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Hollon H, Thacker L, Wolf E, Dinov D, Risney S, Kamdar H, Ferrante C, Ryan MS. A Resident-Led Firearm Curriculum for Pediatrics Residents Improves Safe Storage Counseling. J Pediatr 2023; 263:113680. [PMID: 37607648 DOI: 10.1016/j.jpeds.2023.113680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/21/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE To develop and implement a resident-led firearm safety curriculum, delivered to pediatrics residents, and to evaluate outcomes. STUDY DESIGN A firearm safety curriculum was developed in 2019-2020 at a single academic center, using Kern's framework and cognitive load theory. The curriculum was organized using the "Be SMART" firearm safety model. Sessions were led by resident peers. The content included workshops on firearm safety counseling, advocacy training, and a gun lock program in collaboration with the local police department. Content was integrated into existing residency didactic curriculum. Impact was measured by a pre/posttest knowledge assessment and a systematic chart review. RESULTS The curriculum was provided to 41/66 (62%) pediatrics residents. Knowledge improved (67% to 77% correct) when comparing pre-intervention with post-intervention. A total of 1477 charts were reviewed. Compared with a historical cohort, participants more often asked about presence of a firearm (27% vs 69%, P < .0001) and counseled on firearm safety (9% vs 25%, P < .0001). In the post-intervention timeframe, 25% of eligible families were provided a gun lock. CONCLUSIONS A firearm safety curriculum designed by pediatrics residents and administered to their peers resulted in a statistically significant improvement in inquiries about firearm ownership and safety counseling in an urban tertiary care continuity clinic. These results demonstrate the promising outcomes of a firearm safety program developed by residents and delivered to peers.
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Affiliation(s)
- Hannah Hollon
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond
| | - Leroy Thacker
- Department of Biostatistics, Virginia Commonwealth University
| | - Elizabeth Wolf
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond
| | - Darina Dinov
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond
| | - Scott Risney
- Department of Pediatrics, Vanderbilt University School of Medicine, Monroe Carell Jr. Children's Hospital
| | - Heemali Kamdar
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond
| | - Christopher Ferrante
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Children's Hospital of Richmond
| | - Michael S Ryan
- Department of Pediatrics, University of Virginia School of Medicine.
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2
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Buck-Atkinson J, McCarthy M, Stanley IH, Harnke B, Anestis MD, Bryan CJ, Baker JC, Betz ME. Firearm locking device preferences among firearm owners in the USA: a systematic review. Inj Epidemiol 2023; 10:33. [PMID: 37415242 DOI: 10.1186/s40621-023-00436-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/25/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Preventing firearm-involved injuries is a critical public health priority. Firearm locking devices can prevent firearm injuries, such as suicide and unintentional shootings, as well as theft. Various firearm locking devices exist; however, little is known about firearm owners' preferred locking devices for secure firearm storage. In this systematic review, we examined existing literature on preferred locking devices for secure storage of personal firearms among United States (US) firearm owners with the purpose of understanding practical implications and needs for future research. METHODS We searched 8 major databases, as well as the grey literature, for English-language sources published on or before January 24, 2023, that empirically examined firearm locking device preferences. Following PRISMA guidelines, coders independently screened and reviewed 797 sources using pre-determined criteria. Overall, 38 records met inclusion criteria and were included in this review. RESULTS The majority of studies measure and report on participant use of various types of locking devices, but few go on to measure preference between device options and the attributes and features that may contribute to an individual's preference. Included studies suggest that a preference for larger devices, such as lockboxes and gun safes, may exist among US firearm owners. CONCLUSIONS Review of included studies suggests that current prevention efforts may not be aligned with firearm owners' preferences. Additionally, findings from this systematic review emphasize the need for additional methodological rigorous research to understand firearm locking device preferences. Expanded knowledge in this area will result in actionable data and foundational best practices for programming that encourages behavior change concerning secure storage of personal firearms to prevent injury and death.
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Affiliation(s)
- Jessica Buck-Atkinson
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA.
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place B119, Aurora, CO, 80045, USA.
| | - Megan McCarthy
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place B119, Aurora, CO, 80045, USA
| | - Ian H Stanley
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Center for COMBAT Research, Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, 12950 E Montview Blvd, Aurora, CO, 80045, USA
| | - Michael D Anestis
- Rutgers School of Public Health, New Jersey Gun Violence Research Center, 683 Hoes Lane West, Piscataway, NJ, 08854, USA
- School of Public Health, The State University of New Jersey, 683 Hoes Lane West, Rutgers, Piscataway, NJ, 08854, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH, 43214, USA
| | - Justin C Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 3650 Olentangy River Rd, Suite 330, Columbus, OH, 43214, USA
| | - Marian E Betz
- Firearm Injury Prevention Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place B119, Aurora, CO, 80045, USA
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue B215, Aurora, CO, 80045, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
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Malik F, Mari PC, Jr SNA, Needlman R. Missed Opportunities for Suicide Prevention in Teens with ADHD. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2023.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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4
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Brunson RK, Wade BA, Hitchens BK. Examining risky firearm behaviors among high-risk gun carriers in New York City. Prev Med 2022; 165:107179. [PMID: 35933002 DOI: 10.1016/j.ypmed.2022.107179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/01/2022] [Accepted: 07/30/2022] [Indexed: 11/24/2022]
Abstract
Precarious firearm conduct among inexperienced gun possessors has the potential to intensify firearm-related fatalities and injuries. The current study involves face-to-face interviews with 51 high-risk (and prohibited) residents of Brooklyn and the Bronx, NY, each of whom have either been shot or shot at. We analyze study participants' lived experiences regarding urban gun violence (including as victims and perpetrators), firearm handling, sharing, and improper storage. Despite claiming to be knowledgeable about firearm fundamentals, the vast majority of respondents acknowledged never having received professional instruction, but rather "figured it out" by "playing around" with available guns. These informal methods were shaped by respondents' desire to arm themselves despite inadequate access to firearm training. Study participants also described routinely stashing firearms in unsecure, easily accessible locations. Our study findings have important implications for informing community-based harm reduction and safety strategies among persons within high-risk networks.
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Affiliation(s)
- Rod K Brunson
- Department of Criminology & Criminal Justice, University of Maryland, USA.
| | - Brian A Wade
- Crime and Justice Policy Lab, University of Pennsylvania, USA
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5
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Lee LK, Fleegler EW, Goyal MK, Doh KF, Laraque-Arena D, Hoffman BD, Injury Violence And Poison Prevention CO. Firearm-Related Injuries and Deaths in Children and Youth. Pediatrics 2022; 150:189687. [PMID: 36207778 DOI: 10.1542/peds.2022-060071] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States. In 2020, firearms resulted in 10,197 deaths (fatality rate 9.91/100,000 youth 0-24 years old). Firearms are the leading mechanism of death in pediatric suicides and homicides. Increased access to firearms is associated with increased rates of firearm deaths. Substantial disparities in firearm injuries and deaths exist by age, gender, race, ethnicity, and sexual orientation and gender identity and for deaths related to legal intervention. Barriers to firearm access can decrease the risk to youth for firearm suicide, homicide, or unintentional shooting injury and death. Given the high lethality of firearms and the impulsivity associated with suicidal ideation, removing firearms from the home or securely storing them-referred to as lethal means restriction of firearms-is critical, especially for youth at risk for suicide. Primary care-, emergency department-, mental health-, hospital-, and community-based intervention programs can effectively screen and intervene for individuals at risk for harming themselves or others. The delivery of anticipatory guidance coupled with safety equipment provision improves firearm safer storage. Strong state-level firearm legislation is associated with decreased rates of firearm injuries and death. This includes legislation focused on comprehensive firearm licensing strategies and extreme risk protection order laws. A firm commitment to confront this public health crisis with a multipronged approach engaging all stakeholders, including individuals, families, clinicians, health systems, communities, public health advocates, firearm owners and nonowners, and policy makers, is essential to address the worsening firearm crisis facing US youth today.
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Affiliation(s)
- Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Kiesha Fraser Doh
- Division of Pediatrics and Emergency Medicine, Emory University/Children's Healthcare of Atlanta, Atlanta, GA
| | - Danielle Laraque-Arena
- New York Academy of Medicine, Mailman School of Public Health at Columbia University, Departments of Epidemiology and Pediatrics, New York, NY
| | - Benjamin D Hoffman
- Division of General Pediatrics, Oregon Health and Science University, Portland, OR
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Abstract
OBJECTIVES This study explores the changing prevalence of adolescent handgun carriage, with attention to differences across sociodemographic groups. METHODS Data were drawn from repeated cross-sectional, nationally representative surveys conducted annually from 2002 to 2019, the National Survey on Drug Use & Health. The study sample included adolescents aged 12 to 17 (N = 297 055). Logistic regression models estimated the prevalence of past year handgun carriage across cohort and sociodemographic subgroups. Interactions between 4-time cohorts and other variables explored sociodemographic variability in prevalence rates over time. RESULTS Handgun carriage increased significantly, particularly among rural, White, and higher-income adolescents. Carriage increased by 41% over cohorts, with predicted prevalence rates increasing from 3.3% in 2002-2006 to 4.6% in 2015-2019. Across cohorts, rural (5.1%), American Indian/Alaskan Native (5.2%), lower-income (<$20 000; 3.9%), male (5.9%), and older (16-17 years old; 4.5%) adolescents were the most likely to report carriage. However, these patterns changed significantly over time, with White and higher-income adolescents (>$75 000) most likely to carry in the most recent cohorts. Predicted carriage rates increased from 3.1% to 5.3% among White adolescents, from 2.6% to 5.1% among higher-income adolescents, and from 4.3% to 6.9% among rural adolescents between the 2002-2006 and 2015-2019 cohorts. Carriage among Black, American Indian/Alaskan Native, and lower-income adolescents decreased. CONCLUSIONS Adolescent handgun carriage is increasing, concentrated among particular subgroups of youth, and carriage patterns across sociodemographic groups have changed over time. Programs to address the risk of adolescent gun carriage should be tailored to the specific sociocultural and place-based concerns of diverse adolescents.
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7
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Roberts B, Masiakos PT, Vacek J, Sathya C. Firearm Injury and Mortality Prevention in Pediatric Health-care Settings. Pediatr Rev 2022; 43:212-221. [PMID: 35362027 DOI: 10.1542/pir.2020-001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Bailey Roberts
- Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Peter T Masiakos
- Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA.,Massachusetts General Hospital Center for Gun Violence Prevention, Boston, MA.,Harvard Medical School, Boston, MA
| | - Jonathan Vacek
- Division of Pediatric Surgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL
| | - Chethan Sathya
- Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.,Center for Gun Violence Prevention, Northwell Health, New Hyde Park, NY
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Expanding the Safety Net: Emergency Department-Based Gun Lock Distribution for Violence Prevention. J Emerg Med 2020; 60:562-564. [PMID: 33303277 DOI: 10.1016/j.jemermed.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/01/2020] [Indexed: 11/22/2022]
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Oyetunji TA, Haider AH, Obirieze AC, Fisher M, Cornwell EE, Qureshi FG, Abdullah F, Nwomeh BC. Epidemiology of 577 Pediatric Firearm Fatalities: A 2-year Review of the National Trauma Data Bank. Am Surg 2020. [DOI: 10.1177/000313481408000418] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to delineate the epidemiology of pediatric firearm injuries, including ethno-demographic patterns with impact on years of potential life lost (YPLL). A 2-year review of the National Trauma Data Bank (2007 to 2008) was conducted. Firearm fatalities in records of patients younger than 18 years were identified. Data were analyzed by demographic and injury characteristics and YPLL was calculated by ethnicity. A total of 577 deaths were identified in the pediatric group. Blacks accounted for 49.7 per cent of the fatalities; Hispanics, 19.2 per cent; whites, 17.7 per cent, and other ethnicity, 13.4 per cent. Median Injury Severity Score was 25 with a median Glasgow Coma Scale score of 3. Traumatic brain injury was present in 84.2 per cent of the records. Assault accounted for 72.8 per cent, self-inflicted injury 12.7 per cent, and unintentional injuries were 8.2 per cent. Most firearm fatalities occurred at home (33.6%). By emergency department (ED) disposition, 29.3 per cent died in the ED, 32.9 per cent were admitted to the intensive care unit, and 30.0 per cent taken to the operating room. Blacks had a total of 17,446 YPLL, Hispanics 6,776 YPLL, and whites 6,718 YPLL. Pediatric firearm fatalities still remain an important public health concern. Inclusive gun control policies focused on primary prevention of accidental injuries may be more effective in mitigating its impact.
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Affiliation(s)
- Tolulope A. Oyetunji
- Department of Surgery, Howard University College of Medicine, Washington, DC; the
| | | | | | - Michael Fisher
- Department of Surgery, Howard University College of Medicine, Washington, DC; the
| | - Edward E. Cornwell
- Department of Surgery, Howard University College of Medicine, Washington, DC; the
| | - Faisal G. Qureshi
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; the
| | - Fizan Abdullah
- Department of General and Thoracic Surgery, Children's National Medical Center, Washington, DC
| | - Benedict C. Nwomeh
- Division of Pediatric Surgery, Ohio State University College of Medicine, Columbus, Ohio
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Ozuna L, Champion C, Yorkgitis BK. Partnering With Patients to Reduce Firearm-Related Death and Injury. J Osteopath Med 2020; 120:413-417. [DOI: 10.7556/jaoa.2020.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
In the United States, nearly 40,000 deaths per year are firearm related. Among these fatalities are approximately 1300 children. In addition, there are more than 20,000 unintentional firearm injuries per year. Osteopathic physicians have a unique opportunity to affect this public health concern through patient education. Several evidenced-based recommendations can be incorporated at the bedside to reduce firearm injuries and deaths, including gun education, safe storage, and proper disposal.
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King A, Simonetti J, Bennett E, Simeona C, Stanek L, Roxby AC, Rowhani-Rahbar A. Firearm storage practices in households with children: A survey of community-based firearm safety event participants. Prev Med 2020; 131:105952. [PMID: 31843466 DOI: 10.1016/j.ypmed.2019.105952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/05/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
Abstract
Safe firearm storage is associated with lower risk of unintentional and intentionally self-inflicted firearm injuries among children and adolescents. Ten community-based firearm safety events were conducted across Washington state from 2015 to 2018. We sought to describe characteristics of event participants and assess whether presence and age of children in the household were associated with household firearm locking practices. We assessed demographic characteristics and baseline firearm storage behaviors of participants using a 13-item survey. Multivariable Poisson regression models were used to estimate prevalence ratios (PR) and corresponding confidence intervals (CI) for the association of presence and age of children in households with prevalence of storing a household firearm unlocked. Of 2956 participants, 58.3% were male and 57.9% lived with an individual under 18 years. Among the 89.8% participants living with firearms, 40.1% stored at least one firearm unlocked and 39.1% stored at least one firearm loaded. In adjusted analyses, there was no statistically significant difference in prevalence of storing a household firearm unlocked between those living with no children (reference group) and those living with a child <11 years (PR = 0.91; 95% CI: 0.80,1.04), or a child aged 11-18 years (PR = 0.94; 95% CI: 0.81,1.09). A high proportion of participants stored a firearm unlocked or loaded at home and neither living with young children nor adolescents was associated with safe locking practices. In comparison with firearm safety interventions conducted in clinic settings, a majority of the participants in these community-based interventions were male and owned firearms.
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Affiliation(s)
- Aisha King
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Joseph Simonetti
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Rocky Mountain Mental Illness Research, Education, and Clinical Center, Veterans Health Administration, Aurora, CO, USA
| | - Elizabeth Bennett
- Seattle Children's, Seattle, WA, USA; Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | | | | | - Alison C Roxby
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
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Timsina LR, Qiao N, Mongalo AC, Vetor AN, Carroll AE, Bell TM. National Instant Criminal Background Check and Youth Gun Carrying. Pediatrics 2020; 145:peds.2019-1071. [PMID: 31792166 PMCID: PMC6939841 DOI: 10.1542/peds.2019-1071] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite being unable to purchase firearms directly, many adolescents have access to guns, leading to increased risk of injury and death. We sought to determine if the National Instant Criminal Background Check System (NICS) changed adolescents' gun-carrying behavior. METHODS We performed a repeated cross-sectional study using National Youth Risk Behavior Survey data from years 1993 to 2017. We used a survey-weighted multivariable logistic regression model to determine if the NICS had an effect on adolescent gun carrying, controlling for state respondent characteristics, state laws, state characteristics, the interaction between the NICS and state gun laws, and time. RESULTS On average, 5.8% of the cohort reported carrying a gun. Approximately 17% of respondents who carried guns were from states with a universal background check (U/BC) provision at the point of sale, whereas 83% were from states that did not have such laws (P < .001). The model indicated that the NICS together with U/BCs significantly reduced gun carrying by 25% (adjusted relative risk = 0.75 [95% confidence interval: 0.566-0.995]; P = .046), whereas the NICS independently did not (P = .516). CONCLUSIONS Adolescents in states that require U/BCs on all prospective gun buyers are less likely to carry guns compared with those in states that only require background checks on sales through federally licensed firearms dealers. The NICS was only effective in reducing adolescent gun carrying in the presence of state laws requiring U/BCs on all prospective gun buyers. However, state U/BC laws had no effect on adolescent gun carrying until after the NICS was implemented.
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Affiliation(s)
| | - Nan Qiao
- Department of Economics, School of Liberal Arts,
Indiana University, Indianapolis, Indiana
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Karras E, Stokes CM, Warfield SC, Barth SK, Bossarte RM. A randomized controlled trial of public messaging to promote safe firearm storage among U.S. military veterans. Soc Sci Med 2019; 241:112205. [PMID: 31387766 PMCID: PMC7561038 DOI: 10.1016/j.socscimed.2019.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 01/25/2019] [Accepted: 03/01/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objectives of this study were to determine whether short-term exposure to firearm safety messaging significantly improved (1) firearm storage practices, and (2) attitudes of safe firearm storage behaviors among U.S. veterans, a group at elevated risk for firearm suicide. DESIGN A three-arm, parallel-group RCT was conducted online in the U.S. nationwide from December 2015 to January 2016. SETTING A national random sample of U.S. veterans (N = 358) was recruited from the GfK KnowledgePanel, a probability-based internet panel representative of U.S. adults. All study activities were administered online over a three-week study period. INTERVENTION Participants were randomized and exposed three times (once per week) to either (a) firearm safety message only (n = 115); (b) firearm safety and mental health promotion messages (n = 133); or (c) active control group exposed to mental health promotion message only (n = 110). Each message was less than two minutes long. MEASURES Assessments were completed at baseline (pre-randomization) and at end-of-trial. Changes in awareness of risk for injuries, attitudes/beliefs related to safe storage practices, behavioral intentions, and storage practices were measured using self-reported surveys. Linear mixed effect models with weighted generalized estimating equations were used to test for exposure effects. Analyses were conducted February 2018. RESULTS Analyses restricted to those with baseline firearm access (n = 195) identified no significant changes for intentions or safe storage practices across exposure groups. At baseline, participants' attitudes and beliefs were generally supportive of safe firearm storage. The Firearm Safety message yielded small increases in agreement with the concept that secure storage is "important during emotional or stressful times" (0.36; 95% CI = 0.08, 0.64). Other significant changes in awareness and beliefs were found, but across all study conditions. CONCLUSION Results reinforce the critical need for considerable research and testing prior to the widespread implementation of public messages to increase the likelihood for desired exposure effects.
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Affiliation(s)
- Elizabeth Karras
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua VA, Medical Center, 400 Fort Hill Avenue, Canandaigua, NY 14424, USA; Department of Psychiatry, University of Rochester, Rochester, NY, USA; Injury Control Research Center, West Virginia University, Morgantown, WV, USA.
| | - Cara M Stokes
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua VA, Medical Center, 400 Fort Hill Avenue, Canandaigua, NY 14424, USA; Injury Control Research Center, West Virginia University, Morgantown, WV, USA; Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Sara C Warfield
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua VA, Medical Center, 400 Fort Hill Avenue, Canandaigua, NY 14424, USA; Injury Control Research Center, West Virginia University, Morgantown, WV, USA; Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Shannon K Barth
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua VA, Medical Center, 400 Fort Hill Avenue, Canandaigua, NY 14424, USA; Injury Control Research Center, West Virginia University, Morgantown, WV, USA; Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Robert M Bossarte
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua VA, Medical Center, 400 Fort Hill Avenue, Canandaigua, NY 14424, USA; Injury Control Research Center, West Virginia University, Morgantown, WV, USA; Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, USA; Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, USA
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Ngo QM, Sigel E, Moon A, Stein SF, Massey LS, Rivara F, King C, Ilgen M, Cunningham R, Walton MA. State of the science: a scoping review of primary prevention of firearm injuries among children and adolescents. J Behav Med 2019; 42:811-829. [DOI: 10.1007/s10865-019-00043-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/06/2019] [Indexed: 12/21/2022]
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16
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Cipriani G, Danti S, Carlesi C, Di Fiorino M. Armed and Aging: Dementia and Firearms Do Not Mix ! JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2017; 60:647-660. [PMID: 28929910 DOI: 10.1080/01634372.2017.1376240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The possibility that persons with dementia possess firearms is cause for concern, but only a limited number of research studies have been conducted on such a topic, usually in the form of case reports. Reducing the occurrence of the firearm-related violence requires effectively identifying dangerous individuals and keeping firearms out of their hands. The health care professionals, i.e. the social workers and the physicians, need to work together and to produce a suitable evaluation of patients with dementia to prevent firearm-related injuries and serious and irreparable damage to persons.
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Affiliation(s)
- Gabriele Cipriani
- a Department of Psychiatry , Versilia Hospital , Lido di Camaiore , Italy
- b Department of Psychiatry , Versilia Hospital , Lido di Camaiore , Italia
| | - Sabrina Danti
- a Department of Psychiatry , Versilia Hospital , Lido di Camaiore , Italy
| | - Cecilia Carlesi
- a Department of Psychiatry , Versilia Hospital , Lido di Camaiore , Italy
| | - Mario Di Fiorino
- b Department of Psychiatry , Versilia Hospital , Lido di Camaiore , Italia
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Simonetti JA, Rowhani-Rahbar A, King C, Bennett E, Rivara FP. Evaluation of a community-based safe firearm and ammunition storage intervention. Inj Prev 2017. [PMID: 28642248 DOI: 10.1136/injuryprev-2016-042292] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Safe firearm storage practices are associated with a lower risk of unintentional and self-inflicted firearm injuries among household members, though many firearms remain unlocked and/or loaded. OBJECTIVES Conduct a preliminary evaluation of a community-based firearm safety intervention and assess participants' preferences for firearm locking devices and their comfort with potential firearm safety counsellors. DESIGN/METHODS Baseline event and follow-up surveys among adult participants to assess changes in firearm storage practices, including whether all household firearms were stored locked, all were unloaded, all ammunition was locked, and a composite measure assessing whether all firearms were locked and unloaded and all ammunition was stored locked. RESULTS A total of 206 out of 415 participants completed both surveys and were included. Nearly 9 in 10 respondents preferred the firearm lock box rather than a trigger lock. At follow-up, a significantly greater proportion reported that all household firearms were locked (+13.7%) and unloaded (+8.5%) and a non-significantly greater proportion reported that all ammunition was locked (+6.3%). A significantly greater proportion reported practising all three safe firearm and ammunition storage practices at follow-up (+12.6%). A majority reported they would be comfortable or very comfortable discussing firearm safety with various safety counsellors, though women were less likely to do so than men. CONCLUSION This intervention that included distribution of a free, participant-selected locking device improved safe firearm storage practices among participants. Differences in participant preferences for devices and safety counsellors suggest that a 'one size fits all' approach may be inadequate in affecting population-level storage practices.
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Affiliation(s)
- Joseph A Simonetti
- Hospital Medicine Program, Denver VA Medical Center, Denver, Colorado, USA.,Rocky Mountain MIRECC, Denver VA Medical Center, Denver, Colorado, USA.,Division of General Internal Medicine, School of Medicine, University of Colorado, Denver, Colorado, USA
| | - Ali Rowhani-Rahbar
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA.,Department Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA.,Seattle Children's Research Institute, Seattle, Washington, USA
| | - Cassie King
- Seattle Children's Hospital, Seattle, Washington, USA
| | | | - Frederick P Rivara
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA.,Department Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA.,Seattle Children's Research Institute, Seattle, Washington, USA
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18
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Abstract
Firearm injury is a leading cause of death and injury for children and adolescents, able to cause disability and interfere with normal development. Child developmental stages, variance of behavior, and mental health may all put children at risk for firearm injury or lead to increased morbidity after experiencing firearm violence. Family, community, and contextual factors can accentuate the risk of violence. Adults and social structures have the responsibility to protect children and adolescents from firearm violence.
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Affiliation(s)
- Judy Schaechter
- Department of Pediatrics, University of Miami Miller School of Medicine and Holtz Children's Hospital at Jackson Health Systems, 1601 Northwest 12th Avenue, Miami, FL 33136, USA.
| | - Patricia G Alvarez
- Department of Pediatrics, University of Miami Miller School of Medicine and Holtz Children's Hospital at Jackson Health Systems, 1601 Northwest 12th Avenue, Miami, FL 33136, USA
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19
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Rowhani-Rahbar A, Simonetti JA, Rivara FP. Effectiveness of Interventions to Promote Safe Firearm Storage. Epidemiol Rev 2016; 38:111-24. [PMID: 26769724 DOI: 10.1093/epirev/mxv006] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 11/13/2022] Open
Abstract
Despite supportive evidence for an association between safe firearm storage and lower risk of firearm injury, the effectiveness of interventions that promote such practices remains unclear. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, we conducted a systematic review of randomized and quasi-experimental controlled studies of safe firearm storage interventions using a prespecified search of 9 electronic databases with no restrictions on language, year, or location from inception through May 27, 2015. Study selection and data extraction were independently performed by 2 investigators. The Cochrane Collaboration's domain-specific tool for assessing risk of bias was used to evaluate the quality of included studies. Seven clinic- and community-based studies published in 2000-2012 using counseling with or without safety device provision met the inclusion criteria. All 3 studies that provided a safety device significantly improved firearm storage practices, while 3 of 4 studies that provided no safety device failed to show an effect. Heterogeneity of studies precluded conducting a meta-analysis. We discuss methodological considerations, gaps in the literature, and recommendations for conducting future studies. Although additional studies are needed, the totality of evidence suggests that counseling augmented by device provision can effectively encourage individuals to store their firearms safely.
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20
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Racial Disparities in Cranial Gunshot Wounds: Intent and Survival. J Racial Ethn Health Disparities 2015; 3:687-691. [PMID: 27294759 DOI: 10.1007/s40615-015-0187-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Gunshot wounds (GSW) to the head are associated with the highest mortality of all gun-related injuries, with assault reported as the leading cause of penetrating GSW. Several studies have explored factors and trends related to assault and self-inflicted GSW separately. The aim of this study was to investigate epidemiological characteristics and racial differences collectively in patients with GSW to the head by examining associations to injury intent and survival. METHOD A retrospective study was performed by accessing the hospital trauma registry at our regional Level 1 Trauma Center. A query of neurosurgery consults with penetrating trauma was completed from January 2008 to October 2013. Patients with penetrating intracranial GSW were included in the study. A chi-square test was used to evaluate association between patients' characteristics and intent of injury. Logistic regression analyses predicting intent of injury and survival were also conducted. RESULTS Of 111 patients, the majority were male (87.4 %). Most were African American (57.7 %) and Caucasian (35.1 %). Compared to African Americans, Caucasian patients were more likely to inflict self-harm (odds ratio (OR) 16.369 (95 % confidence interval (CI) 5.633-47.571), p < 0.0001), while African Americans (OR 26.413 (95 % CI 8.957-77.890), p < 0.0001) were more likely to be victims of assault. Race and other demographic variables did not predict survival nor did intent of injury (p = 0.368). CONCLUSION This study reports that there are racial disparities between assault GSW and self-inflicted GSW. However, neither race nor intent is a predictor of survival outcome. Targeted efforts are needed to reduce occurrence of cranial GSW events in order to decrease associated morbidity and mortality.
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21
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Barton BK, Kologi SM. Why do you keep them there? A qualitative assessment of firearms storage practices. J Pediatr Nurs 2015; 30:285-93. [PMID: 25172369 DOI: 10.1016/j.pedn.2014.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 08/01/2014] [Accepted: 08/03/2014] [Indexed: 10/24/2022]
Abstract
Thousands of children are killed or injured each year in the United States after gaining access to firearms. Storage methods are inconsistent and influenced by various contextual factors in the home. We explored reasons underlying parents' choices of firearm storage. Thirty individuals were interviewed regarding firearm storage methods used in their homes and reasons for choosing those methods. Storage practices varied within and across households. Qualitative results suggested that storage practices were related to child presence and age, intended use of firearms, and perception of risk associated with potential access by unsafe individuals. Implications for injury prevention are discussed.
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22
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Abstract
Firearms are involved in the injury and death of a large number of children each year from both intentional and unintentional causes. Gun ownership in homes with children is common, and pediatricians should incorporate evidence-based means to discuss firearms and protect children from gun-related injuries and violence. Safe storage of guns, including unloaded guns locked and stored separately from ammunition, can decrease risks to children, and effective tools are available that pediatricians can use in clinical settings to help decrease children's access to firearms. Furthermore, several community-based interventions led by pediatricians have effectively reduced firearm-related injury risks to children. Educational programs that focus on children's behavior around guns have not proven effective.
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Affiliation(s)
- Eric J Crossen
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR
| | - Brenna Lewis
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR
| | - Benjamin D Hoffman
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR
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23
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Allareddy V, Nalliah RP, Rampa S, Kim MK, Allareddy V. Firearm related injuries amongst children: estimates from the nationwide emergency department sample. Injury 2012; 43:2051-4. [PMID: 22104700 DOI: 10.1016/j.injury.2011.10.040] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 10/03/2011] [Accepted: 10/29/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study is to provide estimates of firearm related injuries in children seeking care in hospital based emergency departments. METHODS The Nationwide Emergency Department Sample (NEDS) for the year 2008 was used for the current study. All ED visits occurring amongst children aged less than or equal to 18 years and that had an External Cause of Injury (E-Code) for any of the firearm related injuries were selected for analysis. RESULTS A total of 14,831 ED visits (in children) in the United States had a firearm injury. The average age of the ED visits was 15.9 years. Males constituted a predominant proportion of all ED visits (89.2%). A total of 494 patients died in the emergency departments (3.4% of all ED visits) whilst 323 died following in-patient admission into the same hospital (6% of all inpatient admissions). The most frequently documented firearms were assaults by firearms and explosives (55% of all ED visits), accidents caused by firearms and air gun missiles (33.6%), and injuries by firearms that were undetermined (7.4%). The average charge for each ED visit was $3642 (25th percentile is $1146, median is $2003, and 75th percentile is $4404). The mean charge for those visits that resulted in in-patient admission into the same hospital was $70,164 (25th percentile is $16,704, median is $36,111, and 75th percentile is $74,165) and the total charges for the entire United States was about $371.33 million. CONCLUSIONS The current study used the largest all-payer hospital based emergency department dataset to provide national estimates of firearm related injuries amongst children in the United States during the year 2008 and highlights the public health impact of such injuries.
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Affiliation(s)
- Veerajalandhar Allareddy
- Department of Pediatric Critical Care and Pharmacology, Rainbow Babies and Children's Hospital, University Hospitals, Case Medical Center, United States
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24
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Grossman DC, Stafford HA, Koepsell TD, Hill R, Retzer KD, Jones W. Improving firearm storage in Alaska native villages: a randomized trial of household gun cabinets. Am J Public Health 2012; 102 Suppl 2:S291-7. [PMID: 22401514 DOI: 10.2105/ajph.2011.300421] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined if the installation of gun cabinets improved household firearm storage practices. METHODS We used a wait list, randomized trial design with 2 groups. The "early" group received the intervention at baseline, and the "late" group received it at 12 months. Up to 2 gun cabinets were installed in each enrolled home, along with safety messages. In-person surveys were conducted at 12 and 18 months to determine the proportion of households reporting unlocked guns or ammunition. Direct observations of unlocked guns were also compared. RESULTS At baseline, 93% of homes reported having at least 1 unlocked gun in the home, and 89% reported unlocked ammunition. At 12 months, 35% of homes in the early group reported unlocked guns compared with 89% in the late group (P < .001). Thirty-six percent of the early homes reported unlocked ammunition compared with 84% of late homes (P < .001). The prevalence of these storage practices was maintained at 18 months. Observations of unlocked guns decreased significantly (from 20% to 8%) between groups (P < .03). CONCLUSIONS Gun cabinet installation in rural Alaskan households improved the storage of guns and ammunition. If these gains are sustained over time, it may lead to a reduction in gun-related injuries and deaths in this population.
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Johnson RM, Runyan CW, Coyne-Beasley T, Lewis MA, Bowling JM. Storage of household firearms: an examination of the attitudes and beliefs of married women with children. HEALTH EDUCATION RESEARCH 2008; 23:592-602. [PMID: 17890758 PMCID: PMC2733798 DOI: 10.1093/her/cym049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 07/09/2007] [Indexed: 05/17/2023]
Abstract
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.
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Affiliation(s)
- R M Johnson
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA 02115, USA.
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26
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Johnson RM, Miller M, Vriniotis M, Azrael D, Hemenway D. Are household firearms stored less safely in homes with adolescents?: Analysis of a national random sample of parents. ACTA ACUST UNITED AC 2006; 160:788-92. [PMID: 16894076 PMCID: PMC3064948 DOI: 10.1001/archpedi.160.8.788] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine whether firearms are more frequently stored loaded, unlocked, or both in households with adolescents only (aged 13-17 years) compared with households with younger children only (aged 0-12 years). DESIGN Random-digit-dial survey on firearms (n = 2770). We computed bivariate associations between the presence of adolescents and firearm storage practices. Statistical significance was assessed using prevalence ratios with 95% confidence intervals. SETTING United States. PARTICIPANTS Survey respondents with children (aged <18 years) who reported the presence of a household firearm. MAIN OUTCOME MEASURES Prevalence of firearms in the home stored loaded and/or unlocked. RESULTS Of the 392 respondents, 22% had a loaded firearm, 32% had an unlocked firearm, and 8% had a firearm stored loaded and unlocked. Compared with households with younger children, households with adolescents only were somewhat more likely to store a firearm unlocked (42% vs 29%; prevalence ratio, 1.48; 95% confidence interval, 1.04-2.02), loaded (26% vs 20%; prevalence ratio, 1.25; 95% confidence interval, 0.82-1.91), or both (10% vs 8%; prevalence ratio, 1.43; 95% confidence interval, 0.64-3.19). CONCLUSIONS Parents of adolescents appear to be more likely to keep household firearms stored unsafely, especially with regard to keeping firearms unlocked. This is of concern because most youth firearm injuries happen to adolescents. Firearm injury prevention programs should directly target parents of adolescents to promote safe firearm storage.
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Affiliation(s)
- Renee M Johnson
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Mass. 02115, USA.
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Coyne-Beasley T, Theodore A. Future Physicians and Firearms: The Need for Additional Training in Firearm Injury Prevention Counseling. South Med J 2006; 99:198-9. [PMID: 16553086 DOI: 10.1097/01.smj.0000204342.96862.57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Okoro CA, Nelson DE, Mercy JA, Balluz LS, Crosby AE, Mokdad AH. Prevalence of household firearms and firearm-storage practices in the 50 states and the District of Columbia: findings from the Behavioral Risk Factor Surveillance System, 2002. Pediatrics 2005; 116:e370-6. [PMID: 16140680 DOI: 10.1542/peds.2005-0300] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine the prevalence of household firearms and firearm-storage practices in the 50 states and the District of Columbia and estimate the number of children exposed to unsafe storage practices. METHODS We analyzed data from the 2002 cross-sectional Behavioral Risk Factor Surveillance System survey of 240735 adults from randomly selected households with telephones in the 50 states and the District of Columbia. RESULTS Nationally, 32.6% of adults reported that firearms were kept in or around their home. The prevalence of adults with household firearms ranged from 5.2% in the District of Columbia to 62.8% in Wyoming (median: 40.8%). The prevalence of adults with loaded household firearms ranged from 1.6% in Hawaii, Massachusetts, and New Jersey to 19.2% in Alabama (median: 7.0%), and the prevalence of adults with loaded and unlocked household firearms ranged from 0.4% in Massachusetts to 12.7% in Alabama (median: 4.2%). Among adults with children and youth <18 years old, the prevalence of loaded household firearms ranged from 1.0% to 13.4% (median: 5.3%), and the prevalence of loaded and unlocked household firearms ranged from 0.3% to 7.3% (median: 2.3%); in each instance, Massachusetts had the lowest prevalence and Alabama had the highest. Findings indicate that approximately 1.69 million (95% confidence interval: 1.57-1.82 million) children and youth in the United States <18 years old are living with loaded and unlocked household firearms. CONCLUSIONS Substantial state variations exist in the prevalence of household firearms and firearm-storage practices. It is vital that surveillance systems such as the Behavioral Risk Factor Surveillance System continue to monitor the prevalence of household firearms and firearm-storage practices so that future interventions to promote safe storage of firearms can be evaluated and more widely implemented based on their efficacy.
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Affiliation(s)
- Catherine A Okoro
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Coyne-Beasley T, Baccaglini L, Johnson RM, Webster B, Wiebe DJ. Do partners with children know about firearms in their home? Evidence of a gender gap and implications for practitioners. Pediatrics 2005; 115:e662-7. [PMID: 15930193 DOI: 10.1542/peds.2004-2259] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The gender gap describing the apparent differences in male and female reports of firearm-ownership and -storage habits has never been evaluated among individuals who live in the same household. Thus, the objective of this study was to examine the level of agreement on household firearms and storage practices among cohabiting partners. METHODS Data for this investigation came from follow-up telephone interviews of participants who underwent a randomized, controlled trial to test the effect of home-safety counseling, including firearm safety, on behavior change. Baseline interviews were conducted at a level 1 pediatric emergency department in North Carolina with adults who took a child or adolescent who was under his or her care to a pediatric emergency department. Follow-up interviews were conducted via telephone at 18 months after intervention with participants who reported household firearms at baseline. Participants then were asked whether their partners could be contacted for a separate telephone interview. The measured outcomes were number and type of household firearms and firearm-storage practices. The strength of agreement between partners' reported firearm-ownership and -storage practices was measured with the kappa statistic. RESULTS Seventy-six partner-respondent pairs completed the study (62% response rate). Most initial respondents were white (89%), female (76%), and college graduates (52%); the median age was 37. There were no same-gender partners, and 91% reported that they were spouses. There was not perfect agreement among male and female partners with regard to the presence of household firearms. More men (80%) reported the presence of household firearms than did women (72%; kappa = .64). The discordance between partner pairs regarding the number of household firearms and type was poor to fair (kappa = .35 and .34, respectively). Although similar proportions of men and women reported storing any household firearms loaded (10%) and storing all household firearms locked up (63% men and 62% women), the kappa values demonstrated only moderate agreement (kappa = .56-.60). Most men (88%) and women (83%) reported that firearm storage was the husband's responsibility; 82% of men compared with 17% of women reported that they personally owned all of the firearms. CONCLUSIONS A gender gap does exist in the reporting of firearm ownership with regard to the number and type of firearms owned. There are also differences in reported firearm-storage practices, which are likely related to the finding that men were reported to be the primary owner of firearms in most households as well as the person more commonly responsible for firearm storage. Firearm-safety counseling should include male partners in the history-taking process to improve knowledge about the presence and storage patterns of household firearms.
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Affiliation(s)
- Tamera Coyne-Beasley
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599-7220, USA.
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Sidman EA, Grossman DC, Koepsell TD, D'Ambrosio L, Britt J, Simpson ES, Rivara FP, Bergman AB. Evaluation of a community-based handgun safe-storage campaign. Pediatrics 2005; 115:e654-61. [PMID: 15930192 DOI: 10.1542/peds.2004-1625] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Safe storage of firearms has been recommended as a means of preventing gun-related pediatric injuries, yet few interventions have led to significant improvements in storage practices. This study examined a multifaceted community education campaign to promote safe handgun storage and the campaign's impact on firearm locking and loading practices in households with children. METHODS Beginning in 1997, a safe-storage campaign consisting of television and radio announcements, educational materials, billboards, and discount coupons for lock boxes was conducted in King County, Washington. The campaign evaluation used a quasi-experimental design and compared the intervention site with 9 control counties outside Washington State and west of the Mississippi River. Cross-sectional, random-digit-dial telephone surveys of handgun-owning households with children were conducted in all study counties both before the intervention in 1996 (n = 302) and again in 2001 (n = 255). The main analyses assessed whether greater improvements in household firearm-storage practices occurred between 1996 and 2001 in the intervention, compared with the control, counties. Primary outcomes were based on up to 3 handguns per household and included (1) all stored with trigger locks, lock boxes, or gun safes (formal locking devices), (2) all stored in lock boxes or gun safes, (3) any stored loaded, (4) any stored loaded without a formal locking device, and (5) any stored loaded and not in a lock box or gun safe. Data were also collected on up to 1 long gun per household; long-gun outcomes included (1) stored with a trigger lock or gun safe and (2) stored loaded. RESULTS Overall, handguns and long guns were generally more likely to be stored locked and less likely to be loaded in 2001 compared with 1996, with these trends seeming to be more consistent in the intervention county. Even so, more than one quarter of households with children and handguns in 2001 failed to store all of their handguns with a formal locking device, and up to 8% continued to possess at least 1 loaded handgun that was not stored with a formal device. The majority of households that stored their handguns with formal devices used lock boxes or gun safes. Storage of handguns in lock boxes or gun safes became more common in both the intervention (adjusted odds ratio [aOR]: 1.71; 95% confidence interval [CI]: 1.03-2.84) and control households (aOR: 1.66; 95% CI: 1.01-2.72) between 1996 and 2001. None of the other measured changes reached statistical significance, such as storing any household handgun loaded (aOR: 0.71; 95% CI: 0.35-1.42 [intervention]; aOR: 1.08; 95% CI: 0.58-2.00 [control]) or keeping any household handgun loaded and not stored in a lock box or gun safe (aOR: 0.59; 95% CI: 0.22-1.55 [intervention]; aOR: 0.67; 95% CI: 0.30-1.49 [control]). Moreover, the intervention county did not experience significantly greater overall improvements in household storage practices for handguns or long guns than did control counties. CONCLUSIONS In both the intervention and control counties, households were more likely to lock all handguns in 2001 compared with 1996. After accounting for temporal trends, this educational campaign, combined with economic incentives to purchase lock boxes, did not seem to significantly change safe storage practices in households with handguns and children. Even if the campaign did result in small improvements in firearm safe storage, simultaneous national and state-specific gun-safety activities or legislative efforts may have drawn increasing attention to gun-related issues in the control counties, thereby making it more difficult to identify effects of our specific handgun storage intervention.
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Affiliation(s)
- Elanor A Sidman
- Harborview Injury Prevention and Research Center, Department of Epidemiology, University of Washington, Seattle, Washington, USA
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31
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Coyne-Beasley T, Runyan CW, Baccaglini L, Perkis D, Johnson RM. Storage of poisonous substances and firearms in homes with young children visitors and older adults. Am J Prev Med 2005; 28:109-15. [PMID: 15626565 PMCID: PMC3694570 DOI: 10.1016/j.amepre.2004.09.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Tamera Coyne-Beasley
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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Shenassa ED, Rogers ML, Spalding KL, Roberts MB. Safer storage of firearms at home and risk of suicide: a study of protective factors in a nationally representative sample. J Epidemiol Community Health 2004; 58:841-8. [PMID: 15365110 PMCID: PMC1763337 DOI: 10.1136/jech.2003.017343] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To estimate the protective effect of storing firearms locked or unloaded, or both, on the risk of suicide by firearms among people with relatively low intention to die. DESIGN AND SETTING Cross sectional survey. The 1993 National Mortality Followback Survey of 22 957 deaths in the United States, representing 2.2 million people, conducted by the National Center for Health Statistics. PARTICIPANTS Decedent's next of kin answered questions regarding various aspects of decedent's life to supplement information from death certificates. MAIN RESULTS Compared with decedents who stored their firearm unlocked or loaded, those who stored their firearms locked or unloaded, or both, were less likely to commit suicide by firearms (locked: OR = 0.39, 95% CI = 0.24 to 0.66; unloaded OR = 0.30, 95% CI = 0.18 to 0.49). CONCLUSIONS This study further supports the utility of devices and practices intended to reduce the likelihood of unauthorised or impulsive use of firearms.
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Affiliation(s)
- Edmond D Shenassa
- Department of Community Health and Centers for Behavioral and Preventive Medicine, Brown Medical School, One Hoppin Street, Suite 500, Providence, RI 02903, USA.
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Johnson RM, Coyne-Beasley T, Runyan CW. Firearm ownership and storage practices, U.S. households, 1992-2002. A systematic review. Am J Prev Med 2004; 27:173-82. [PMID: 15261906 DOI: 10.1016/j.amepre.2004.04.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Because the presence and improper storage of household firearms are risk factors for injury, it is important to understand the prevalence of ownership and storage practices within households to help guide intervention development. This systematic review of published articles (1992 to 2002) provides prevalence estimates of firearm ownership and storage practices in U.S. households. METHODS A search of bibliographic databases (MedLine, CINAHL, PsycInfo, Sociological Abstracts) was completed in January 2003. RESULTS Although all were cross-sectional, the 42 articles included in this review varied in type; there were seven national and five state prevalence studies, as well as studies using clinic-based convenience samples (n =14) and samples of professionals (n =10). Published studies indicate that firearms are present in about one third of U.S. households. Handguns in particular are present in more than half of U.S. households with firearms, or about 19% of all U.S. households. The prevalence of firearms and handguns in households with young people was similar to the prevalence overall. Firearm ownership was highest in the South. CONCLUSIONS Although the methodologic rigor of published articles varies substantially, the literature clearly establishes that firearms are common in U.S. households, even in the homes of medical professionals and those with children.
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Affiliation(s)
- Renee M Johnson
- Injury Prevention Research Center, School of Public Health, Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Horn A, Grossman DC, Jones W, Berger LR. Community based program to improve firearm storage practices in rural Alaska. Inj Prev 2003; 9:231-4. [PMID: 12966011 PMCID: PMC1730982 DOI: 10.1136/ip.9.3.231] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop and evaluate a pilot program to reduce unauthorized access to firearms by youth by distributing gun safes and trigger locks to households. DESIGN Pilot intervention with pre/post-evaluation design. SETTING Two Alaska Native villages in the Bristol Bay Health Corporation region of southwest Alaska. SUBJECTS Forty randomly selected households with two or more guns in the home. INTERVENTION Initially, a focus group of community members who owned guns was convened to receive input regarding the acceptability of the distribution procedure for the gun storage devices. One gun safe and one trigger lock were distributed to each of the selected households during December 2000. Village public safety officers assisted with the distribution of the safes and provided gun storage education to participants. MAIN OUTCOME MEASURES Baseline data were collected regarding household gun storage conditions at the time of device distribution. Three months after distribution, unannounced onsite home visits were conducted to identify if residents were using the gun safes and/or trigger locks. RESULTS All selected households had at least two guns and 28 (70%) of the 40 households owned more than two guns. At baseline, 85% of homes were found to have unlocked guns in the home and were most often found in the breezeway, bedroom, storage room, or throughout the residence. During the follow up visits, 32 (86%) of the 37 gun safes were found locked with guns inside. In contrast, only 11 (30%) of the 37 trigger locks were found to be in use. CONCLUSIONS This community based program demonstrated that Alaska Native gun owners accepted and used gun safes when they were installed in their homes, leading to substantial improvements in gun storage practices. Trigger locks were much less likely to be used.
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Affiliation(s)
- A Horn
- Indian Health Service, Reno, Nevada, USA
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McGee KS, Coyne-Beasley T, Johnson RM. Review of evaluations of educational approaches to promote safe storage of firearms. Inj Prev 2003; 9:108-11. [PMID: 12810734 PMCID: PMC1730973 DOI: 10.1136/ip.9.2.108] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To systematically review evaluation studies of educational interventions promoting safe firearm storage. METHODS Medline, ERIC, PsycINFO, Criminal Justice Periodicals Index, Cumulative Index of Nursing and Allied Health Literature, and Sociofile were searched. The references from each potentially eligible study were checked, and experts in the field were contacted for additional reports. In addition, an internet search was performed to identify programs not published in the conventional literature. Sources relevant to safe firearm storage promotion were selected and evaluated. RESULTS Seven studies met inclusion criteria: adult subjects, program description was included, and firearm storage outcomes were measured. One was a randomized controlled trial and the other six were one group pre-test and/or post-test. The studies were classified into the following categories based on the intervention strategies used: (1). counseling and firearm safety materials (n=3); (2). counseling/educational message (n=3); and (3). firearm safety materials distribution (n=1). The outcomes were safe firearms storage (firearms locked up and unloaded or removal from home) after intervention. Four studies, three using counseling and materials distribution, reported improved storage after the interventions. CONCLUSIONS It is not yet clear what types of interventions, or which specific intervention components, prompt gun owners to securely store their weapons. Increased understanding of gun storage behaviors and stronger evaluation designs will aid further understanding of this important issue.
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Affiliation(s)
- K S McGee
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, School of Public Health, Chapel Hill, North Carolina, USA.
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