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Original Investigation
January 2019

Firearm Storage and Adult Alcohol Misuse Among Washington State Households With Children

Author Affiliations
  • 1Department of Epidemiology, School of Public Health, University of Washington, Seattle
  • 2Harborview Injury Prevention and Research Center, University of Washington, Seattle
  • 3Injury and Violence Prevention Unit, Public Health–Seattle & King County, Seattle, Washington
  • 4Department of Pediatrics, School of Medicine, University of Washington, Seattle
JAMA Pediatr. 2019;173(1):37-43. doi:10.1001/jamapediatrics.2018.3624
Key Points

Questions  What proportion of children in Washington State live in firearm-owning households, and what is the association between unsafe firearm storage and exposure to adult alcohol misuse?

Findings  In this cross-sectional analysis of survey data from 5241 respondents to Behavioral Risk Factor Surveillance System surveys, it was found that 30% of children in Washington State lived in firearm-owning households, an estimated 55% of whom lived with an unsafely stored firearm. Firearms were 20% more likely to be stored unsafely in homes with an adult who misused alcohol.

Meaning  Many children in Washington live in firearm-owning households; those who live with an adult who reports alcohol misuse may also be more likely to be exposed to unsafely stored firearms.


Importance  Firearm injuries and fatalities among children are an important public health problem. Children living with an adult misusing alcohol may be at a heightened risk for self-harm or unintentional injury, highlighting the need to investigate the association between household firearm storage and adult alcohol misuse.

Objectives  To characterize household firearm presence among children by various sociodemographic characteristics, and to assess the association between children living in a home with an unsafely stored firearm and an adult reporting alcohol misuse.

Design, Setting, and Participants  This cross-sectional investigation uses data from the 2013 and 2016 Behavioral Risk Factor Surveillance System in the state of Washington, a program that administers a telephone survey statewide to randomly selected noninstitutionalized adults at least 18 years of age about their health-related risk behaviors, chronic health conditions, and use of preventive services. The 2013 and 2016 data included 5241 responses to the firearm ownership and storage module and the Random Child Selection module (intended for a randomly selected child younger than age 18 years and reported by an adult living in the same household). Data for this study were collected from January 1 through December 31, 2013, and January 1 through December 31, 2016. Data were analyzed from March through May 2018.

Main Outcomes and Measures  The primary outcomes were a child’s residence in a firearm-owning home, the manner in which household firearms were stored, and the adult respondent’s alcohol consumption.

Results  Among the 3443 children living in a non–firearm-owning household, 50.7% were male (all values given as a percentage only are weighted); among those reporting specific age, the weighted mean age was 9.3 years (unweighted mean [SD], 10.1 [5.2] years). In the 1756 children living in a firearm-owning household, 52.5% were male; among those reporting specific age, the weighted mean age was 9.1 years (unweighted mean [SD], 9.8 [5.4] years). An estimated 470 000 children (29.4%; 95% CI, 27.3%-31.7%) in the state resided in a firearm-owning household. Among them, 258 000 children (54.6%; 95% CI, 51.5%-57.6%) lived with at least 1 firearm that was not stored safely (ie, not locked and unloaded). Firearms were more likely to be stored unsafely in homes in which an adult reported alcohol misuse (prevalence ratio: 1.20; 95% CI, 1.07-1.35).

Conclusions and Relevance  Children living in a household with an adult who misuses alcohol may be more likely to live with an unsafely stored firearm, which is concerning given the association between adult alcohol misuse and children’s risk for sustaining injury.