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Grossman DC, Mueller BA, Riedy C, et al. Gun Storage Practices and Risk of Youth Suicide and Unintentional Firearm Injuries. JAMA. 2005;293(6):707–714. doi:10.1001/jama.293.6.707
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.
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,
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.