[Skip to Content]
[Skip to Content Landing]
Original Investigation
May 13, 2019

Association of Increased Safe Household Firearm Storage With Firearm Suicide and Unintentional Death Among US Youths

Author Affiliations
  • 1Division of Emergency Medicine, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
  • 2Harvard Injury Control Research Center, Department of Health Policy and Management, T. H. Chan Harvard School of Public Health, Boston, Massachusetts
  • 3Department of Health Sciences, Northeastern University, Bouve College of Health Sciences, Boston, Massachusetts
JAMA Pediatr. 2019;173(7):657-662. doi:10.1001/jamapediatrics.2019.1078
Key Points

Question  How many suicide and unintentional firearm deaths among US residents aged 0 to 19 years could be prevented by a modest increase in safe household firearm storage?

Findings  This modeling study using Monte Carlo simulation estimated that 6% to 32% of youth firearm deaths (by suicide and unintentional firearm injury) could be prevented, depending on the probability that an intervention motivates adults who currently do not lock all household firearms to instead lock all guns in their home.

Meaning  Results of this modeling study suggest that approaches that will motivate adults who live in homes with youths to store firearms safely may prevent up to 32% of firearm deaths.


Importance  Firearm injury is the second leading cause of death in the United States for children and young adults. The risk of unintentional and self-inflicted firearm injury is lower when all household firearms are stored locked.

Objective  To estimate the reduction in youth firearm suicide and unintentional firearm mortality that would result if more adults in households with youth stored household guns locked.

Design, Setting, and Participants  A modeling study using Monte Carlo simulation of youth firearm suicide and unintentional firearm mortality in 2015. A simulated US national sample of firearm-owning households where youth reside was derived using nationally representative rates of firearm ownership and storage and population data from the US Census to test a hypothetical intervention, safe storage of firearms in the home, on youth accidental death and suicide. Data analyses were performed from August 3, 2017, to January 9, 2018.

Exposures  Observed and counterfactual household-level safe firearm storage (ie, storing all firearms locked), the latter estimated by varying the probability that a hypothetical intervention increased safe firearm storage beyond that observed in 2015.

Main Outcomes and Measures  Observed and counterfactual counts of firearm suicide and unintentional firearm mortality among youth aged 0 to 19 years, the latter estimated by incorporating an empirically based estimate of the mortality benefit expected from additional safe storage (beyond that observed in 2015).

Results  A hypothetical intervention among firearm owners residing with children with a 20% probability of motivating these owners to lock all household firearms was significantly associated with a projected reduction in youth firearm mortality (median incidence rate ratio = 0.90; interquartile range, 0.87-0.93). In the overall model, 6% to 32% of deaths were estimated to be preventable depending on the probability of motivating safer storage.

Conclusions and Relevance  Results of this modeling study suggest that a relatively modest uptake of a straightforward safe storage recommendation—lock all household firearms—could result in meaningful reductions in firearm suicide and unintentional firearm fatalities among youth. Approaches that will motivate additional parents to store firearms safely are needed.