % points less likely to report that their child always sat in the back seat of the car, and 3 % points less likely to have at least one working smoke detector in the home. Fathers’ depressive symptoms were associated with a lower likelihood of both owning a gun and of it being stored locked. Fathers’ depressive symptoms amplified associations between mothers’ depressive symptoms and owning a gun, such that having both parents exhibit depressive symptoms was associated with an increased likelihood of gun ownership of between 2 and 6 % points. Conclusions Interventions that identify and treat parental depression early may be effective in promoting appropriate safety behaviors among families with young children.