The Views of Police Officers Toward Gun Legislation and Public Health Policies Driven by Firearm Safety Concerns.

Gun violence is a principal cause of premature death in America. It has been suggested that solutions to gun violence may be found using a public health approach, which is broader than dealing with the problem via law enforcement alone. A component of a public health approach to gun violence is the implementation of policies or laws. Unfortunately, there is a serious gap in our understanding of how street-level police officers view proposed or existing firearms legislation. This is an important omission, because it is line-level personnel who are tasked with enforcing these policies within highly discretionary contexts. We surveyed police from three jurisdictions to establish a baseline understanding of officers' views about potential gun legislation and identify possible resistance and implementation barriers of firearms laws. The findings suggest that those responsible for enforcing new laws show limited or mixed support for the same. Officers were most supportive of laws that increase the presence of trained gun owners within certain contexts and ensure that individuals with criminal backgrounds or mental health concerns do not have access to firearms. Most officers support prohibiting gun ownership following conviction of a domestic violence offense. However, officers generally opposed gun legislation banning assault weapons, large capacity magazines, and internet ammunition purchases. Finally, officers with the Buffalo Police Department-which recently had experienced an active-shooter event-were more supportive of almost all types of legislation. Respondents expressing greater concern about officer safety related to firearms were supportive of several types of firearm legislation.

A PRISMA Scoping Review to Explore Interventions to Prevent Firearm-Related Injury and Suicide in Older Adults.

OBJECTIVES: This scoping review aims to examine existing research into firearm safety interventions designed to prevent firearm injury and suicide in older adults. METHODS: Select databases were searched in 5/2023. Included articles involved an/a 1. aim to develop or investigate firearm safety interventions, 2. focus on adults 50 years and older, and 3. primary analysis. RESULTS: The search yielded 10 articles which primarily focused on firearm safety counseling with older adults with suicide risk or emerging impairment. The review found that older adults may be open to receiving firearm safety counseling but that providers feel ill-equipped to have these conversations and to reliably identify suicide risk. Two studies presented promising data on the impact and acceptability of training providers in a firearm safety intervention. The review also identified the importance of building trust between older patients and providers to have helpful discussions regarding firearms, and highlighted specific approaches that facilitate openness to participate in these exchanges. CONCLUSIONS: Further research into adapting interventions to meet the clinical needs of older adults and treatment efficacy trials is necessary. CLINICAL IMPLICATIONS: Training healthcare providers to conduct firearm safety interventions with older adults may be an acceptable and impactful avenue to prevent suicide.

Trends in firearm production and firearm deaths in U.S. youth.

INTRODUCTION: Firearms are now the leading cause of death for U.S. children and teens ages 0-19. The U.S. Department of Justice Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) reported data in 2022 on firearm production, for specific firearm types and calibers. We hypothesized there would be a correlation between firearm production and firearm deaths and nonfatal injuries in youth. METHODS: All firearm deaths and nonfatal injury rates for youth ages 0-19 were extracted from the Centers for Disease Control and Prevention from 2001 to 2020. Firearm production from 2001 to 2020 was extracted from the 2022 ATF Firearms in Commerce Report for overall firearm production, production by weapon type and pistol caliber. Relationships between firearm death and injury and firearm production were evaluated using correlational analyses. RESULTS: Firearm death and nonfatal injury rates for youth increased from 2001 to 2020 by 48.2% and 69.2%, respectively, and firearm production increased 265% overall and 1298% for 9 mm pistols. There was no correlation between total firearm manufacturing and total firearm deaths or nonfatal injury rates from 2001 to 2020 (all r < 0.28). Pistol caliber (25 and 9 mm) was associated with total firearm deaths and nonfatal injuries (all r > 0.55). CONCLUSION: While total firearm manufacturing was not related to firearm deaths and injuries, except suicides, there were strong relationships between 9 mm pistol production and firearm deaths and injuries in youth. Firearm injuries are preventable; we must invest in stronger information systems that track details of firearms linked with deaths and injuries.

Using Longitudinal Curriculum to Improve Psychiatry Residents' Attitudes Regarding Firearm Anticipatory Guidance.

OBJECTIVE: Over the last decade, there has been an increased focus on firearm use in violent acts and suicides. There is no known published firearm safety curriculum specific to psychiatric training and limited guidance on curriculum development from national organizations. The authors' goals were to develop a firearm lecture series that would encompass essential knowledge related to firearm safety and risk assessments and assess its effect on psychiatric residents' interest and confidence in firearm safety guidance. METHODS: The authors developed a six-lecture series on firearm safety that was conducted over all post-graduate year (PGY) training levels and a grand rounds on basic firearm safety. All levels of psychiatry residents at one urban academic center participated in a pre- and post-lecture series questionnaire designed to evaluate attitudes related to firearm safety guidance. They developed and administered the questionnaire through New Innovations collecting qualitative and quantitative data for analysis. The quantitative analysis was completed using paired t-test. RESULTS: Forty-seven residents participated. Twenty-seven respondents met inclusion criteria: attended at least one lecture or the grand rounds, completed pre- and post-lecture surveys, and submitted their pre-lecture survey before their first lecture. After the educational intervention, there was a statistically significant increase (p<0.05) in interest in firearm safety, and confidence in all areas surveyed-risk assessment, safety guidance, and pertinent legislation. CONCLUSIONS: The curriculum increased residents' interest and confidence in providing firearm safety guidance. Areas of development include assessing the curriculum's impact on clinical practice.

Firearm Safety Counseling in Pediatric Primary Care.

Injury from firearms is the leading cause of death among children and adolescents in the United States. Prevention requires a multi-pronged approach involving clinicians and policy. One evidence-based method to improve firearm safety is counseling with lock provision. Through sharing our experiences, we aim to inspire more health care practices to adopt firearm safety prevention strategies.

Provider Perspectives on Addressing Firearm Safety with Older Adults in Primary Care.

OBJECTIVES: Chronic conditions, including mild cognitive impairment and depression, place older adults at high risk of firearm suicide. Approximately 40% of older adults have access to a firearm, and many do not store their firearms safely. However, firearm counseling occurs infrequently in clinical settings. Using by the Ottawa Decision Support Framework (ODSF) to conceptualize the decisional support needed by patients and their providers to facilitate firearm counseling, we explore provider perspectives on desired resources for addressing firearm safety with older adult patients. METHODS: From March - August 2022, we conducted 21 semi-structured interviews with primary care providers caring for older adults. We report deductive concepts as well as emergent themes. RESULTS: Major themes were identified from the three components of the ODSF; decisional needs, decision support and decisional outcomes. Themes included: provider self-efficacy to conduct firearm counseling, clinical workflow considerations, stories for change, patient diagnosis implications, and caregiver involvement. CONCLUSIONS: There is a need for decision aids in the clinical setting that facilitate firearm counseling and promotes shared decision-making about firearm storage. CLINICAL IMPLICATIONS: Implementing a decision aid in the clinical setting can improve provider self-efficacy to conduct firearm counseling and help reduce risk factors associated with firearm-related harm among older adults.

Firearm Safety and Suicide Prevention for Medically Complex Older Veterans: Perspectives of VA Home-Based Primary Care Directors and Psychologists.

OBJECTIVES: Determine strategies and resources used by VA Home-Based Primary Care (HBPC) teams to discuss firearm safety and suicide risk with older veterans and their families or caregivers. Training and resource needs for promoting firearm safety with older veterans were also ascertained. METHODS: Ten focus groups (N = 37) were conducted virtually in 2022 with HBPC directors and psychologists. Qualitative rapid response coding identified domains and themes within transcripts. RESULTS: Analysis revealed three major domains: firearm safety, suicide risk, and resources/trainings. Firearm safety themes included discussions during clinical procedures, firearm-related challenges, veteran culture, and barriers and facilitators to effective conversations. Suicide risk themes included assessment procedures, frequency/types of risk conversations, factors related to suicidal ideation/behavior, challenges, and strategies to enhance communication. Resource/training themes included those currently used and perceived needs. CONCLUSIONS: Participants described strategies for facilitating firearm safety and suicide prevention discussions with older veterans, their families, and caregivers. Using respectful language and attending to values related to firearm ownership were identified as essential. CLINICAL IMPLICATIONS: Additional clinician/staff training/resources are needed for addressing older veteran firearm safety and suicide risk, including how to conduct more effective conversations with older veterans on these topics and better engage families/caregivers in prevention efforts.

How Americans encounter guns: Mixed methods content analysis of YouTube and internet search data.

Firearm-related injury and death is a serious public health issue in the U.S. As more Americans consume news and media online, there is growing interest in using these channels to prevent firearm-related harms. Understanding the firearm-related narratives to which consumers are exposed is foundational to this work. This research used the browsing behavior of a representative sample of American adults to identify seven firearm-related content "ecosystems" (defined as naturally occurring networks of channels watched by the same users) on YouTube; we then described the demographics and internet search patterns of users affiliated with each ecosystem. Over the 9-month study period, 72,205 panelists had 16,803,075 person-video encounters with 7,274,093 videos. Among these, 282,419 were related to firearms. Using fast greedy clustering, we partitioned users and channel interactions into seven distinct channel-based content ecosystems that reached more than 1/1000 YouTube users per day. These ecosystems were diverse in reach, users, and content (e.g., guns for self-protection, guns for fun). On average, 0.5% of panelists performed a firearm-related internet search on a given day. The vast majority of searches were related to mass shootings or police-involved shootings (e.g., "active shooter"), and virtually none were about more common firearm harm such as suicide. Searches for firearm safety information were most common among panelists affiliated with the "Hunting & Fishing" and "Guns & Gear" ecosystems, which were watched primarily by older, white men. These findings identify an opportunity for analyzing firearm-related narratives and tailoring firearm safety messaging for users affiliated with specific online content ecosystems.

An informed approach to the development of primary care pediatric firearm safety messages.

BACKGROUND: Firearm ownership is prevalent in the US and many children spend time in areas where firearms are not stored safely. The AAP recommends firearm safety counseling at pediatric well-visits. METHODS: We developed and tested six contextual messages to promote safe firearm storage based on: absence of harm, collective appeal to understanding child behavior, pediatrician's authority, evidence-based, fear appeal, and general safety considerations. One hundred four parents who keep firearms at home were recruited from Amazon Mechanical Turk Prime and viewed video messages and reported behavioral intentions and emotional reactions following each message. RESULTS: All six contextual messages were perceived as important and believable and increased parents' intentions to follow safety advice provided, but also elicited negative emotions. The authority message elicited more negative emotions and resulted in lower intentions to follow safe storage advice. CONCLUSIONS: Including firearm messages with other child safety advice merits further evaluation. Authority messages should be avoided.

Why some parents made firearms more accessible during the beginning of the COVID-19 pandemic: results from a national study.

The objective of this study was to assess parents' firearm storage behaviors during the COVID-19 pandemic and characterize reasons why some parents made their firearms more accessible during this time. In June-July 2020, the study team conducted the FACTS National Survey-a cross-sectional, web-based, survey of 2,924 parents and their teens (ages14-18) regarding firearm-related practices. We weighted descriptive analyses to be nationally representative of parents of teens in the United States. We utilized qualitative thematic analysis to identify parents' reasons for making firearms more accessible. Five percent of firearm-owning parents of teens reported making their firearms more accessible during the beginning of the COVID-19 pandemic. Reasons why parents increased the ease of firearm access included: (1) Increased civil unrest and riots; (2) Threat of home invasion and/or crime victimization; (3) Fear of panic and the unknown; and (4) Easier access and greater protection, threat unspecified. Some parents-largely motivated by fear-chose to store firearms in a more accessible manner during the beginning of the COVID-19 pandemic to protect their family against possible external threats. Understanding the fear that motivates parents' decisions regarding storage practices might aid interventions focused on harm reduction and safer storage.

Perspectives from firearm stakeholders on firearm safety promotion in pediatric primary care as a suicide prevention strategy: a qualitative study.

The primary objective of the current study was to examine the perspective of firearm stakeholders, including firearm safety course instructors, members of law enforcement, and firearm retailers, with regard to the implementation of an evidence-based approach to firearm safety promotion, the Firearm Safety Check, as a universal suicide prevention strategy in pediatric primary care. Twelve firearm stakeholders participated in semi-structured interviews. Using an integrated analytic approach, several themes emerged from the interviews. With regard to acceptability of the intervention, participants generally found counseling caregivers to store firearms safely and the provision of firearm locking mechanisms to be acceptable, but expressed concern about screening for firearm ownership in health systems. Participants identified distinct roles of responsibility for firearm advocacy groups, firearm owners, healthcare clinicians, and caregivers with regard to the promotion and execution of safe firearm storage. Participants called for partnerships between healthcare systems and firearm stakeholders, and also identified potential threats to these partnerships, including lack of trust firearm owners may have in health systems and the government. Finally, participants suggested strategies for preventing firearm-related suicides. Findings support a growing body of literature suggesting the value in researchers, health systems, and firearm stakeholders partnering around a shared agenda of firearm safety promotion as a strategy to prevent suicide.

School-Based and Community-Based Gun Safety Educational Strategies for Injury Prevention.

BACKGROUND: Nearly 1,300 children in the United States die because of firearm-related injury each year and another 5,790 survive gunshot wounds, making the prevention of firearm-related unintentional injury to children of vital importance to families, health professionals, and policy makers. OBJECTIVE: To systematically review the evidence on school-based and community-based gun safety programs for children aged 3 to 18 years. STUDY DESIGN: Systematic review. METHOD: Twelve databases were searched from their earliest records to December 2016. Interventional and analytic studies were sought, including randomized controlled trials, quasi-experimental studies, as well as before-and-after studies or cohort studies with or without a control that involved an intervention. The low level of evidence, heterogeneity of studies, and lack of consistent outcome measures precluded a pooled estimate of results. A best evidence synthesis was performed. RESULTS: Results support the premise that programs using either knowledge-based or active learning strategies or a combination of these may be insufficient for teaching gun safety skills to children. CONCLUSIONS: Gun safety programs do not improve the likelihood that children will not handle firearms in an unsupervised situation. Stronger research designs with larger samples are needed to determine the most effective way to transfer the use of the gun safety skills outside the training session and enable stronger conclusions to be drawn.

Who owns guns and how do they keep them? The influence of household characteristics on firearms ownership and storage practices in the United States.

Our paper aims to describe firearm-related behavior among American households and to quantify the influence of household characteristics on the probability of firearms possession and storage practices. Applying logistic regression techniques to data from the 2004 Behavioral Risk Factor Surveillance Survey (BRFSS), we use separate models to estimate the effect of an array of respondent demographic characteristics factors on the likelihood that households will have a gun at home and, if so, whether they will keep it at either of two levels of risk. We find that rates of firearm ownership vary widely by household characteristics, including the state in which they reside. Simultaneously controlling for all of these factors scarcely diminishes variation in odds for ownership. Differences in the likelihood that owners will store guns unsafely are narrower and significant for fewer factors. Having children in the home scarcely affects the propensity to possess firearms but greatly reduces the chances a domestic firearm will be stored loaded and unsecured. Our findings support a consensus on the demographics of ownership but show more and stronger predictors of storage behavior than previous work. Differing dynamics of ownership and storage reveal the existence of two regional gun cultures. From these findings, we conclude that to mitigate mortality risks associated with guns in the home, encouraging safer storage by owners may be as effective as controlling sales. States and localities should test a range of promising but largely unproven interventions.

Associations between active shooter incidents and gun ownership and storage among families with young children in the United States.

The presence of firearms and their unsafe storage in the home can increase risk of firearm-related death and injury, but public opinion suggests that firearm ownership is a protective factor against gun violence. This study examined the effects of a recent nearby active shooter incident on gun ownership and storage practices among families with young children. A series of regression models, with data from the nationally representative Early Childhood Longitudinal Study-Birth Cohort merged with the FBI's Active Shooter Incidents data collected in 2003-2006, were used to examine whether household gun ownership and storage practices differed in the months prior to and following an active shooter incident that occurred anywhere in the United States or within the same state. Approximately one-fifth of young children lived in households with one or more guns; of these children, only two-thirds lived in homes that stored all guns in locked cabinets. Results suggest that the experience of a recent active shooter incident was associated with an increased likelihood of storing all guns locked, with the magnitude dependent on the temporal and geographic proximity of the incident. The severity of the incident, defined as the number of fatalities, predicted an increase in storing guns locked. Findings suggest that public shootings change behaviors related to firearm storage among families with young children.

Parents' Depressive Symptoms and Gun, Fire, and Motor Vehicle Safety Practices.

OBJECTIVE: This study examined associations between mothers' and fathers' depressive symptoms and their parenting practices relating to gun, fire, and motor vehicle safety. METHODS: Using data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), a nationally representative sample of children birth to age five, linear probability models were used to examine associations between measures of parents' depressive symptoms and their use of firearms, smoke detectors, and motor vehicle restraints. Parents reported use of smoke detectors, motor vehicle restraints, and firearm ownership and storage. RESULTS: Results suggest mothers with moderate or severe depressive symptoms were 2 % points less likely to report that their child always sat in the back seat of the car, and 3 % points less likely to have at least one working smoke detector in the home. Fathers' depressive symptoms were associated with a lower likelihood of both owning a gun and of it being stored locked. Fathers' depressive symptoms amplified associations between mothers' depressive symptoms and owning a gun, such that having both parents exhibit depressive symptoms was associated with an increased likelihood of gun ownership of between 2 and 6 % points. CONCLUSIONS: Interventions that identify and treat parental depression early may be effective in promoting appropriate safety behaviors among families with young children.

What is Taught on Firearm Safety in Undergraduate, Graduate, and Continuing Medical Education? A Review of Educational Programs.

OBJECTIVE: Because there have been no published formal reviews on teaching of firearm safety, we set out to systematically locate and review the literature on curricula that educated physicians and other health care providers, residents across specialties, and medical students on how to counsel on firearm safety. METHODS: We searched for all papers with outcomes that described firearm safety training programs for healthcare providers and trainees. Studies were identified through PubMed, Scopus, Google Scholar, PsychInfo, EMBASE, and MedEdPortal databases and electronically searched using combinations of words from general topic areas of firearms, learners, and education. RESULTS: We found four programs that met inclusion criteria. These targeted a narrow range of learners including medical students, pediatric residents, practicing pediatricians, and nurse practitioners. Teaching methods included lectures, case-based learning, group discussions, and audiotape training. There were two randomized controlled trials, one cohort design, and one posttest design. One of the randomized controlled trials was an office-based high quality multisite national study, although the focus of teaching was not on firearm safety alone. All studies used different outcomes, and only one study validated the outcome measures. There were no studies targeting psychiatrists or psychiatry residents. CONCLUSION: These results underscore a priority for developing firearm safety education programs in undergraduate, graduate, and continuing medical education settings.

Firearm screening in pediatric patients.

Introduction: In the United States, firearm-related injuries are the leading cause of death among children and adolescents 1-19 years of age. Although many pediatricians believe addressing firearm safety is important and have guidance from organizations like the American Academy of Pediatrics, few routinely screen and counsel on firearm safety. The goal of this project was to screen all patients presenting to the pediatric emergency department, pediatric floor, and pediatric intensive care unit for the presence of firearms in the home, firearm storage practices, and whether they had previously received any firearm counseling by medical professionals. Methods: A 13-item survey was administered to each participant. Items included demographic information, willingness to answer questions about firearms, practice of asking questions about firearms, previous counseling from medical professionals about the presence of firearms in the home and the presence of firearm in their personal home as well as storage practices. Results: A total of 200 parents responded to the survey. Of those that responded to the survey, 171 (85.5%) did not have a firearm in the home and 28 (14%) did have a firearm in the home. 75% (n = 21) had never had a medical provider discuss firearm safety with them. 100% had never been asked by another parent about the presence of a firearm in their home when a child came over for a playdate. 39% (n = 11) of parents with a firearm in the home had asked other parents whether they have a firearm in the home where their child goes to play. Discussion: Findings from our study highlight a significant lack of screening of our pediatric patients both in the inpatient and outpatient settings, with the majority reporting that they had never been asked by a medical provider about firearm safety. In addition, three quarters of parents with a firearm in the home reported that they did not mind answering questions about firearms yet none had been asked by other parents about firearms. Thus, although firearm possession and safety is considered to be a sensitive topic, many parents are willing to discuss it with their health care providers and other parents.