Gun Storage Practices and Risk of Youth Suicide and Unintentional Firearm Injuries | Adolescent Medicine | JAMA | JAMA Network
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Kellermann A, Rivara F, Somes G.  et al.  Suicide in the home in relation to gun ownership.  N Engl J Med. 1992;327:467-472Google ScholarCrossref
Brent DA, Perper JA, Allman CJ, Moritz GM, Wartella ME, Zelenak JP. The presence and accessibility of firearms in the homes of adolescent suicides: a case-control study.  JAMA. 1991;266:2989-2995Google ScholarCrossref
Brent DA, Perper JA, Moritz G, Baugher M, Schweers J, Roth C. Firearms and adolescent suicide: a community case-control study.  AJDC. 1993;147:1066-1071Google Scholar
Cummings P, Koepsell TD, Grossman DC, Savarino J, Thompson RS. The association between the purchase of a handgun and homicide or suicide.  Am J Public Health. 1997;87:899-901Google ScholarCrossref
Bukstein OG, Brent DA, Perper JA.  et al.  Risk factors for completed suicide among adolescents with a lifetime history of substance abuse: a case-control study.  Acta Psychiatr Scand. 1993;88:403-408Google ScholarCrossref
Brent DA, Perper JA, Goldstein CE.  et al.  Risk factors for adolescent suicide: a comparison of adolescent suicide victims with suicidal inpatients.  Arch Gen Psychiatry. 1988;45:581-588Google ScholarCrossref
Grossman DC, Reay DT, Baker SA. Self-inflicted and unintentional firearm injuries among children and adolescents: the source of the firearm.  Arch Pediatr Adolesc Med. 1999;153:875-878Google ScholarCrossref
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;27:173-182Google ScholarCrossref
Schuster MA, Franke TM, Bastian AM, Sor S, Halfon N. Firearm storage patterns in US homes with children.  Am J Public Health. 2000;90:588-594Google ScholarCrossref
Stennies G, Ikeda R, Leadbetter S, Houston B, Sacks J. Firearm storage practices and children in the home, United States, 1994.  Arch Pediatr Adolesc Med. 1999;153:586-590Google ScholarCrossref
Grossman DC, Cummings P, Koepsell TD.  et al.  Firearm safety counseling in primary care pediatrics: a randomized, controlled trial.  Pediatrics. 2000;106:22-26Google ScholarCrossref
Weil DS, Hemenway D. Loaded guns in the home: analysis of a national random survey of gun owners.  JAMA. 1992;267:3033-3037Google ScholarCrossref
Cummings P, Grossman DC, Rivara FP, Koepsell TD. State gun safe storage laws and child mortality due to firearms.  JAMA. 1997;278:1084-1086Google ScholarCrossref
Webster DW, Vernick JS, Zeoli AM, Manganello JA. Association between youth-focused firearm laws and youth suicides.  JAMA. 2004;292:594-601Google ScholarCrossref
Vernick JS, O'Brien M, Hepburn LM, Johnson SB, Webster DW, Hargarten SW. Unintentional and undetermined firearm-related deaths: a preventable death analysis for three safety devices.  Inj Prev. 2003;9:307-311Google ScholarCrossref
Wintemute GJ, Teret SP, Kraus JF, Wright MA, Bradfield G. When children shoot children: 88 unintended deaths in California.  JAMA. 1987;257:3107-3109Google ScholarCrossref
Azrael D, Miller M, Hemenway D. Are household firearms stored safely? it depends on whom you ask.  Pediatrics. 2000;106:E31Google ScholarCrossref
Hemenway D, Solnick SJ, Azrael DR. Firearm training and storage.  JAMA. 1995;273:46-50Google ScholarCrossref
Senturia YD, Christoffel KK, Donovan M. Gun storage patterns in US homes with children: a pediatric practice-based survey.  Arch Pediatr Adolesc Med. 1996;150:265-269Google ScholarCrossref
Centers for Disease Control and Prevention.  2002 Behavioral Risk Factor Surveillance System Summary Data Quality Report. Available at: Accessibility verified January 11, 2005
Biener L, Garrett CA, Gilpin EA, Roman AM, Currivan DB. Consequences of declining survey response rates for smoking prevalence estimates.  Am J Prev Med. 2004;27:254-257Google ScholarCrossref
Coyne-Beasley T, Schoenbach VJ, Johnson RM. “Love Our Kids, Lock Your Guns”: a community-based firearm safety counseling and gun lock distribution program.  Arch Pediatr Adolesc Med. 2001;155:659-664Google ScholarCrossref
Horn A, Grossman DC, Jones W, Berger LR. A community-based program to improve firearm storage practices in rural Alaska.  Inj Prev. 2003;9:231-234Google ScholarCrossref
Original Contribution
February 9, 2005

Gun Storage Practices and Risk of Youth Suicide and Unintentional Firearm Injuries

Author Affiliations

Author Affiliations: Departments of Health Services and Pediatrics (Dr Grossman), Department of Epidemiology (Dr Mueller), and Harborview Injury Prevention and Research Center (Drs Grossman, Mueller, Riedy, and Villaveces and Ms Prodzinski), University of Washington, Seattle; Medical Examiner Offices of King, Pierce, and Snohomish Counties, Washington (Drs Howard, Thiersch, and Harruff, and Mr Nakagawara); and Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Mo (Dr Dowd). Dr Grossman is now with the Department of Preventive Care and Center for Health Studies, Group Health Cooperative, Seattle, Wash.

JAMA. 2005;293(6):707-714. doi:10.1001/jama.293.6.707

Context Household firearms are associated with an elevated risk of firearm death to occupants in the home. Many organizations and health authorities advocate locking firearms and ammunition to prevent access to guns by children and adolescents. The association of these firearm storage practices with the reduction of firearm injury risk is unclear.

Objective To measure the association of specific household firearm storage practices (locking guns, locking ammunition, keeping guns unloaded) and the risk of unintentional and self-inflicted firearm injuries.

Design and Setting Case-control study of firearms in events identified by medical examiner and coroner offices from 37 counties in Washington, Oregon, and Missouri, and 5 trauma centers in Seattle, Spokane, and Tacoma, Wash, and Kansas City, Mo.

Cases and Controls Case firearms were identified by involvement in an incident in which a child or adolescent younger than 20 years gained access to a firearm and shot himself/herself intentionally or unintentionally or shot another individual unintentionally. Firearm assaults and homicides were excluded. We used records from hospitals and medical examiners to ascertain these incidents. Using random-digit dial telephone sampling, control firearms were identified by identification of eligible households with at least 1 firearm and children living or visiting in the home. Controls were frequency matched by age group and county.

Main Exposure Measures The key exposures of interest in this study were: (1) whether the subject firearm was stored in a locked location or with an extrinsic lock; (2) whether the firearm was stored unloaded; (3) whether the firearm was stored both unloaded in a locked location; (4) whether the ammunition for the firearm was stored separately; and (5) whether the ammunition was stored in a locked location. Data regarding the storage status of case and control guns were collected by interview with respondents from the households of case and control firearms.

Results We interviewed 106 respondents with case firearms and 480 with control firearms. Of the shootings associated with the case firearms, 81 were suicide attempts (95% fatal) and 25 were unintentional injuries (52% fatal). After adjustment for potentially confounding variables, guns from case households were less likely to be stored unloaded than control guns (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.16-0.56). Similarly, case guns were less likely to be stored locked (OR, 0.27; 95% CI, 0.17-0.45), stored separately from ammunition (OR, 0.45; 95% CI, 0.34-0.93), or to have ammunition that was locked (OR, 0.39; 95% CI, 0.23-0.66) than were control guns. These findings were consistent for both handguns and long guns and were also similar for both suicide attempts and unintentional injuries.

Conclusions The 4 practices of keeping a gun locked, unloaded, storing ammunition locked, and in a separate location are each associated with a protective effect and suggest a feasible strategy to reduce these types of injuries in homes with children and teenagers where guns are stored.