Parent and Adolescent Reports of Adolescent Access to Household Firearms in the United States

Key Points Question Can adolescents in gun-owning homes access loaded firearms, and how often are parent’s reports of access discordant with their child’s? Findings In this nationally representative survey study of 280 parent-child dyads who live in households with firearms, more than one-third of adolescents reported being able to access a loaded household firearm in less than 5 minutes; this proportion fell to nearly one-quarter when all firearms were locked. Although 70% of parents reported that their adolescent could not independently access a household firearm, more than one-third were contradicted by their child’s report. Meaning Approaches to reducing firearm injury should focus on adolescents’ access to firearms, not solely on firearm storage.


+ Invited Commentary + Supplemental content Introduction
The risk of suicide and unintentional firearm injury is several times higher for adolescents when they live in homes with firearms compared with children who lives in homes without them. [1][2][3][4][5] For children and young adults in households with firearms, firearm injury is less likely when all firearms are stored locked and unloaded, as opposed to unlocked, loaded, or both unlocked and loaded. 2 These observations underpin long-standing recommendations by the American Academy of Pediatrics for parents who choose to keep firearms in their home: lock up and unload all household firearms and store ammunition separately from the firearm. 6 An issue that may get lost with a focus on in-home storage [7][8][9] is the extent to which storing guns locked up, unloaded, or both effectively reduces youth access to loaded firearms in their home. While there is a large amount of literature on household firearm storage, 1,3-5,10,11 the most recent of which estimates that approximately 10 million children live in households with at least 1 unlocked or loaded firearm, 12 few studies have examined youth access to guns in their home. 12 For example, the only nationally representative survey to have examined adolescent access to firearms in their homes found that between 2001 and 2004, 41% of youths aged 13 to 18 years who lived in homes with guns responded affirmatively to, "Could you get [to a household gun] and shoot it right now if you wanted to?" 13 Two more recent studies 14,15 among children presenting to emergency departments produced lower estimates. One found that 28% of adolescents aged 12 to 17 years reported being able to access a loaded firearm in less than 3 hours. 14 The second found that 14% of children aged 7 to 17 years who lived in a household with firearms could "obtain a gun today." 15 The only data that speak to agreement between parent and child reports of access to firearms come from a study conducted in a family practice clinic in rural Alabama in 2002. In this study, approximately 1 in 5 parents who reported that their child (aged 5-14 years) had never handled a household gun were contradicted by their child's report. 16 To our knowledge, no study before ours has examined the association between access and firearm storage.
The current nationally representative survey describes adolescents' access to household firearms in 2019 as reported by dyads of parents and their adolescent children. It extends prior work in 3 ways: (1) by describing contemporary youth access to household firearms, (2) by examining the association between firearm storage and youth firearm access, and (3) by reporting discordance in parent-child report of current access.

Sample and Data Collection
The present study uses data on parents and their adolescent children drawn from a nationally representative online survey (the 2019 National Firearms Survey [NFS]), conducted by the research firm Ipsos from July 30 to August 11, 2019. Respondents were drawn from Ipsos's KnowledgePanel (KP), an online sampling frame comprising approximately 55 000 US adults recruited using addressbased sampling methods. Samples selected from KP using probability-based recruitment methods are representative of the US population. Additional details can be found elsewhere. 17 Eligible participants for the 2019 NFS were English-speaking noninstitutionalized US adults (18 years of age or older) residing in gun-owning households, excluding those on active duty in the US military. A gun-owning household was defined as a household where the respondent indicated either that they personally owned a gun or that someone else in their household did. Panel members' reports of whether they lived in a home with firearms are collected on enrollment in KP and annually thereafter, allowing us to restrict invitations to adults who had previously reported that they lived in a home with firearms. Those who personally owned guns and parents or legal guardians of adolescents aged separate survey. If the respondent had more than 1 child in that age group, they were asked to have the child with the most recent birthday participate. Reporting of response rates follows the Association for Public Opinion Research (AAPOR) definition for response rate 2, which includes partial interviews; partial interviews are defined as those who completed 50% to 80% of essential survey questions. 18 Study-specific poststratification weights provided by Ipsos adjust for survey nonresponse and undercoverage or overcoverage resulting from the study-specific sample design. Poststratification weights also adjust for benchmark demographic distributions (from the US Census Current Population Survey [CPS] and the American Community Survey [ACS]) and for population characteristics, such as gun ownership (which are not available in the CPS or ACS), from weighted KP profile data.
The Harvard School of Public Health institutional review board approved the study. Panel members provide blanket consent to be recruited to participate in surveys on joining KP. Consent for this study was sought in the initial survey text seen by participants who could choose after reading the text to continue or not. These parents were also asked to allow their adolescent children to complete the survey in private and to let the adolescent know that they could decline to take the survey if they chose, skip any questions that make them uncomfortable, or stop taking the survey at any point.

Adolescent-Reported Measures
Adolescents were asked whether "as far as you know, are there any guns in your home?" Adolescents who responded yes were asked additional questions about household firearms, including "How long would it take you to get 1 of the guns in your home (and load it, if it wasn't already loaded)?" Mutually exclusive response options were less than 5 minutes, less than 1 hour, less than 2 hours, and cannot get to it in less than 2 hours. Adolescents self-reported their age and gender. Adolescents' age was dichotomized as 13 to 14 years or 15 to 17 years of age.

Parent-Reported Measures
Parents who agreed to have their child participate were asked to complete an additional survey module that focused on the child who participated. To assess parent's knowledge of the surveyed adolescent's access to firearms, all parents were asked, "As far as you know, can your [surveyed] child access any of the guns in your home independently, that is without you or another adult in your house accessing it for him/her?" Possible responses were yes or no.
Respondents were asked whether they personally owned a gun. Gun-related information about the household (ie, number and type of guns, firearm storage) was elicited from parent respondents who personally owned guns to avoid measurement bias from adults who did not own guns, who have been known to underreport the presence of household firearms and overestimate how safely household firearms are stored. 19,20 Individuals who owned guns were asked how many handguns they owned, how many long guns they owned, and how many guns in total were owned by other household members. Respondents who owned guns were also asked about the number of long guns and handguns they owned that were stored (1) loaded and unlocked, (2) unloaded and locked, (3) unloaded and unlocked, and (4) loaded and locked. Locking was defined as the use of a "trigger lock, cable lock, in a lock box or in another locked container." For those who reported living with someone else who owned guns, they were also asked whether the other person who owned firearms stored any firearms (1) unlocked, (2) loaded, and (3) loaded and unlocked. These items were combined to identify whether the household had any firearms stored unlocked as well as whether the household had any firearms stored loaded. For households that had all firearms locked, we determined whether any locked guns were loaded. For households that had unlocked firearms, we determined whether any were loaded and unlocked.

Statistical Analysis
Our analyses had 3 goals: (1) to describe the demographic and firearm-ownership characteristics of our sample of firearm-owning households with adolescents 13 to 17 years of age; (2) to estimate the proportion of adolescents who reported being able to gain access to household firearms in less than 5 minutes and in less than an hour and assess modifiers of reported access; and (3) to quantify the extent of discordance between parents' and adolescents' reports of adolescent access to firearms in the home. Discordance in reporting of adolescent access was noted when parents reported that their child could not access a firearm independently but the adolescent reported being able to access a gun in less than 5 minutes or less than 1 hour. Weighted percentages and their 95% CIs were estimated. Sampling weights supplied by Ipsos were applied such that all estimates are representative of households with firearms and children between 13 to 17 years of age. Description of sampling weights can be found in the eAppendix in the Supplement. Confidence intervals were set as 95% CIs (α = .05) using a 2-tailed distribution. Analyses were conducted from June 1, 2020, to January 4, 2021, in Stata version 16 (StataCorp).

Results
Of

Descriptive Statistics of Firearm-Ownership Characteristics
Households where the parent respondent owned guns were similar to homes where the parent respondent did not personally own household guns, except that a larger proportion of parent respondents who owned guns were male compared with parents who did not own guns (123 parents

Adolescent Report of their Access to Loaded Household Firearms
One-third of adolescents reported that they could access a loaded firearm in under 5 minutes of parents who owned guns), most were corroborated by their child's report (nearly two-thirds within 5 minutes and more than 85% within 1 hour).

Discussion
Four key findings emerged from our analysis. First, in at least one-third of gun-owning households with an adolescent 13 to 17 years of age, adolescents reported that they could access a loaded firearm In homes with all guns locked, are any loaded in their home in less than 5 minutes (half reported being able to do so within an hour). Second, while unlocked firearm storage was associated with greater adolescent access, in homes where all guns were locked 1 in 4 adolescents reported being able to access a loaded firearm in less than 5 minutes (and 1 in 3 in under an hour). Third, in more than one-quarter of gun-owning households, parents reported that their adolescent child could independently gain access to a household firearm. And fourth, among the 70% of households where parents did not believe their child could access a household firearm, more than 1 in 5 adolescents reported being able to access a loaded household firearm within 5 minutes (37% within an hour).
To our knowledge, no prior nationally representative study has examined the ways in which household firearm storage practices are associated with adolescent access to firearms. Our finding that storage practices are imperfect proxies for adolescent access suggests that the advice to lock all household firearms, as recommended by several professional medical associations, should always incorporate the caveat, now empirically grounded, that locking all firearms does not necessarily prevent access. In addition, our discordance findings suggest that efforts to reduce adolescent access to firearms in households may benefit from engaging parents with their adolescents in conversations about access to household firearms, especially when parents think their child cannot   access a household gun. These conversations might include efforts to make the parent who does not personally own a firearm aware that they are especially likely to misjudge their child's independent access to a gun in the home. Finally, our finding that 1 in 4 parents said that their adolescent can independently access household firearms suggests that a nontrivial proportion of parents view such access as likely a net benefit (or at least not a net risk). If so, this finding suggests that millions of US parents underestimate the injury risk or overestimate the protective benefit that ready access confers on their adolescents.

Limitations
Five aspects of our study design should be considering when interpreting our results. First, although our sample of adolescent-parent dyads is the largest of which we are aware in the published peerreviewed literature, our sample size limits the precision of estimates. In 64% of gun-owning parentadolescent dyads, the adolescent was male (54% of non-gun-owning dyads were male). This imbalance may have been due to chance alone (the confidence intervals largely overlap). It is also possible that parents who own guns preferentially called on their male children to answer the survey.
Because male and female adolescents do not differ materially in their report of access to household guns (or of parent-child agreement regarding access; data not shown), poststratification weighting by adolescent gender would not meaningfully change our point estimates. Second, some adolescents responded that they either did not know if or did not think there was a gun in the home.
If we assigned these adolescents to not being able to access a firearm in under 2 hours, our overall estimates of adolescent access to a loaded household firearm would be slightly, but not significantly, adolescents were asked about access to a loaded household gun, some parents may have reported that their child had access to a household gun when they would have reported otherwise had they  b Based on parent question, "As far as you know, can your child access any of the guns in your home independently, that is without you or another adult in your house accessing it for him/her?"

JAMA Network Open | Pediatrics
Parent and Adolescent Reports of Adolescent Access to Household Firearms been asked about access to a loaded gun. Because of this, the discordance we reported with respect to access to a household gun is a lower bound compared with what we might have found had we asked parents about their child's access to loaded firearms.

Conclusions
Prevention efforts aimed at reducing access to household firearms should be informed by the findings of this study. They were that (1) many adolescents reported having ready access to loaded guns in their home, even when all household firearms are locked, (2) many adolescents who reported having access to household firearms lived with parents who knew they had access, and (3) many others live with parents who did not.