Firearm Safety Research Articles

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

To examine rankings of credible sources for discussing secure storage within a representative sample of firearm-owning service members, and examine how combinations of demographic variables impact the ranking of credible sources. The probability-based sample was collected with the help of Ipsos. Participants were US service members who owned a firearm at the time of the survey (n = 719). The total sample ranked service members, Veterans, and members of law enforcement as the most credible sources and faith leaders, casual acquittances, and celebrities as the least credible sources. Black men ranked the NRA as a highly credible source whereas Black females ranked the NRA as one of the least preferred sources. Regardless of political preference, those who lived in non-metropolitan rural environments ranked members of law enforcement as highly credible sources. Those who lived in non-metropolitan rural and urban settings and identified as liberal ranked the National Shooting Sports Foundation as a highly credible source. Law enforcement officers, military members, and Veterans are ranked as highly credible sources by most subgroups of firearm-owning service members. Leveraging these voices in firearm safety conversations is necessary, may increase adherence to secure storage recommendations, and ultimately reduce suicide.

Public Health in the Crosshairs of Culture Wars

This JAMA Forum discusses the topics of reproductive rights, transgender care, firearm safety, and COVID-19 vaccines in the context of public health and the political climate in the US.

A Study of Households with Children and Firearms in Baltimore, Maryland.

Firearm injuries are the leading cause of death among children and adolescents in the US. Safe storage of firearms in the home is one of the most effective ways of preventing firearm injuries in children. This feasibility study was conducted in both the pediatric and general Emergency Departments of a large urban academic medical center in a community with high rates of firearm injuries in children. The objective was to pilot a survey seeking to describe sociodemographic characteristics, firearm specific risk factors, and firearm storage practices of households with children in the community. One hundred participants completed a survey containing items regarding participant demographics, household features, firearm ownership, firearm characteristics, and storage practices. Descriptive statistics were used to define sociodemographic characteristics of the enrolled population, comparing those with firearms to those without, and to describe firearms and storage practices of firearm owners in households with children. Of 100 participants, 30 lived in households with firearms and children. Most firearms in homes with children were stored locked and unloaded most of the time; however, 30% of participants with firearms and children in the home reported not consistently storing a firearm locked and unloaded. The most common reason given for not storing a firearm in the safest manner possible was that storing a firearm locked and unloaded would make it difficult to access quickly. Engaging families with children in discussions around firearm prevention during Emergency Department visits is feasible and may have implications for future efforts to promote safe firearm storage practices.

Firearm exposure and safety training of rural Iowa youth.

Our objective was to investigate rural adolescents' use of firearms and whether they had received firearm training. 2019 Iowa FFA Leadership Conference attendees were surveyed. Descriptive and comparative analyses were performed. One thousand three hundred and eighty-two FFA members aged 13-18 years participated. The vast majority (85%) had fired a rifle/shotgun; 58% reported firing them >20 times. Of those who had fired rifles/shotguns, 32% had done so before 9 years old; 79% before 13 years. Most had also fired a handgun (62%), with 30% having fired handguns >20 times. Of those who had fired handguns, 34% had done so before 11 years old. The average age for first firing rifles/shotguns was 10.1 (SD 2.9) years, and 11.9 (SD 2.8) years for handguns. Males, older teenagers, and those living on farms or in the country had significantly greater percentages that had fired a rifle/shotgun or a handgun. Greater proportions of males had used firearms >20 times and started firing them at younger ages. Over half (55%) reported having gone hunting. Of those, 24% first hunted before 9 years old; 48% before 11 years. Of those who had used a firearm, 61% had completed a firearm safety training course. For hunters, 80% had taken a course. Most participants had used firearms, and many did so at very young ages. Substantial numbers had not received formal training. The authors believe that families should be counseled when it is developmentally appropriate to introduce youth to firearms, and all should take firearm safety training before using them.

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

ObjectivesTo understand how crime and victimisation fears and risks operate alongside social status threats and motivations to shape unsafe in-home firearm storage practices and beliefs.MethodsUsing data from firearm owners identified...

Strategies for recruiting adolescents in rural areas in firearm injury research

BackgroundParticipant recruitment is a central aspect of human sciences research. Barriers to participant recruitment can be categorised into participant, recruiter and institutional factors. Firearm injury research poses unique barriers to...

Reducing firearm access for youth at risk for suicide in a pediatric emergency department.

Firearm-related suicide is the second leading cause of pediatric firearm death. Lethal means counseling (LMC) can improve firearm safe-storage practices for families with youth at risk of suicide. This study aims to evaluate the feasibility of pediatric emergency department (ED) behavioral mental health (BMH) specialists providing LMC to caregivers of youth presenting with BMH complaints and to test for changes in firearm safety practices, pre-post ED LMC intervention, as measures of preliminary efficacy. Prospective pilot feasibility study of caregivers of youth presenting to a pediatric ED with BMH complaints. Caregivers completed an electronic survey regarding demographics and firearm safe-storage knowledge/practices followed by BMH specialist LMC. Firearm owners were offered a free lockbox and/or trigger lock. One-week follow-up surveys gathered self-reported data on firearm safety practices and intervention acceptability. One-month interviews with randomly sampled firearm owners collected additional firearm safety data. Primary outcomes were feasibility measures, including participant accrual/attrition and LMC intervention acceptability. Secondary outcomes included self-reported firearm safety practice changes. Feasibility benchmarks were manually tabulated, and Likert-scale acceptability responses were dichotomized to strongly agree/agree vs. neutral/disagree/strongly disagree. Descriptive statistics were used for univariate and paired data responses. In total, 81 caregivers were approached; of which, 50 (81%) caregivers enrolled. A total of 44% reported having a firearm at home, 80% completed follow-up at one week. More than 80% affirmed that ED firearm safety education was useful and that the ED is an appropriate place for firearm safety discussions. In total, 58% of participants reported not having prior firearm safety education/counseling. Among firearm owners (n = 22), 18% reported rarely/never previously using a safe-storage device, and 59% of firearm owners requested safe storage devices.At 1-week follow-up (n = 40), a greater proportion of caregivers self-reported asking about firearms before their child visited other homes (+28%). Among firearm owners that completed follow-up (n = 19), 100% reported storing all firearms locked at one week (+23% post-intervention). In total, 10 caregivers reported temporarily/permanently removing firearms from the home. It is feasible to provide LMC in the pediatric ED via BMH specialists to families of high-risk youth. Caregivers were receptive to LMC and reported finding this intervention useful, acceptable, and appropriate. Additionally, LMC and device distribution led to reported changes in safe storage practices.

An approach to evaluation of digital data in public health campaigns

Mass media campaigns for public health often rely heavily on digital media and advertising tools that are customarily the domain of marketing professionals and primarily used for commercial purposes. Digital campaigns also generate a myriad of metrics, which can pose both a challenge and opportunity for scientists wishing to leverage these data for research and evaluation. Objective The aim of this article is to provide practical guidance for the evaluation of paid media campaigns, with a focus on analyzing digital data generated directly by the campaign. Methods Building off the Centers for Disease Control framework for program evaluation, we describe a step-by-step process for evaluation tailored to the unique considerations of digital and paid media campaigns. We contextualize our guidance with our experience evaluating a suicide prevention campaign conducted from 2021 to 2023 that focused on firearms safety in U.S. military veterans. Results Key terminology, conceptual models, and selected findings from our evaluation are presented alongside our guidance. Conclusions We conclude with key lessons learned and offer recommendations that are broadly applicable to evaluation of other digital campaigns.

Domestic firearm violence against women (2018–2021)

BackgroundOver 50 % of US female homicides occur during domestic violence, with half involving firearms. Public health measures to control COVID-19 may have isolated individuals with abusive partners at a time when firearm sales and new firearm ownership surged. This study sought to evaluate trends in domestic firearm violence (DFV) over time, hypothesizing that rates of DFV increased in the wake of COVID-19. Materials and methodsA retrospective query of the Gun Violence Archive (2018–2021) was conducted for incidents of DFV. The primary outcome was the number of DFV-related shootings. Statistical testing, including one-way and two-way ANOVAs, was performed to compare monthly rates of DFV over time and to compare DFV per 100,000 women in states with strong versus weak gun laws. ResultsAverage monthly DFV incidents rose nationwide during this study's time period, though injuries and fatalities did not. States with weaker gun laws had increased incidents, deaths, and injuries from 2018 to 2021 (all p<0.05). In a two-way ANOVA, stronger gun laws were associated with fewer incidents of DFV when compared with weaker gun law states. We also found that the use of a long gun in DFV more often resulted in a victim's death when compared to a handgun (p<0.01). ConclusionDFV incidents increased over time. States with weaker gun laws bore the brunt of the violence, demonstrating that DFV may be curtailed through legislative efforts. Methods of injury prevention aimed at preventing and reducing domestic violence and improving firearm safety may curtail DFV.

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

In the USA, an estimated 45% of veterans personally own firearms. Firearm access increases the risk of suicide, so suicide prevention efforts in the US Department of Defense (DoD) focus on lethal means safety, including reducing firearm access. Spouse input may enhance effective messaging and intervention delivery of lethal means safety. This study used qualitative methods to explore the perspectives of military spouses or partners on personal firearm storage, including at-home decisions, on-base storage and existing messaging from the DoD. Qualitative data were obtained using 1:1 interviews and focus groups with spouses/partners of US military service members (active duty, Reserve, National Guard, recently separated from the military) and representatives from military support organisations. Sessions focused on personal firearm storage (at home or on military installations) and military messaging around secure firearm storage and firearm suicide prevention. Data were analysed using a team-based, mixed deductive-inductive approach. Across 56 participants (August 2022-March 2023), the themes were variability in current home firearm storage and spousal participation in decision-making; uncertainty about firearm storage protocols on military installations; mixed awareness of secure firearm storage messaging from the military; and uncertainty about procedures or protocols for removing firearm access for an at-risk person. US military spouses are important messengers for firearm safety and suicide prevention, but they are currently underutilised. Tailored prevention campaigns should consider spousal dynamics and incorporate education about installation procedures.

The Views of Police Officers Toward Gun Legislation and Public Health Policies Driven by Firearm Safety Concerns.

Gun violence is a principal cause of premature death in America. It has been suggested that solutions to gun violence may be found using a public health approach, which is broader than dealing with the problem via law enforcement alone. A component of a public health approach to gun violence is the implementation of policies or laws. Unfortunately, there is a serious gap in our understanding of how street-level police officers view proposed or existing firearms legislation. This is an important omission, because it is line-level personnel who are tasked with enforcing these policies within highly discretionary contexts. We surveyed police from three jurisdictions to establish a baseline understanding of officers' views about potential gun legislation and identify possible resistance and implementation barriers of firearms laws. The findings suggest that those responsible for enforcing new laws show limited or mixed support for the same. Officers were most supportive of laws that increase the presence of trained gun owners within certain contexts and ensure that individuals with criminal backgrounds or mental health concerns do not have access to firearms. Most officers support prohibiting gun ownership following conviction of a domestic violence offense. However, officers generally opposed gun legislation banning assault weapons, large capacity magazines, and internet ammunition purchases. Finally, officers with the Buffalo Police Department-which recently had experienced an active-shooter event-were more supportive of almost all types of legislation. Respondents expressing greater concern about officer safety related to firearms were supportive of several types of firearm legislation.

Conversation starters: Understanding the facilitators and barriers to physician-initiated secure firearm storage conversations

ObjectiveThis paper aims to understand what general practice physicians (GPs) perceive as facilitators and barriers to initiating anticipatory guidance around firearm safety. MethodsWe employ qualitative interviewing to have in-depth conversations with 18 GPs. Participants were randomly selected from a national panel of physicians and screened for specialty (general practice or internist), practice setting (not hospital-based), and time spent on direct patient care (80% +). The sample was stratified at the state level by the presence of safe storage or child access protection laws, with half of the participants selected from each stratum. ResultsWe identify five physician-perceived barriers to providing secure firearm storage counseling, including inadequate screening mechanisms to trigger conversations, physician perceptions of who is at risk for firearm injury, time pressures, concerns about patient receptivity, and a need for training. ConclusionPrior to focusing on how to have conversations about firearm safety, interventions designed to increase the incidence of physician-initiated guidance need to address the structural issues of why those conversations typically do not occur. Practice implicationsFindings indicate the need for revised screening tools and improved physician education as to who is at risk for gun injury and how to best approach firearm safety conversations.

The role of nurses in firearm safety

Many nursing organizations have taken a position on this pressing issue.

Surgeon views on firearm safety counseling in clinical practice: A cross-sectional survey.

Firearms are commonplace in the United States, and one proposed strategy to decrease risk of firearm injury is to have physicians counsel their patients about safe firearm ownership. Current rates of firearm safety counseling by surgeons who care for injured people are unknown. This study used an anonymous cross-sectional survey derived from previously published survey instruments and was piloted (n = 13) at the annual meeting of the American Association for the Surgery of Trauma (2022). The finalized survey was distributed using a quick response code during two sessions at the 2022 American College of Surgeons Clinical Congress. Eligible participants included the surgeons and surgical trainees who attended these sessions. One hundred fourteen individuals completed the survey (20% response rate), and a majority were male (n = 71 [62.3%]), attending surgeons (n = 108 [94.7%]), and specialized in acute care surgery (n = 72 [63.2%]). Few participants (n = 43 [37.7%]) reported counseling patients on firearm safety as part of their routine clinical practice; however, the majority (n = 102 [89.5%]) believed that surgeons should provide firearm safety counseling. Counseling rates did not vary significantly by age, sex, surgical specialty, or region of practice, but attitudes toward counseling did differ by firearm safety counseling practices ( p = 0.03) and region of practice (0.04). Noted barriers to counseling included lack of time (n = 47 [41.2%]), perceived lack of training (n = 43 [37.7%]), and lack of firearm knowledge/experience (n = 36 [31.6%]). Most surgeon respondents did not provide firearm safety counseling to their patients despite the fact the majority believed they should. This suggests that counseling interventions that do not solely rely on surgeons for implementation could increase the number of patients who receive firearm safety guidance during clinical encounters. Prognostic and Epidemiological; Level III.

Engagement with Preventive Health Behaviors and Safe Firearm Storage Practices Using the 2017 Behavioral Risk Factor Surveillance System.

"Behavioral bundling" is a theory that explains how some health behaviors reinforce one another. This study aims to investigate the relationship between preventive health behaviors (PHBs) and safe firearm storage. This study used a cross-sectional design using 2017 Behavioral Risk Factor Surveillance Survey data. Survey participants resided in California, Idaho, Kansas, Oregon, Texas, and Utah. There were 12,817 people living in households with a firearm included in this study. We classified individuals' engagement in 5 PHBs: cholesterol screening, influenza immunization, physical activity, primary care, and seatbelt use. We defined safe firearm storage as storing a firearm unloaded, or loaded but locked. Using Poisson regression models, we calculated adjusted prevalence ratios (aPRs) to estimate the association between engagement in the five PHBs with safe firearm storage. Most firearm owners reported safe firearm storage (80.3%). The prevalence of safe firearm storage was 3% higher for each additional PHB engaged in (aPR = 1.03 [1.01, 1.05]). There was a higher prevalence of safe firearm storage among those who always wore a seatbelt while driving or riding in a car compared to those who did not (aPR = 1.12 [1.05, 1.18]). This study found preliminary evidence to suggest that engagement in seatbelt usage may be bundled with safe firearm storage, though we are not able to determine causality.

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

RationaleThere are theoretical reasons to expect loneliness related to firearm purchasing. For instance, loneliness might amplify social isolation and feelings of insecurity, anxiety, perceived danger, and need for self-reliance. Purchasing a firearm might be seen as a way to bolster one's security and gain a sense of control when faced with potential threats, yet there is a lack of research assessing this possibility. ObjectiveThis study aimed to examine the relationship between loneliness and purchasing a firearm among a sample of low-income U.S. military veterans. MethodsData are from a national survey of 1,004 low-income U.S. veterans collected in December 2022 and January 2023. Firth logistic regression—a rare event logistic regression model to address small-sample bias stemming from rare outcomes through a penalized likelihood approach—was used to estimate the adjusted association between loneliness and purchasing a firearm in the past year. ResultsApproximately 5.4% reported the purchase of a new firearm in the past year, and respondents reported an average loneliness score of 1.82 (standard deviation = 1.96; range = 0–6). Results of Firth Logit regression analyses found that net of control variables for demographic, socioeconomic, and household characteristics, loneliness was positively associated with purchasing a firearm in the past year (OR = 1.167, 95% CI = 1.006, 1.352). ConclusionThe findings indicate that loneliness among U.S. military veterans is associated with firearm purchasing. Considering the risks posed by both loneliness and firearm ownership for veteran suicide, the findings suggest the need for greater focus and synergistic strategies to address loneliness and safe firearm practices among U.S. veterans.

Mass shootings, firearm injuries, and mental health

IntroductionThe correlation between mass shootings, firearm injuries, and mental health is an ongoing polarized debate within the U.S., making it essential to develop public policy on mental illness and firearm injuries exacerbated by a significant increase in firearm sales in March 2020. Although many mass shooters are labeled “mentally ill,” mental illness is only present in a small minority of cases. Most mentally ill people are never violent but are more likely to be the victims of violence.Easy access to firearms and a triggering event deriving from social and economic inequalities are primary causes of mass shootings and growing online radicalization. Radicalization can easily lead to fatal firearm injuries, particularly for individuals with diagnosed or undiagnosed mental illness. RecommendationsProposed solutions include permits for firearms purchase, including a 25-year-old age limit, universal background checks, and banning large-capacity magazines. Additionally, a speedy and effective law enforcement response is the sole factor and the most reliable way to stop a mass shooting once it has started. The research identified several other recommendations, including expanding Medicare and mental health care access, expanding school safety and law enforcement training, and promoting public education about mental health and firearm safety.

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

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

Provider Perspectives on Addressing Firearm Safety with Older Adults in Primary Care

ABSTRACT Objectives Chronic conditions, including mild cognitive impairment and depression, place older adults at high risk of firearm suicide. Approximately 40% of older adults have access to a firearm, and many do not store their firearms safely. However, firearm counseling occurs infrequently in clinical settings. Using by the Ottawa Decision Support Framework (ODSF) to conceptualize the decisional support needed by patients and their providers to facilitate firearm counseling, we explore provider perspectives on desired resources for addressing firearm safety with older adult patients. Methods From March – August 2022, we conducted 21 semi-structured interviews with primary care providers caring for older adults. We report deductive concepts as well as emergent themes. Results Major themes were identified from the three components of the ODSF; decisional needs, decision support and decisional outcomes. Themes included: provider self-efficacy to conduct firearm counseling, clinical workflow considerations, stories for change, patient diagnosis implications, and caregiver involvement. Conclusions There is a need for decision aids in the clinical setting that facilitate firearm counseling and promotes shared decision-making about firearm storage. Clinical Implications Implementing a decision aid in the clinical setting can improve provider self-efficacy to conduct firearm counseling and help reduce risk factors associated with firearm-related harm among older adults.

Firearm Safety &amp; Mental Health: A Call to ARMS (Assess and Reduce Means to Suicide)

Firearm violence is a significant public health problem. Public opinion data suggests that most Americans support evidence-based policies that can help reduce firearm violence. Even without national policy changes, nurses can refocus the conversation and make a lasting impact by acting now. Suicide is the leading cause of firearm-related deaths. Unsafe firearm storage is associated with a higher risk for self-directed violence. Nurses are uniquely positioned to promote a safety culture around firearms and safe storage practices. Nurses can assess, screen, and provide education to patients that can help decrease deaths related to firearms. This article explores how the attributes of cultural humility provide an outline and framework that can enable nurses to respond to the risk of firearm violence and take up a call to ARMS – Assess &amp; Reduce Means to Suicide.