Firearm injury among youths is a public health problem that presents differently in rural and metropolitan (urban) areas. Ellyson and colleagues1 focus on handgun carrying by youths who grew up in rural areas. Handgun carrying by adolescents is a precursor to gun assault and homicide because these crimes typically occur away from home.2 However, interpersonal violence is a less pressing problem in rural areas than in urban areas. In this commentary, we broaden the focus to include suicide, which almost always occurs at home, and consider the need to limit access to guns by children and adolescents.
Of course, the growing propensity nationwide to carry guns is a public health concern. Ellyson and colleagues1 track self-reported handgun carrying in a cohort of youths. The first wave of interviews was in 2005, when respondents were 12 years of age, and subsequent waves were conducted in most years thereafter until 2019, when the respondents were 26 years of age. The sample of 2002 individuals was taken from students in 12 rural towns distributed across 7 states and was not designed to be nationally representative. In each interview, respondents were asked how often they had carried a handgun in the previous 12 months. Most respondents (70%) responded “zero” in every interview, and, indeed, only 14% of the original sample indicated in more than 1 interview that they had carried a handgun in the previous year. Some of those who were repeat handgun carriers had started young, although only 7.4% of the sample indicated that they had carried a handgun at 12 years of age, and still fewer (5.7%) at 13 years of age. The survey did not ask for details, and it is quite possible that the respondents were reporting legal incidents in which they were hunting or target shooting with a parent. Although the prevalence of handgun carrying was quite low, the main conclusion of the article is “that promoting handgun safety in rural areas should start early,” in late childhood and the elementary school period.
In our view, “promoting handgun safety” by educating rural children is of limited value, especially given that the predominant gun problem for adolescents in rural areas is suicide. Indeed, firearm suicide rates are far higher in rural areas than in urban areas for youths aged 12 to 17 years in the United States.3 During the 21st century, the mean annual gun suicide rate among youths aged 12 to 17 years in rural areas has been 3.3 per 100 000, accounting for half of all suicides in that age group and twice the rate in urban areas.3 Since 2018, the gun suicide rate has increased to more than 5 per 100 000.3
To some extent, the rural-urban gap reflects availability; the prevalence of households with guns—both handguns and long guns—is considerably higher in rural areas than in either suburban or urban areas.4 On the other hand, the rates of violent crime are relatively low in rural areas, which helps account for the comparatively low rate of gun homicides.5 In preventing the misuse of guns by adolescents leading to either self-inflicted or interpersonal violence, a reasonable place to start is with the enforcement of existing regulations.
We know that most guns used in youth suicides belong to the parents, and most of those were carelessly stored.6 Unsupervised access, possession, and carrying of guns by adolescents is restricted by both federal and state laws. The federal Gun Control Act of 1968 bars sales of handguns by licensed retailers to those younger than 21 years of age; it also bars possession of handguns by those younger than 18 years.7 The law specifies certain exceptions, which can be summarized as a requirement for adult supervision. State laws also place age-based restrictions on possession, carrying, and use, which reinforce the federal ban on handgun possession by unaccompanied minors.8 Even while many states have relaxed restrictions on concealed carry, age restrictions have remained in place. Of the states that allow permitless concealed carry, for example, 12 states set the minimum age at 21 years, 8 set the minimum age at 18 years, and 1 (Vermont) set the minimum age at 16 years.8
Ellyson and colleagues1 focus their recommendations on programs to teach gun safety to youths, although there is little evidence that training or educational programs are effective in reducing risky behavior.9 An alternative approach is to target the behavior of the parents, who typically are the immediate source of the guns that end up misused by the children in the family. It is the parents’ responsibility to prevent unauthorized access by their children, either by keeping guns out of the home or securing them.
To encourage parents to take due care, 30 states have enacted child access prevention (CAP) laws.10 These laws hold parents liable for preventing children from gaining access to household guns without appropriate supervision. CAP laws in 12 states hold parents criminally liable if a child younger than a specified age is allowed access to a gun kept in the household. In 10 other states, adults are held liable only if they knowingly or recklessly provide firearms to minors, while in 8 states, parents are held criminally liable only if a child shoots someone with a gun kept in the household. An extensive evaluation of literature on CAP laws suggests that they save lives.9,10
A complementary approach, with the same goal of preventing firearm deaths among children, is to ensure that guns kept in the home can be fired only by an authorized user. Such “personalized” guns require the authorized user’s fingerprint or fob to release the safety mechanism. Although these guns are not yet sold on the US market, they have the potential to reduce unauthorized gun access by children and should be made widely available.
In summary, in rural areas, adolescent suicide prevention is a particularly pressing issue. Any comprehensive campaign to reduce youth suicide should include measures to persuade, facilitate, or incentivize parents to maintain control over guns in the household. Success in that effort would likely also reduce interpersonal violence associated with unauthorized carrying by adolescents.
Published: April 4, 2022. doi:10.1001/jamanetworkopen.2022.5136
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Cook PJ et al. JAMA Network Open.
Corresponding Author: Philip J. Cook, PhD, Sanford School of Public Policy, Duke University, Box 90239, Durham, NC 27708 (email@example.com).
Conflict of Interest Disclosures: None reported.
Cook PJ, Parker ST. Reducing Misuse of Handguns by Rural Youth—Focus on the Parents. JAMA Netw Open. 2022;5(4):e225136. doi:10.1001/jamanetworkopen.2022.5136
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