Firearm Safety Research Articles

Association between community violence exposure and teen parental firearm ownership: data from a nationally representative study.

Firearm injuries are the leading cause of death for U.S. adolescents. Given the prevalence of firearm ownership in the U.S., particularly among parental figures in homes with children and teens, and the relationship between firearm access and injury outcomes, it is vital to shed light on potential parental motivations for keeping firearms in their homes. The purpose of this analysis was to examine whether exposure to community violence is associated with parental firearm ownership. Data from the Firearm Safety Among Children and Teens Consortium's National Survey (6/24/2020-7/24/2020) was examined. The survey sample comprised parents/caregivers of high-school-age teens (age 14-18). The survey examined various measures, including firearm ownership, storage, community violence exposure, and sociodemographic characteristics. Stepwise logistic regression was used to examine the association between community violence exposure and parental firearm ownership. The study included 2,924 participants, with 45.1% identifying as male, 12.9% identifying as Hispanic, and 25.3% identifying as non-White. Among these participants, 43.1% reported firearm ownership, and 49.9% reported exposure to community violence. Regression models demonstrate that community violence exposure is associated with an increased likelihood of firearm ownership among parents/caregivers of high-school age teens (OR = 1.08, p < 0.05). Other significant predictors of firearm ownership among parents/caregivers included parent/caregiver age (OR = 0.99, p < 0.01), marital status (OR = 1.29, p < 0.05), and educational attainment (OR = 0.60, p < 0.001). The findings supported the hypothesis that community violence exposure was associated with an increased likelihood of parental firearm ownership, even after adjusting for potential confounders. These findings contribute to the existing literature by shedding light on the possible contributing factors for firearm ownership among parents/caregivers of teens. Public health interventions focused on raising awareness about the risks of firearm access in households with youths, providing counseling on locked storage practices, and offering resources for accessing secure firearm storage options, such as rapid access storage, may contribute to reducing firearm access among youth. Additionally, community-based initiatives focused on violence prevention and addressing the root causes of community violence can help create safer environments, thereby reducing the perceived need for accessible firearms in the home by parents and caregivers.

Are veterans willing to assist with firearm safety for suicide prevention?

ABSTRACT Veterans in the United States are affected by suicide at higher rates than the general population. This may be due to a higher probability for veterans to use more lethal methods of suicides such as firearms. While veterans often decline to disclose suicidal tendencies to healthcare providers, they show higher connectedness and willingness to heed the advice of peers. Considering this information, it is important to analyze how veteran peers could assist in a suicidal crisis. Veteran responses (n = 1,247) to the Gatekeeper Behavior Scale (GBS) and Firearm Safety Scale (FSS) were analyzed to determine predictive traits of willingness to assist a peer securely store or disable firearms during a suicidal crisis. Results show that veterans are willing to assist in securing firearms to prevent suicide death but are more willing to do so by locking, removing or disabling the firearms than storing them with law enforcement. Older veterans were also more likely to report a willingness to intervene than their younger peers. Of the GBS predictors, only the Likeliness to Help subscale predicted a willingness to intervene with firearm safety. Recommendations for training and interventions that further encourage helping behavior during suicidal episodes are discussed.

Association between unintentional firearm injury characteristics and deaths in adolescents

BackgroundApproximately 15% of pediatric firearm injuries are unintentional. While demographic characteristics of unintentional firearm injuries have been described, the relationship between injury characteristics and mortality is not well understood. In this study, we identified injury characteristics associated with fatality among unintentional firearm injuries in adolescents.MethodsWe conducted a retrospective (May 2022-May 2023) cross-sectional study of unintentional firearm injuries among adolescents 12–17 years old using the Gun Violence Archive. Variables included victim age and sex, shooter age and sex, injury location, injury circumstance, number of firearms, type of firearm, firearm owner, census region, and shooter relationship to the victim. Logistic regression was used to identify variables associated with fatality.ResultsOf 319 unintentional incidents, 212 (66.5%) were non-fatal and 107 (34.5%) were fatal. Of all shootings, 176 (55.2%) occurred in a residence. A shooter was identified in 256 (80.3%) cases; 43.0% of these were a peer of the victim. The adjusted odds of fatality were higher when a peer was the shooter (aOR 5.38, 95% CI 2.57, 11.80) compared to self-inflicted injury and when the shooting took place in the victim’s residence (aOR 2.87, 95% CI 1.07, 7.88) or another residence (aOR 3.03, 95% CI 1.45, 6.67) versus a public location (Fig. 1).ConclusionsUnintentional firearm injuries were more likely fatal when a peer was the shooter and when the shooting occurred at a residence. This amplifies the importance of safe home firearm storage and exploring other evidence-based approaches to decreasing youth access to firearms.

Redefining Social Norms With Firearm Safety in Children: A Framework to Influence Change

Pediatric firearm violence is the number one cause of death in all children and a threat that must be addressed. Applying a harm reduction framework to this growing crisis recognizes that firearms exist and incorporates evidence-based practice actionable strategies for pediatric-focused Advanced Practice Registered Nurses (APRNs) to follow to address this public health crisis. This harm reduction framework encompasses several strategies, including an understanding of the physical and mental health care impact that pediatric firearm violence has on survivors, as well as recognizing the inherent health inequities associated with it. This framework also includes strategies to implement firearm safety education at the community level, discusses key laws and policies that pediatric-focused APRNs can advocate for to effect change, and raises awareness of accessible resources and funding for pediatric-focused APRNs to utilize.

Reinterpreting the NRA’s Eddie Eagle GunSafe® program as a corporate political activity

Abstract Background In the US firearm injuries are the leading cause of death among children and adolescents. However, and despite there being limited evidence to support the adoption of gun safety education programs, firearm industry-funded groups like the National Rifle Association (NRA) promote the delivery of their education-based Eddie Eagle Gunsafe® program while lobbying against other firearm policies less favourable to the firearm industry. The study aimed to address an important research gap by examining how the NRA frame gun ownership, safety and the role of the Eddie Eagle GunSafe® program as an effective firearm safety intervention and whether the design, promotion and delivery of the program serves the corporate political interests of the firearm industry, and if so, how. Methods We conducted a critical analysis of program-related texts and films and the NRA’s practices to promote its legitimacy and effectiveness, guided by the application of published taxonomies of corporate framing and action strategies. Data was collected from the program-specific websites and other NRA outlets to capture the breadth of strategies used to promote their education program. Results The NRA’s practices support the corporate political agenda of the firearm industry. The NRA adopts framing and action strategies that present the presence of firearms in homes and communities as inevitable and normal and the education of children through the delivery of their “lifesaving” program as the common-sense and effective way of keeping children safe from firearm injuries. They make misleading claims about the effectiveness of the program while undermining the credibility of those who advocate for the safety of children and adolescents. Conclusions The ongoing delivery of the Eddie Eagle GunSafe® program needs to be questioned. Policies based on a recognition that children and adolescents are safest when their homes and communities are free of firearms are needed to prevent firearm injuries. Key messages • The NRA makes misleading claims about their program’s effectiveness and distorts understanding of what is needed to prevent firearm injuries and ensure the safety of all children. • The firearm industry needs more attention from the global public health community. Evidenced policy measures that prioritize the prevention of firearm injuries are needed to save children’s lives.

Confronting the Global Crisis of Youth and Firearms in the Wake of Serbia’s First School Shooting

Abstract Issue School shootings reflect crucial systemic flaws, notably the ease of firearm access and training for children, despite rigorous firearm regulations. Description In May 2023, Serbia was rocked by its first school shooting in Belgrade, where a 13-year-old boy, armed with guns and Molotov cocktails, killed 9 and injured 6.His actions were amplified by his proficiency with firearms, a skill honed under his father’s guidance at shooting ranges. This tragic event ignited a nationwide debate on gun control. Our study seeks to attain an in-depth analysis on regulations on minimum age for firearm training in context of school shootings in Serbia and USA as countries with highest rates of civilian gun ownership globally. Results Serbian regulations lack a definitive minimum age for firearm training at shooting ranges, mirroring a situation in the USA, where 17 states do not have child access prevention laws, and 43 states lack mandated safe storage requirements. A worrying trend is the escalation in mass shootings by individuals aged 21 or younger, deviating from the earlier trend of middle-aged perpetrators. This younger demographic often seeks fame, inspired by previous mass shooters, contributing to the rise in both deliberate and accidental shootings by young people. Lessons We need to consider the implementation of regulations on minimum age for children firearm training at shooting ranges, as well as stricter control of the ranges. This problem extends beyond national boundaries, reflecting a global issue. The accessibility of firearms to youth, coupled with their developmental susceptibility to impulsive and aggressive behavior, raises significant concerns. Key messages • To increase global awareness and stricter regulations on youth firearm access, emphasizing the stricter regulations on shooting ranges and the integration of firearm safety education into curricula. • Firearm control and children safety is a collective international duty, crucial for addressing a concern that impacts public safety and youth welfare.

Development, dissemination and survey evaluation of layered education for healthcare professionals to support implementation of firearm injury and mortality prevention strategies in emergency care settings, New York, USA

BackgroundThere is consensus on the need and ability to address firearm injury risk in healthcare settings; however, the lack of education for healthcare professionals hinders the implementation of evidence-based firearm...

Firearm safety: Nurses’ knowledge and comfort

Education and organizational support can help nurses provide patients with critical safety information.

EMS Clinicians in the West Texas Area Frequently Encounter Firearms During Patient Assessments with Limited Gun Safety Training

Introduction - Firearms are commonly encountered in the prehospital setting, sometimes with devastating consequences. However, the frequency with which EMS workers find and handle firearms when evaluating patients in the field and the firearm safety training they have received remains largely unstudied. Objectives - We sought to answer the following questions: 1) How frequently do EMS personnel in West Texas and Southern New Mexico USA encounter and handle firearms when caring for patients? 2) How many of these clinicians are aware of agency policy or have received agency training in the safe handling of firearms? 3) Do these clinicians support integrating firearm training into the EMS curriculum? Methods - In this observational, cross-sectional study, a survey evaluating weapon and firearm encounters, confidence handling firearms, and formal firearms training was distributed to EMS providers in West Texas and Southern New Mexico between July 1, 2022, and January 1, 2023. Results - Two hundred forty-seven out of a potential 609 EMS clinicians completed the online survey, representing a 41% response rate. Among respondents, 61% reported encountering firearms at least once per year. These firearms were handled by EMS personnel over a quarter of the time. Sixty-eight percent of prehospital providers were unaware of any agency policy regarding handling firearms. Despite broad personal experience with firearms, 90% of respondents received no agency training in gun safety. Eighty-seven percent of providers reported they would attend an agency training course on firearm safety, and 95% indicated that this topic should be added to the EMS curriculum. Conclusion - EMS personnel in West Texas and Southern New Mexico routinely encounter and handle guns despite minimal agency firearm safety training. This initial study may demonstrate a potential need for introducing firearm safety didactics and training into the EMS curriculum, and the need for additional research.

Perceptions of Firearm Safety and Youth Suicide Among Adults With a Child in Their Home.

Perceptions of Firearm Safety and Youth Suicide Among Adults With a Child in Their Home.

Emergency Department Visits Among Adolescents for Intentional Assault, Firearm, Poison, and Self-Harm Injuries Before and During the COVID-19 Pandemic in the United States.

Purpose This study aimed to examine changes in adolescent emergency department (ED) visits for firearm, poison, self-harm, and intentional assault injuries before and during the COVID-19 pandemic and to identify sociodemographic factors influencing these variations. Methods Utilizing the Nationwide Emergency Department Sample (NEDS), the study analyzes data for intentional self-harm, poison-related, intentional assaults, and firearm injuries from 2019 to 2021 in adolescents aged 10 to 18 years. A difference-in-differences analysis was conducted to investigate the potential impacts of COVID-19 on injury-associated ED visits, accounting for adjustments related to year, patient factors, and hospital characteristics. Results There was a substantial decline in the number of all ED visits from pre-COVID to during the COVID, but we observed increases in the volume of ED visits for firearm-related injuries (13,248 to 20,611; p-value < 0.0001), poison-related injuries (147,812 to 213,753; p-Value < 0.0001), and intentional self-harm-related injuries (153,297 to 229,591; p-value < 0.0001). Conversely, intentional assault-related injuries decreased (167,614 to 154,940; p-value < 0.0001). During the COVID-19 pandemic, ED visits for intentional self-harm increased by 15% (95% CI = 1.09-1.21), intentional assault by 6% (95% CI = 1.02-1.09), and poison-related injuries by 17% (95% CI = 1.11-1.21) compared to pre-pandemic levels. Racial disparities were observed, with Black individuals having lower odds of self-harm (aOR = 0.63) and poison-related visits (aOR = 0.69) but higher odds of assault-related visits (aOR = 1.40) compared to Whites. Hispanic individuals had fewer ED visits across all injury types, while Native Americans had higher odds across all injury types. Disparities between Black and White individuals in assault-related visits narrowed during the pandemic (aOR = 1.40 to 0.94), but disparities for Native Americans in assault-related injuries widened. Insurance status influenced ED visits, with Medicaid recipients having higher odds of self-harm (aOR = 1.11) but lower odds of assault visits (aOR = 0.82) compared to those with private insurance. Uninsured adolescents had lower odds of self-harm (aOR = 0.85) and poison-related visits (aOR = 0.95), but higher odds of assault-related visits (aOR = 1.17). Gender disparities persisted, with females having higher odds of self-harm (aOR = 1.66) and poison-related visits (aOR = 1.42) but lower odds of assault-related visits (aOR = 0.91) compared to males, with these disparities widening for self-harm and poison-related visits during the pandemic. Conclusions The findings underscore the heightened vulnerability of adolescents to certain injuries during the COVID-19 pandemic. Targeted interventions and policies to support mental health, firearm safety measures, and strategies to prevent poisoning are recommended. Addressing socioeconomic disparitiesis necessary to mitigate the impact of intentional injuries among racially/ethnically diverse adolescents during future pandemics.

Parental Engagement With Children Around Firearms and Unsecure Storage

This cross-sectional study analyzed the association between parents’ engagement with their children regarding responsible and safe firearm use and the security of firearm storage in their homes.

A national study of firearm exposure and safety training among rural youth

BackgroundData regarding rural youths’ experience with firearms, including safety training, is highly limited despite their frequent presence in homes. Our objective was to investigate rural adolescents’ use of firearms and whether they had received formal firearm training.MethodsA convenience sample of 2021 National FFA (formerly Future Farmers of America) Convention & Expo attendees were given an anonymous survey at the University of Iowa Stead Family Children’s Hospital injury prevention booth. The survey explored their use of rifles/shotguns and handguns and whether they had completed a certified firearm safety course. Descriptive and comparative analyses, including multivariable logistic regression analyses, were performed on compiled data.Results3206 adolescents ages 13–18 years participated with 45% reporting they lived on a farm or ranch. The vast majority of participants (85%) had fired a rifle/shotgun; 43% reported firing them > 100 times. Of those that had fired rifles/shotguns, 41% had done so before 9 years old. Most had also fired a handgun (69%), with 23% having fired handguns > 100 times. Of those that had fired handguns, 44% had done so before 11 years. Average age for first firing rifles/shotguns was 9.5 (SD 3.1) years, and 11.1 (SD 3.0) years for handguns. Males, non-Hispanic Whites, and those living on farms or in the country had significantly greater percentages who had fired a rifle/shotgun or a handgun. Significant differences were also seen by U.S. census region. Over half (64%) reported having gone hunting. Of those that had used a firearm, 67% had completed a firearm safety training course. Overall, 23% were/had been members of a school or club shooting team and of these, 87% had taken a safety course.ConclusionsMost FFA member participants had fired both rifles/shotguns and handguns, many at very young ages. Significant differences in firearm use were noted by demographic factors including the home setting (i.e., farms and ranches) and their U.S. census region. Nearly one-third of adolescent firearm users had not received formal safety training. Promoting firearm safety should include advising families on when it is developmentally appropriate to introduce youth to firearms and on the importance of firearm safety training.

Implementation of a Secure Firearm Storage Program in Pediatric Primary Care

Increased secure firearm storage can reduce youth firearm injury and mortality, a leading cause of death for children and adolescents in the US. Despite the availability of evidence-based secure firearm storage programs and recommendations from the American Academy of Pediatrics, few pediatric clinicians report routinely implementing these programs. To compare the effectiveness of an electronic health record (EHR) documentation template (nudge) and the nudge plus facilitation (ie, clinic support to implement the program; nudge+) at promoting delivery of a brief evidence-based secure firearm storage program (SAFE Firearm) that includes counseling about secure firearm storage and free cable locks during all pediatric well visits. The Adolescent and Child Suicide Prevention in Routine Clinical Encounters (ASPIRE) unblinded parallel cluster randomized effectiveness-implementation trial was conducted from March 14, 2022, to March 20, 2023, to test the hypothesis that, relative to nudge, nudge+ would result in delivery of the firearm storage program to an additional 10% or more of the eligible population, and that this difference would be statistically significant. Thirty pediatric primary care clinics in 2 US health care systems (in Michigan and Colorado) were included, excluding clinics that were not the primary site for participating health care professionals and a subset selected at random due to resource limitations. All pediatric well visits at participating clinics for youth ages 5 to 17 years were analyzed. Clinics were randomly assigned in a 1:1 ratio to receive either the nudge or nudge+. Patient-level outcomes were modeled to estimate the primary outcome, reach, which is a visit-level binary indicator of whether the parent received both components of the firearm storage program (counseling and lock), as documented by the clinician in the EHR. Secondary outcomes explored individual program component delivery. A total of 47 307 well-child visits (median [IQR] age, 11.3 [8.1-14.4] years; 24 210 [51.2%] male and 23 091 [48.8%] female) among 46 597 children and 368 clinicians were eligible to receive the firearm storage program during the trial and were included in analyses. Using the intention-to-treat principle, a higher percentage of well-child visits received the firearm storage program in the nudge+ condition (49%; 95% CI, 37-61) compared to nudge (22%; 95% CI, 13-31). In this study, the EHR strategy combined with facilitation (nudge+) was more effective at increasing delivery of an evidence-based secure firearm storage program compared to nudge alone. ClinicalTrials.gov Identifier: NCT04844021.

Characterization of Wear Patterns in Gun Barrel’s Throat Region Using Forensic Microscope: Insights Into Long-Term Effects of High-Pressure Gas Exposure

Objectives: This research aims to explore the damage sustained by the gun barrel's throat region over a long period of use, shedding light on the wear characteristics, and providing valuable insights into the long-term effects of high-pressure gas exposure during firing. Methods: To achieve this objective, the appearance of the gun barrel's throat region was characterized using forensic microscopy techniques. Visual and microscopic examinations were conducted on five (5) gun barrels with ten years or less of service usage and five (5) gun barrels with over ten years of service usage from the Philippine National Police to assess the degree of wear in the barrel’s throat region. Findings: The findings revealed varying degrees of wear in the barrel throat regions. Firearms with 10 years or less of service usage exhibited moderate corrosion, narrow cracks, and minimal soot particle presence while firearms with over 10 years of service usage showed severe corrosion, deep cracks, scattered potholes, superficial scraped surfaces, and heavy soot particle presence. Novelty: This research contributes to the understanding of barrel performance, maintenance, and potential hazards associated with aging firearms, thus providing novel insights into the long-term effects of high-pressure gas exposure during firing. By examining the changes in material properties and surface roughness of the gun barrel’s throat region, this study seeks to improve the understanding of how repeated firing impacts gun barrel performance and longevity. This, in turn, may aid in developing future maintenance practices to enhance firearm durability and safety. Keywords: Gun Barrels, Wear Characteristics, Gun Barrel Throat Region, High-Pressure Gas Exposure, Wear Patterns

Integrating firearm storage and safety devices into health care.

Millions of US children and adolescents live in homes with loaded firearms, with only half of these homes securing their guns. Firearm-related deaths among youth have doubled over the past decade, making firearms the leading cause of death for children and adolescents in the United States. The recent advisory by the US Surgeon General, identifying firearm violence as a public health crisis, underscores the urgent need for responsible firearm ownership, including safe firearm storage. However, the healthcare community currently lacks durable medical equipment (DME) codes for firearm storage devices, limiting the ability of healthcare providers to support responsible gun ownership. We propose the establishment of DME codes for firearm storage and safety devices, which would facilitate insurance coverage of these vital prevention measures. Durable medical equipment codes would empower physicians and other healthcare providers to integrate anticipatory guidance and lethal means counseling of firearm safety into routine care and support hospital- and community-based efforts to prevent firearm-related injuries and deaths among children and adolescents.

A Randomized Trial of Virtual Reality Training to Improve Firearm Safety Counseling Skills

ObjectiveTo evaluate the efficacy of Resident Education And Counseling on Household (REACH) Firearm Safety, a novel virtual reality (VR) intervention. MethodsWe conducted a single-center, randomized controlled trial among pediatric residents in a Midwestern academic primary care center comparing REACH Firearm Safety with didactic training (intervention) to didactic training alone (control). In the intervention arm, participants practiced firearm safety counseling with virtual characters and received immediate feedback. All residents completed audio-recorded standardized patient (SP) encounters before and after the training as well as a retrospective pre-post survey. Two reviewers, blinded to the allocation arm, used a standardized assessment tool to generate performance scores. Outcomes of interest included the difference between groups in SP performance scores and self-reported confidence. ResultsFrom March to July 2023, 62% of eligible pediatric residents (n = 47/76) completed the allocated study tasks (intervention 19, control 28). In both groups, SP performance scores and self-reported confidence improved. Compared to the control group, the intervention group demonstrated improvement in sharing information on secure storage devices (P = 0.009) and increased confidence in providing information on secure storage (P = 0.002). ConclusionsCompared with didactic training alone, a VR intervention using deliberate practice improved residents’ skills and confidence related to firearm safety counseling.

Pilot Evaluation of a Co-Designed Gamified Farm Injury Prevention Educational Resource for Adolescents

ABSTRACT Objectives Adolescents are at-risk of fatal and non-fatal injuries in the farm environment. School-based agricultural safety and farm injury prevention education is likely to be more effective when utilizing co-designed and gamification principles; however, this needs to be tested. This study examined data from a pilot evaluation of a co-designed farm injury prevention gamified educational resource for adolescents. Methods Online, anonymous surveys were conducted with students studying agriculture in regional Australia who had previously participated in the co-design process to develop “Calm Your Farm”. Three courses were developed (vehicles, workshop, and water safety) and before and after playing each of the courses for the first time, students completed survey questions regarding self-reported knowledge on the course topic, and assessment of content, design, ease of play, and how much they learned. Survey data were analyzed using descriptive statistics, chi square tests of association, and independent sample t tests. Results We analyzed 66 responses (66.7% male; 60.6% aged 13 years). Staged course release meant all respondents assessed the vehicle and workshop courses, while 58% assessed the water safety course. Vehicle and workshop courses were rated 7.64 out of a possible 10 (SD = 1.85) and 7.65 (SD = 1.78), respectively, for the information presented, slightly higher than water safety (7.47 [SD = 1.91]). Statistically significant improvements in self-reported knowledge post play were seen among boys for the water safety course (63% said knowledge improved; X2 = 4.98; p = .026) and 13-year-olds for vehicles (35%; X2 = 4.31; p = .038) and workshop safety (50%; X2 = 4.29; p = .038). Respondents indicated being more likely to replay the game at school (M = 6.62 [SD = 2.96]) than at home (M = 5.57 [SD = 3.07]). Of respondents, 61% (n = 40) agreed that “Calm Your Farm” taught them more about farm safety and was more fun than other farm safety education previously received. Tractor safety (62%), chemical safety (58%), and firearm safety (58%) were the most popular topics suggested to be added to the game. Conclusion The co-design and gamification approach taken with “Calm Your Farm” appeared to be successful in improving self-reported knowledge around farm injury prevention and was perceived by 62% of the respondents as being fun and educational. Future expansion should incorporate student suggested topics.

Acceptability and feasibility of video-based firearm safety education in a Colorado emergency department for caregivers of adolescents in firearm-owning households

BackgroundEasy firearm access increases injury risk among adolescents. We evaluated the acceptability and feasibility of improving knowledge of a 3 min safe firearm storage education video in the paediatric emergency...

Suicide among Veterans in Veterans Health Administration care: Differences in methods by tier of predicted suicide risk

Veterans' suicide rates exceed those of non-Veteran adults, and Veteran suicides more often involve firearms. However, the relationship between Veteran characteristics and suicide method is not well understood. Using the Veteran Health Administration suicide prediction algorithm, we assessed differences in suicide method by predicted risk among Veteran suicide decedents. Significant predictors of firearm involvement included lower algorithm-predicted suicide risk, no recent suicide attempts, male sex, and older age. Non-firearm methods were most common at high tiers of suicide risk. Firearm safety counseling is important for all Veterans and non-firearm lethal means safety counseling may be particularly important for high-risk Veterans.