Gun storage patterns in US homes with children. A pediatric practice-based survey. Pediatric Practice Research Group

The Relationship Between Parents' Reported Storage of Firearms and Their Children's Perceived Access to Firearms: A Safety Disconnect

Locked-up and unloaded firearm storage is a tenet of injury prevention campaigns to decrease children's access to firearms. This study cohort describes the reported presence of, storage mechanisms for, and children's perceived access to firearms. Parent-child dyads (n = 297) were recruited from pediatric emergency departments in Atlanta, GA. Gun owners were 25% of cohort; 53% reported storing some firearms insecurely. Gun owners were more likely to believe their child could access a firearm versus non-gun owners (11% vs 3%). Children of gun owners versus non-gun owners indicated increased ability to acquire a gun (14% vs 4%). Fifty-nine percent of children could not identify a real versus toy gun in a picture. This study highlights a plurality of parents storing firearms insecurely with a significant portion of children reporting gun access and demonstrating inability to recognize actual guns. This disconnect points to the importance of public health interventions to decrease access to firearms in this vulnerable population.

Epidemiology of 577 Pediatric Firearm Fatalities: A 2-year Review of the National Trauma Data Bank

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.

Storage Practices of US Gun Owners in 2016

OBJECTIVES

To examine gun storage practices and factors influencing those practices among gun owners.

METHODS

We conducted a nationally representative online survey of US gun owners (n = 1444) in 2016 to assess gun storage practices and attitudes, factors influencing storage practices, and groups that might effectively communicate regarding safe storage. We generated descriptive statistics by using cross-tabulations and used logistic regression to estimate characteristics that influenced safe storage practices.

RESULTS

Forty-six percent of gun owners reported safely storing all of their guns. Factors associated with higher odds of reporting safe storage were having a child in the home (adjusted odds ratio [AOR] = 1.44; 95% confidence interval [CI] = 1.03, 2.03), only owning handguns (AOR = 1.84; 95% CI = 1.24, 2.73), and reporting that storage decisions were influenced by a gun safety course (AOR = 2.05; 95% CI = 1.54, 2.74) or discussions with family members (AOR = 1.39; 95% CI = 1.05, 1.86). Gun owners ranked law enforcement, hunting or outdoors groups, active-duty military, and the National Rifle Association as most effective in communicating safe storage practices.

CONCLUSIONS

Public health campaigns to promote safe gun storage should consider partnering with groups that garner respect among gun owners for their experience with safe use of guns.

Parents' Expectations of High Schools in Firearm Violence Prevention

Firearm violence remains a significant problem in the US (with 2787 adolescents killed in 2015). However, the research on school firearm violence prevention practices and policies is scant. Parents are major stakeholders in relation to firearm violence by youths and school safety in general. The purpose of this study was to examine what parents thought schools should be doing to reduce the risk of firearm violence in schools. A valid and reliable questionnaire was mailed to a national random sample of 600 parents who had at least one child enrolled in a public secondary school (response rate = 47%). Parents perceived inadequate parental monitoring/rearing practices (73%), peer harassment and/or bullying (58%), inadequate mental health care services for youth (54%), and easy access to guns (51%) as major causes of firearm violence in schools. The school policies perceived to be most effective in reducing firearm violence were installing an alert system in schools (70%), working with law enforcement to design an emergency response plan (70%), creating a comprehensive security plan (68%), requiring criminal background checks for all school personnel prior to hiring (67%), and implementing an anonymous system for students to report peer concerns regarding potential violence (67%). Parents seem to have a limited grasp of potentially effective interventions to reduce firearm violence.

Evaluation of the “Respect Not Risk” Firearm Safety Lesson for 3rd-Graders

The purpose of this study was to evaluate the MORE HEALTH “Respect Not Risk” Firearm Safety Lesson for 3rd-graders in Pinellas County, Florida. Six schools representative of various socioeconomic levels were selected as the test sites. Qualitative and quantitative data were collected. A total of 433 matched pretests/posttests were used to determine the effectiveness of the class in increasing student knowledge about firearm safety. The results revealed a significant increase in the mean scores on the posttest compared with the pretest. Qualitative findings showed the lesson was positively received by both students and teachers, and 65% of responding students reported discussing the lesson with family members. School nurses are encouraged to take a leading role in promoting firearm injury prevention to students.

Development and Psychometric Evaluation of a Self-Administered Questionnaire to Assess Parental Attitudes Toward Firearms and Related Parenting Decisions

The study sought to develop and evaluate the psychometric properties of the Parental Attitudes Toward Firearms Survey (PATFS), a self-report measure of parental attitudes about firearms and parenting behavior. The initial item pool was generated based on a literature review and discussion with experts in violence reduction, psychometrics, and public health. Data were collected online from 362 volunteers and subjected to exploratory factor analysis which revealed a 13-item, 3-factor solution accounting for 59.7% of the variance. The 3 conceptual factors (subscales) were interpreted as Firearms Exposure, Parental Control, and Violent Play. The PATFS demonstrated good internal consistency and content and construct validity. The PATFS can be used to investigate parenting attitudes and behaviors specific to firearms and violent play.

Family process correlates of firearm ownership and firearm storage among families with young children

To understand how family relations and dynamics were associated with firearm ownership among US families with 4-year-olds and with firearm storage among those families with firearms, controlling for sociodemographic characteristics of families and states. With representative data from the Early Childhood Longitudinal Study-Birth Cohort (n = 8,100), logistic regression models employed a set of family process variables (e.g., parenting practices, parental stress, maternal depression, and safety behaviors) as (1) predictors of firearm ownership among all families and, (2) as predictors of safe firearm storage among firearm owning families. An estimated 22 % of families with pre-kindergarten age children reported having firearms in their households. Among firearm owning families, 69 % of families kept firearms in a locked cabinet. Comparing families who did and did not report owning firearms, those who did were more likely to report spanking their children. Firearm owning parents who reported higher levels of parenting stress and lower likelihood that their child always wore a helmet when bicycling were also more likely to report unsafe firearm storage practices. Family processes differentiated both firearm owners from non-firearm owners and firearms owners who locked up their firearms from firearm owners who did not. These findings suggest that firearm ownership and firearm safety behaviors likely arise from a more general family context related to child health and safety.

Health disparities analysis of critically ill pediatric trauma patients in Milwaukee, Wisconsin

BACKGROUND

Injury is the leading cause of childhood morbidity and mortality in the US. The associated costs exceed $20 billion annually. This study examined disparities in disadvantaged populations of critically injured pediatric patients admitted to a level 1 pediatric trauma center.

STUDY DESIGN

A retrospective study was conducted of all trauma patients admitted to the pediatric intensive care unit (PICU) at a level 1 pediatric trauma hospital from 2005 to 2009.

RESULTS

Data on 324 patients were analyzed; 45% of patients were Caucasian, 33% were African American, 12% were Hispanic, and 10% were other. There was no difference in age, Glasgow Coma Scale (GCS), or Injury Severity Score (ISS) across ethnic groups. The mortality rate was 12%. A higher percentage of Caucasians were commercially insured and from the highest income quartile than non-Caucasians (p < 0.001). African Americans had the highest rate of penetrating trauma and intentional injury compared with other ethnicities (p < 0.001). Nearly 75% of firearm injuries were clustered in 7 ZIP codes with the lowest median household incomes. The home was the most common location for firearm injuries. Children involved in assaults were more likely to have a single parent (67%) than 2 parents (26%, p < 0.001). Both ethnicity and payer status were significantly associated with mortality.

CONCLUSIONS

Significant disparities in socioeconomic status exist in severely injured pediatric patients treated in the PICU. Disparities were associated with adverse outcomes. These results should inform community and public health efforts to identify the areas and populations at highest risk for violence-related injuries.

Evaluation of a firearm injury prevention web-based curriculum

BACKGROUND

Firearm injury prevention training is lacking in pediatric residency programs.

DESCRIPTION

This study aimed to evaluate a web-based curriculum teaching residents how to provide injury prevention anticipatory guidance, emphasizing firearm injury prevention. Ninety-two residents participated and completed pretesting. Residents in the intervention group completed the curriculum, posttesting, and 6-month follow-up testing. Residents in the nonintervention group completed 6-month follow-up testing. Pre- and posttest comparisons between and within each group were made.

EVALUATION

Baseline knowledge of the participants was high, and no significant change in knowledge was shown in either group. Changes in attitude were noted regarding physician role in providing firearm injury anticipatory guidance in the intervention group, which persisted at 6 months. Participants completing the curriculum showed significant improvement for all self-efficacy questions in the immediate and 6-month follow-up testing.

CONCLUSIONS

Participants reported changes in attitudes and in confidence in their ability to provide firearm injury prevention counseling after completion of a web-based curriculum.

Storage of household firearms: an examination of the attitudes and beliefs of married women with children

Although safe firearm storage is a promising injury prevention strategy, many parents do not keep their firearms unloaded and locked up. Using the theory of planned behavior as a guiding conceptual framework, this study examines factors associated with safe storage among married women with children and who have firearms in their homes. Data come from a national telephone survey (n=185). We examined beliefs about defensive firearm use, subjective norms, perceived behavioral control and firearm storage practices. A Wilcoxon-Mann-Whitney test was conducted to assess associations between psychosocial factors and firearm storage practices. Women were highly motivated to keep firearms stored safely. Those reporting safe storage practices had more favorable attitudes, more supportive subjective norms and higher perceptions of behavioral control than those without safe storage. One-fourth believed a firearm would prevent a family member from being hurt in case of a break-in, 58% believed a firearm could scare off a burglar. Some 63% said they leave decisions about firearm storage to their husbands. Women were highly motivated to store firearms safely as evidenced by favorable attitudes, supportive subjective norms and high perceptions of behavioral control. This was especially true for those reporting safer storage practices.

Is office-based counseling about media use, timeouts, and firearm storage effective? Results from a cluster-randomized, controlled trial

OBJECTIVE

The objective of this study was to determine whether patients' families' violence-prevention behaviors would be affected by their primary care practitioner's use of a violence-prevention clinical intervention during the routine well-child examination.

METHODS

In this cluster-randomized, controlled trial (2002-2006), 137 Pediatric Research in Office Settings practices were randomly assigned and initiated patient recruitment for either an office-based violence-prevention intervention or a control group (educational handout on literacy promotion provided). Primary caregivers of children who were aged 2 to 11 years and presented for a well-child visit were surveyed at baseline and 1 and 6 months. Practitioners were trained to (1) review a parent previsit summary regarding patient-family behavior and parental concern about media use, discipline strategies, and children's exposure to firearms, (2) counsel using brief principles of motivational interviewing, (3) identify and provide local agency resources for anger and behavior management when indicated, and (4) instruct patient-families on use of tangible tools (minute timers to monitor media time/timeouts and firearm cable locks to store firearms more safely where children live or play). Main outcomes were change over time in self-reported media use <120 minutes per day, use of timeouts, and use of firearm cable locks.

RESULTS

Generalized estimating equation analysis revealed a significant effect at 6 months for decreased media use and safer firearm storage. The intervention group compared with the control group showed an increase in limiting media use to <120 minutes per day. There was no significant effect for timeout use. There was a substantial increase in storing firearms with cable locks for the intervention group versus a decrease for the control group.

CONCLUSIONS

This randomized, controlled trial demonstrated decreased media exposure and increased safe firearm storage as a result of a brief office-based violence-prevention approach.

Firearm ownership and storage patterns among families with children who receive well-child care in pediatric offices

OBJECTIVE

In this study we examined firearm storage patterns and their associations in a diverse sample of families who attended pediatric practices from both rural and nonrural areas across the United States.

METHODS

Parents who brought their children who were aged 2 to 11 years (N = 3745) to 96 Pediatric Research in Office Settings practices from 45 states, Canada, and Puerto Rico participated in an office-based survey before a well-child examination. The survey measured demographic variables; family history of guns in the home; and firearm types, storage behaviors, and ownership.

RESULTS

Twenty-three percent of families reported firearm ownership. The majority (60%) of respondents reported making firearm storage decisions. Only one third of firearm owners reported safe firearm storage. Gun type owned was associated with storage habits, with long-gun owners storing their gun in places other than locked cabinets but with ammunition separate from guns and handgun users more likely to store guns loaded and to use gun locks. In a multivariate analysis, not being raised with a firearm was associated with safe storage behaviors. Families who had children aged 2 to 5 years and owned long guns were more likely to store their guns safely than families with older children.

CONCLUSIONS

Few families reported safe firearm storage. Storage patterns are most influenced by firearm type(s) owned, family socialization with guns, and the age of the child. Primary care providers need to understand better not only whether firearms are in the home but also which types are present and whether parents were raised in homes with guns.

Firearm injuries: epidemic then, endemic now

There has been a transition in US firearm injuries from an epidemic phase (mid-1980s to early 1990s) to an endemic one (since the mid-1990s). Endemic US firearm injuries merit public health attention because they exact an ongoing toll, may give rise to new epidemic outbreaks, and can foster firearm injuries in other parts of the world. The endemic period is a good time for the development of ongoing prevention approaches, including assessment and monitoring of local risk factors over time and application of proven measures to reduce these risk factors, development of means to address changing circumstances, and ongoing professional and public education designed to weave firearm injury prevention into the fabric of public health work and everyday life.

Evaluation of age-appropriate firearm safety interventions

OBJECTIVES

The purpose of this study was to determine if firearm safety training increased the knowledge of school-age children about gun safety. It was predicted that children's knowledge, attitudes, and feelings about firearm safety would be impacted by the method used to teach the key firearm safety constructs. The specific aim was to test the effects of 3 levels of firearm safety training on school-age children's knowledge about gun safety. The hypothesis was that children who attended a firearm injury prevention program that used a scripted discussion, psychomotor exercise, and a role-playing exercise about firearm safety would have greater knowledge about firearm safety.

METHODS

A quasi-experimental pretest-posttest randomized complete block design was used. There were 57 participants, 58% were male and the mean age was 5.89 years. A pictorial tool was used to assess kindergarten and first-grade students' baseline and postintervention knowledge of firearm safety.

RESULTS

Knowledge increased in all of the intervention groups [F(3,53) = 6.69, P = 0.001]. The greatest increase in knowledge occurred in the scripted discussion/psychomotor exercise group which exhibited an 81% increase in knowledge from the pretest to the posttest. There was no change in the control group's knowledge from pretest to posttest (P = 0.3).

CONCLUSIONS

This study provides evidence that children do retain firearm safety training. The long-term objective of this research is to reduce the incidence of firearm injuries during childhood by teaching children how to be safe around guns.

Evaluation of a community-based handgun safe-storage campaign

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.

The association between presence of children in the home and firearm-ownership and -storage practices

OBJECTIVE

American children's ready access to firearms contributes to high rates of firearm-related injuries. Understanding the factors that influence storage decisions is critical for prevention. This study examined the influence of geography and presence of children <16 years old in the home on firearm-ownership and storage decisions of northeast-Ohio residents.

METHODS

Analysis was based on 522 responses to randomized telephone surveys of urban and rural households in northeast Ohio. Relationships between 4 dependent variables (firearm ownership, type of firearm owned, reasons for owning, and storage) and 2 independent variables (geography and presence of children in the home) were evaluated using odds ratios and multinomial logistic regression.

RESULTS

Firearms were significantly more common in rural (31%) than in urban (13%) households. Twenty-two percent of gun owners reported securing all firearms with trigger locks or storing them in locked safes, drawers, or gun cabinets; 12% reported storing guns unlocked and either loaded or together with ammunition. Most gun owners (66%) reported storing all firearms unlocked, unloaded, and separate from ammunition. Rural respondents without children were approximately twice as likely as those with children to have handguns, but children did not influence long-gun ownership. In the urban group, the presence of children was not related to likelihood of firearm ownership. Having children in the home was not significantly associated with higher rates of safe storage for either group.

DISCUSSION

These results illustrate the inadequacy of 1-size-fits-all interventions and highlight the need to better understand gun owners' reasoning about children and guns to design and implement successful interventions. Physicians and others interested in reducing pediatric exposure to firearms cannot be credible messengers on gun-safety topics if they cannot demonstrate an understanding of the issues from the perspective of patients and their families.

Firearm ownership and storage practices, U.S. households, 1992-2002. A systematic review

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.

Reliability of a short gun questionnaire

BACKGROUND

The purpose of the study was to develop and test a short gun questionnaire and compare its reliability to a long gun questionnaire to identify youths who may have access to or ownership of a gun.

METHODS

A seven-question short gun questionnaire asking about gun accessibility, ownership, and usage was modified from the much longer gun questionnaire. To determine reliability of the short tool, the results of the short gun questionnaire were compared with the long gun questionnaire. Both the long and the short gun questionnaires were administered to a convenience sample of 100 consenting young people aged 10 to 24 years old treated for any complaint. The study was approved by the institutional review board.

RESULTS

Of the 100 youths, 66% of participants were black and 31% were Hispanic. The average age was 21 years and 39% were male. Two youths said that they had a gun, 38.0% said it would be easy to get a gun, and 25% said it would be impossible to obtain one. None of the youths had shared ownership of a gun and 4% said that there was a gun in their home, garage, or car. Eight percent of the youths had fired a gun in the past 6 months and 24% had fired a gun more than 6 months ago. The respondents' answers to all the questions in the short questionnaire were not statistically different from the responses in the long questionnaire at the P < 0.05 level.

CONCLUSION

The developed short questionnaire provides results similar to the long questionnaire: a low number of gun owners but a high level of gun accessibility and availability.

"They're too smart for that": predicting what children would do in the presence of guns

OBJECTIVES

We examined parents' beliefs about how children would react to finding guns, with particular emphasis on how parents reasoned about children's actions.

METHODS

Based on a randomized telephone survey of Northeast Ohio residents, we focused on the 317 urban and 311 rural respondents who had children 5 to 15 years old in their homes. Respondents were asked about gun ownership and their expectations of how children would react to finding guns. Analysis examined responses in relation to various demographic and socioeconomic variables.

RESULTS

All respondents--regardless of gun ownership, geography, race, gender, education level, income, or child age--were equally likely (approximately 87%) to believe that their children would not touch guns they found. Fifty-two percent of those reasoned that children were "too smart" or "knew better." Only 40% based their predictions on specific instructions they had given their children. Only 12% (15/122) of owners stored guns locked and unloaded. Only 3 of 13 variables tested were positively associated with safe storage: having a child 5 to 9 years old, having at least a 4-year college education, and having an income >or=65,000 dollars per year.

CONCLUSION

Results indicate that parental beliefs may effectively relieve adults of responsibility and place the burden on children to protect themselves. The implication for injury prevention is that caregivers' unrealistic expectations of children's developmental levels and impulse control may influence storage decisions or the inclination to address gun safety issues with children or other adults with whom children spend time (relatives, playmates' parents).

Unintended shootings in a large metropolitan area: an incident-based analysis

STUDY OBJECTIVE

We determine the proportion of unintended shootings that might be prevented by promoting safe storage, safe handling, and/or safer firearm designs.

METHODS

A regional firearm injury surveillance system was used to identify fatal and nonfatal unintentional shootings in a 5-county metropolitan area. Case reports were reviewed, and the causes of each shooting were independently classified by 4 members of the research team. A consensus conference was held to resolve disagreements.

RESULTS

Between May 1, 1996, and June 30, 2000, 216 cases of unintentional firearm injury were identified, 3.8% of the shootings documented during the study period. Six (2.8%) were fatal. The majority of victims were between 15 and 34 years of age. One fourth (54) of the shootings involved victims younger than 18 years. Handguns were involved in 87% of the incidents. Enough information was available to characterize the incident in 122 (57%) cases. All but 6 fell into 1 or more of 3 broad categories of causation: Child access (14%), mishandling (74%), and/or deficiencies in firearm design (32%).

CONCLUSION

Many unintentional shootings could be prevented by promoting safe storage of guns in the home, promoting safe handling of firearms, and requiring that all new handguns incorporate basic safety features.

Seeing is believing: what do boys do when they find a real gun?

OBJECTIVES

To determine how boys behave when they find a handgun in a presumably safe environment and to compare parental expectations of their child's interest in real guns with this observed behavior.

METHODS

A convenience sample of 8- to 12-year-old boys was recruited from families that completed a survey on firearm ownership, storage practices, and parental perceptions. Parents were asked to rate their child's interest in real guns on a scale from 1 to 5: 1-2 = low interest, 3 = moderate interest, and 4-5 = high interest. Parents of an eligible child were asked to bring to the exercise 1 of their son's playmates and/or a sibling in the same age range. After informed parental consent was obtained, each pair or trio of boys was placed in a room with a 1-way mirror and observed for up to 15 minutes. Two water pistols and an actual.380 caliber handgun were concealed in separate drawers. The handgun contained a radio transmitter that activated a light whenever the trigger was depressed with sufficient force to discharge the firearm. After the exercise, each boy was asked whether he thought that the pistol was real or a toy. Before leaving, each child was counseled about safe behavior around guns.

RESULTS

Twenty-nine groups of boys (n = 64) took part in the study. The mean age of participants was 9.8 years. Twenty-one of the groups (72%) discovered the handgun (n = 48 boys); 16 groups (76%) handled it (n = 30 boys). One or more members in 10 of the groups (48%) pulled the trigger (n = 16 boys). Approximately half of the 48 boys who found the gun thought that it was a toy or were unsure whether it was real. Parental estimates of their child's interest in guns did not predict actual behavior on finding the handgun. Boys who were believed to have a low interest in real guns were as likely to handle the handgun or pull the trigger as boys who were perceived to have a moderate or high interest in guns. More than 90% of the boys who handled the gun or pulled the trigger reported that they had previously received some sort of gun safety instruction.

CONCLUSION

Many 8- to 12-year-old boys will handle a handgun if they find one. Guns that are kept in homes should be stored in a manner that renders them inaccessible to children.guns, weapons, firearms, children, childhood behavior, injury prevention.

Children and guns in a well child cohort

BACKGROUND

The purpose of this study was to estimate the extent of and to identify predictors of preadolescent gun use in a well child cohort with matched parent and child data.

METHODS

We analyzed self-report questionnaires from children and their parents using conditional logistic regression models. Questionnaires were given to 3,145 ten- to twelve-year-old children and 3,145 parents enrolled by their pediatricians in a prevention cohort study.

RESULTS

Thirty-two percent of the children lived in households with guns. Children and parents generally agreed about the presence of guns in their homes; 17% had access to unlocked guns in their homes; 22% had fired guns. In this preadolescent cohort, firing guns was associated with being male, having guns in the home, having friends who use guns, and initiation of alcohol use.

CONCLUSIONS

In this well child cohort, significant numbers of preadolescent, healthy boys in white, middle-class U.S. homes have access to guns, are using guns, and have friends who use guns. These children are also early alcohol adopters. Safety interventions with parents of preadolescents about the risks for accidental injury, death, and suicide due to child gun use may prove beneficial.

Reexamining the association between child access prevention gun laws and unintentional shooting deaths of children

CONTEXT

A previous study estimated that child access prevention (CAP) laws, which hold adults criminally liable for unsafe firearm storage in the environment of children, were associated with a 23% decline in unintentional firearm mortality rates among children.

OBJECTIVE

To reassess the effects of CAP laws and more fully examine the consistency of the estimated law effects across states.

DESIGN

A pooled time-series study of unintentional firearm mortality among children from 1979 through 1997. Setting. The 50 states and the District of Columbia.

PARTICIPANTS

All children <15 years.

MAIN OUTCOME MEASURES

Rates of unintentional deaths attributable to firearms.

RESULTS

When the effects of all 15 state CAP laws enacted before 1998 were aggregated, the laws were associated with a 17% decline unintentional firearm death rates among children. The laws' effects were not equal across states. Florida's CAP law was associated with a 51% decline; however, there were no statistically significant aggregate or state-specific law effects in the other 14 states with CAP laws.

CONCLUSIONS

Florida's CAP law-1 of only 3 such laws allowing felony prosecution of violators-appears to have significantly reduced unintentional firearm deaths to children. However, there is no evidence of effects in the other 14 states with CAP laws.

Compliance with recommendations to remove firearms in families participating in a clinical trial for adolescent depression

OBJECTIVE

To assess the rate and correlates of compliance with clinicians' recommendations to remove firearms from the homes of depressed adolescents participating in a clinical trial.

METHOD

The parents of 106 adolescents with major depression who participated in a randomized psychotherapy clinical trial were asked systematically about firearms in the home. Those who answered affirmatively were given information about the suicide risk conveyed by guns in the home and urged to remove them. The rates of gun removal and acquisition were assessed at the end of the treatment and over the subsequent 2-year naturalistic follow-up.

RESULTS

Of those who had guns at intake, 26.9% reported removing them by the end of the acute trial. Retention was associated with urban origin, marital dissatisfaction, and paternal psychopathology. Of those who did not have guns at intake, 17.1% reported acquiring them over 2-year follow-up. Living in a 2-parent household and marital dissatisfaction were associated with gun acquisition.

CONCLUSIONS

Families of depressed adolescents may frequently be noncompliant with recommendations to remove guns from the home despite compliance with other aspects of treatment. More efficacious interventions to reduce access to guns in the homes of at-risk youths are needed.

Physician firearm ownership as a predictor of firearm injury prevention practice

OBJECTIVES

This study explored the relation between physicians' gun ownership and their attitudes and practices regarding firearm injury prevention.

METHODS

Internists and surgeons were surveyed, and logistic regression models were developed with physicians' personal involvement with firearms (in the form of a gun score) as the primary independent variable.

RESULTS

Higher gun scores were associated with less agreement that firearm injury is a public health issue and that physicians should be involved in firearm injury prevention but with a greater likelihood of reporting the inclusion of firearm ownership and storage as part of patient safety counseling.

CONCLUSIONS

Despite being less likely to say that doctors should participate in firearm injury prevention, physician gun owners are more likely than nonowners to report counseling patients about firearm safety.

Are household firearms stored safely? It depends on whom you ask

OBJECTIVE

To determine gun storage practices in gun-owning households with children.

DESIGN

National random digit-dial telephone survey of 2521 households conducted in March 1999 through July 1999. This study uses a subsample of 434 households with children <18 years old in which a respondent reported either: 1) personally owning a gun, or 2) living in a gun-owning household but not owning a gun themselves. Respondents were asked whether any household gun was currently stored loaded, and, if yes, whether any gun was currently stored loaded and unlocked.

RESULTS

Twenty-one percent of gun owners compared with 7% of non-owners reported that a household gun was stored loaded, while 9% and 2%, respectively, reported that a household gun was stored loaded and unlocked. Non-gun owners were significantly more likely than were gun owners to be female (87% vs 22%) and to report that they lived in a house with only 1 gun (70% vs 57%) and no handguns (51% vs 31%). Based on the reports of actual gun owners (n = 252), households with children <13 years old were significantly less likely to store a gun loaded and unlocked (multivariate odds ratio:.1; 95% confidence interval:.0,.4) than were households with teenagers only.

CONCLUSIONS

We find that among gun-owning households with children, non-gun owners report significantly lower rates of guns stored loaded and unlocked than do gun owners. These findings are consistent with recent studies that have found that married men are far more likely to report household gun ownership than are married women, and that gun users are far more likely to report that a gun is stored loaded or loaded and unlocked than are never users. Our findings suggest that non-gun owners, the vast majority of whom are women (87%), may be unaware that guns in their homes are stored in a manner that experts agree is unsafe. Our findings reinforce the importance of many pediatricians' current efforts to offer anticipatory guidance about firearms to gun-owning families, and, in addition, suggest that this guidance can be adapted depending on whether the physician is speaking with a gun-owning or non-gun-owning parent. In particular, because gun owners (mostly fathers) are less likely to bring children to the pediatrician's office than are non-owners (mostly mothers), physicians should take advantage of any opportunities that they have to address gun-related issues with parents who personally own guns. More commonly, physicians can encourage non-gun owners to participate more fully in household decision-making about gun storage by letting them know not only about recommended storage practices, but also that many non-owners may not know how guns are actually stored in their own homes. firearm, storage, children, survey.

Firearm storage patterns in US homes with children

OBJECTIVES

This study determined the prevalence and storage patterns of firearms in US homes with children.

METHODS

We analyzed data from the 1994 National Health Interview Survey and Year 2000 objectives supplement. A multistage sample design was used to represent the civilian noninstitutionalized US population.

RESULTS

Respondents from 35% of the homes with children younger than 18 years (representing more than 22 million children in more than 11 million homes) reported having at least 1 firearm. Among homes with children and firearms, 43% had at least 1 unlocked firearm (i.e., not in a locked place and not locked with a trigger lock or other locking mechanism). Overall, 9% kept firearms unlocked and loaded, and 4% kept them unlocked, unloaded, and stored with ammunition; thus, a total of 13% of the homes with children and firearms--1.4 million homes with 2.6 million children--stored firearms in a manner most accessible to children. In contrast, 39% of these families kept firearms locked, unloaded, and separate from ammunition.

CONCLUSIONS

Many children live in homes with firearms that are stored in an accessible manner. Efforts to prevent children's access to firearms are needed.

Firearms in the home: parental perceptions

BACKGROUND

Each year, thousands of children are injured or killed from unintentional gunshot wounds. Discovering a gun while playing in the home places children at risk of being injured by the firearm.

OBJECTIVES

To determine parental firearm storage practices and parental perceptions of the behavior of their children around guns.

METHODS

Cross-sectional survey of parents of children from 4 to 12 years of age. A sample of 424 parents, bringing their children to one of five pediatric ambulatory care centers, were asked to complete a 20-point self-administered questionnaire at the time of their visit.

RESULTS

A total of 400 parents (94%) completed the questionnaire; 113 parents (28%) reported keeping a firearm (most often a handgun) in the home. Firearm owners were predominantly male, 30 years of age or older, white, and married. Of the gun owners, 52% stored their firearms loaded or unlocked, and 13% kept one or more guns loaded and unlocked. Three fourths of gun-owning parents believed that their 4- to 12-year-old child could tell the difference between a toy gun and a real gun, and 23% believed that their child could be trusted with a loaded gun. Although the majority of gun-owning parents (53%) endorsed safe storage as the best firearm injury prevention strategy, 61% of parents who do not own firearms endorse not owning guns as the best way to prevent pediatric firearm injuries.

CONCLUSION

A majority of gun-owning parents store their firearms loaded or unlocked, substantially underestimating the risk of injury to their children. Many firearm-owning parents trust their child with a loaded gun and believe that their young child can tell the difference between a toy gun and a real gun.

Firearm injury prevention counseling: are We missing the mark?

OBJECTIVE

To determine whether pediatricians accurately estimate the likelihood of gun ownership among their patients' families. Design. Self-administered, written surveys completed simultaneously by pediatricians and their patients' parents.

SETTING

A total of 23 pediatric practices and hospital-based clinics in three cities in the United States.

SUBJECTS

A total of 66 pediatricians paired with 169 of their patients' parents.

MAIN OUTCOME MEASURES

Parent survey: ownership and storage of guns, willingness to admit gun ownership, and previous counseling by pediatrician. Pediatrician survey: estimated prevalence of gun ownership, likelihood of gun ownership by each participant family, and beliefs about firearm injury prevention counseling.

RESULTS

All parents who owned guns indicated they would acknowledge owning a gun if asked by their pediatricians. Of the participating families, 28% owned at least one gun; 39% of the homes with guns contained a gun that was unlocked, loaded, or both. Of the parents, 11% reported that their pediatrician had discussed firearm safety with them. Pediatricians' average estimate of the overall prevalence of gun ownership in their patient populations was 25%. When asked to predict the likelihood of gun ownership by the specific families in the study, pediatricians predicted a 0% likelihood of gun ownership for 33% of the families. Of those families, 30% reported owning at least one gun. Considering physician predictions of any likelihood of gun ownership >0% (1%-100%) to be a positive prediction and using parent reports as the gold standard, physician estimates of gun ownership were only 65% sensitive. Approximately half (55%) of the participating pediatricians believed that pediatricians should discuss gun safety with all families, and 98% believed that pediatricians should discuss gun safety with all gun-owning families.

CONCLUSIONS

Pediatricians believe that all families with guns should receive firearm safety counseling. However, pediatricians significantly underestimate the likelihood of gun ownership by specific families. Parents who own guns indicate that they would acknowledge gun ownership if their pediatrician asked about guns in the home. Therefore, rather than relying on assumptions about whether particular patients seem likely to be gun owners, pediatricians should ask all families whether they own guns.

Handgun safety features: a review for physicians

OBJECTIVE

Handguns are a ubiquitous consumer product in the United States, which annually cause significant morbidity and mortality. Handgun safety devices are often proposed as potential solutions to this problem. Their effectiveness at reducing handgun injuries and deaths is intensely debated. However, to effectively analyze the potential utility of handgun safety devices, physicians need to be aware of the safety devices available in the consumer market and how they operate.

METHODS

A wide variety of safety devices are available in the consumer market, which vary in terms of their ease of operation, cost, and the types of injuries they may prevent. We reviewed several types of handgun safety devices, including loaded chamber indicators, manual thumb safeties, grip safeties, magazine disconnectors, drop safeties, built-in locks, trigger locks, lockboxes, and personalized handguns. Each device is described within the context of reducing unintended discharge and unauthorized use.

RESULTS

This review is not exhaustive. There are other types of safety devices that limit access to handguns. Many of these devices, such as barrel locks and chamber locks, work in a similar manner as trigger locks and have the same limitations. The user of any type of safety device should think about the types of injuries the device is designed to prevent and be aware of its limitations.

CONCLUSION

Physicians have the potential to reduce the risk of firearm injuries with their patients and communities. Providing accurate information on firearm safety devices and their limitations is important, just as it is for other aspects of health care advice. Armed with accurate information, physicians can hopefully be effective in firearm injury prevention.

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

INTRODUCTION

The prevalence with which firearms are stored loaded or unlocked has been measured in previous surveys. Our purpose was to compare household firearm storage practices reported by firearm users and nonusers.

METHODS

We analyzed telephone survey data from the 1992 and 1993 Oregon Behavioral Risk Factor Surveillance System on 2454 randomly selected adults in households with firearms. We compared reported firearm storage practices among persons who ever used firearms with persons who had never used firearms by demographics and type of firearm.

RESULTS

Nonusers of firearms were much less likely than firearm users to report that household firearms were always or sometimes stored loaded [odds ratio (OR) = 0.45, 95% confidence interval (CI):0.36-0.54] or stored loaded and unlocked (OR = 0.46, 95% CI: 0.36-0.57). Except for persons aged 18 to 34 years and persons in handgun-only households, differences in reported firearm storage practices between nonusers and users varied little by demographic characteristics or by type of firearm. Nonusers of household firearms may be unaware that firearms are stored loaded or stored loaded and unlocked in their homes.

CONCLUSIONS

Surveys that do not consider firearm use status may underestimate household exposure to loaded firearms or to loaded and unlocked firearms.

Pediatric practice based evaluation of the Steps to Prevent Firearm Injury program

OBJECTIVE

To estimate the prevalence of gun ownership and methods of gun storage in homes of pediatric patients before and after an educational intervention.

DESIGN

Before and after trial.

SETTING

Hospital based, inner city, pediatric primary care practice.

PARTICIPANTS

Consecutive sample of parents of patients with appointments August to November 1994.

INTERVENTION

Before the intervention, participants completed an anonymous questionnaire regarding ownership and storage of guns in their home. The intervention followed the Steps to Prevent Firearm Injury program of the American Academy of Pediatrics. It began after the parent completed the questionnaire and was reinforced at subsequent visits until July 1995. Families completing a baseline questionnaire and returning to the office July to October 1995 were resurveyed.

MAIN OUTCOME MEASURE

Reported change in gun ownership and methods of storage.

RESULTS

A gun(s) in the home was reported by 8.7% of respondents. Matched baseline and follow up questionnaires were available for 23.6% of families. In these, gun ownership reportedly decreased after intervention from 9.4% to 7.0%, handgun ownership fell from 5.4% to 3.0%, and long gun ownership fell from 6.1% to 5.5%. Storing guns outside of a locked container did not change from the baseline prevalence of 2.7%, but keeping any gun loaded fell from 1.6% to 0.5%. All p values were >0.05.

CONCLUSION

This study was unable to demonstrate a statistically significant decline in gun ownership or improvement in gun storage after a practice based intervention designed to encourage these behaviors.

Personality traits in juvenile delinquents: relation to criminal behavior and recidivism

OBJECTIVE

To examine the relation between personality traits and criminal behavior and to determine whether such factors are predictive of future recidivism.

METHOD

A sample of 481 incarcerated males (mean age = 16 years) completed questionnaires assessing distress and restraint relating to personality characteristics. In addition, official criminological data were gathered from subjects' records. A subsample of 148 juveniles was followed up to 4.5 years after release and examined for rearrests and time out of prison since last incarceration.

RESULTS

Results indicate a significant association between self-reported levels of distress and restraint and prior criminal behavior as well as behavior during incarceration. Furthermore, of the sample surveyed, 67% were rearrested. Personality traits measured during incarceration were predictive of recidivism rates, above and beyond the effects of such criminological factors as age and number of prior offenses.

CONCLUSIONS

The results support the view that juvenile delinquents are a heterogeneous population in terms of personality features. These traits have discriminant and predictive validity. Adding personality measures to the assessment of delinquents may further our understanding of how personality influences criminal activity and future recidivism. We may be able to use this understanding to target specific domains of functioning to develop more effective intervention strategies.