Firearm Purchasing During the COVID-19 Pandemic: Results From the 2021 National Firearms Survey.

BACKGROUND: The surge in background checks beginning in March 2020 suggested an acceleration in firearm purchases. Little was known about the people who bought these guns. OBJECTIVE: To estimate the number and describe characteristics of firearm purchasers over a period spanning prepandemic and pandemic time, characterize new gun owners, and estimate the number of persons newly exposed to household firearms. DESIGN: Probability-based online survey conducted in April 2021. Survey weights generated nationally representative estimates. SETTING: United States, 1 January 2019 to 26 April 2021. PARTICIPANTS: 19 049 of 29 985 (64%) English-speaking adults responded to the survey invitation; 5932 owned firearms, including 1933 who had purchased firearms since 2019, of whom 447 had become new gun owners. MEASUREMENTS: The estimated number and characteristics of adults who, since 2019, have purchased firearms, distinguishing those who became new gun owners from those who did not, and the estimated number of household members newly exposed to firearms. RESULTS: An estimated 2.9% of U.S. adults (7.5 million) became new gun owners from 1 January 2019 to 26 April 2021. Most (5.4 million) had lived in homes without guns, collectively exposing, in addition to themselves, over 11 million persons to household firearms, including more than 5 million children. Approximately half of all new gun owners were female (50% in 2019 and 47% in 2020 to 2021), 20% were Black (21% in 2019 and in 2020-2021), and 20% were Hispanic (20% in 2019 and 19% in 2020-2021). By contrast, other recent purchasers who were not new gun owners were predominantly male (70%) and White (74%), as were gun owners overall (63% male, 73% White). LIMITATIONS: Retrospective assessment of when respondents purchased firearms. National estimates about new gun owners were based on 447 respondents. CONCLUSION: Efforts to reduce firearm injury should consider the recent acceleration in firearm purchasing and the characteristics of new gun owners. PRIMARY FUNDING SOURCE: The Joyce Foundation.

Patterns of household gun ownership and firearm suicide among black men compared to white men.

Little is known about the patterns of household gun ownership among Black Americans, so little is known about the relationship between the patterns of Black household gun ownership and the patterns of Black firearm suicide. We analyze data from the 2001-2004 Behavioral Risk Factor Surveillance System, the first and last years for which a gun question was part of the core questions. We compare household gun ownership patterns for Black men compared to White men across geographic (region, urbanicity), demographic (age, education, married, children at home), and health-related characteristics (binge drinking, smoking), and find that the patterns are quite similar for all eight variables. However, when we compare these race-specific patterns to the race-specific firearm suicide patterns for 2001-2004, while the White firearm suicide patterns follow their gun ownership patterns, the Black patterns do not. While gun ownership increases with age, adult male Black firearm suicide rates are highest in the younger age group-an age group that also has a high proportion of suicides that are firearm suicides. Differences in unadjusted demographic patterns in firearm suicide between Black men and White men cannot be explained by differences in the self-reported patterns of household gun ownership.

Patterns of household gun ownership and firearm suicide among black men compared to white men.

Little is known about the patterns of household gun ownership among Black Americans, so little is known about the relationship between the patterns of Black household gun ownership and the patterns of Black firearm suicide. We analyze data from the 2001-2004 Behavioral Risk Factor Surveillance System, the first and last years for which a gun question was part of the core questions. We compare household gun ownership patterns for Black men compared to White men across geographic (region, urbanicity), demographic (age, education, married, children at home), and health-related characteristics (binge drinking, smoking), and find that the patterns are quite similar for all eight variables. However, when we compare these race-specific patterns to the race-specific firearm suicide patterns for 2001-2004, while the White firearm suicide patterns follow their gun ownership patterns, the Black patterns do not. While gun ownership increases with age, adult male Black firearm suicide rates are highest in the younger age group-an age group that also has a high proportion of suicides that are firearm suicides. Differences in unadjusted demographic patterns in firearm suicide between Black men and White men cannot be explained by differences in the self-reported patterns of household gun ownership.

Perspectives on clinician-delivered firearm safety counseling during routine care: Results of a national survey.

Only 7.5% of United States (U.S.) adults report ever having spoken with a clinician about firearm safety. One reason that clinicians may infrequently counsel patients about firearm safety is that they are unsure whether patients are open to these discussions. The aim of this study was to assess public opinion about whether clinicians should provide firearm safety counseling for patients in specific clinical contexts. We conducted a cross-sectional analysis of online survey data collected in 2019 from a nationally representative sample of U.S. adults residing in households with firearms (n = 4030, response 65%). Participants were asked "As part of routine care, should physicians and/or other health care professionals talk with their patients about firearms and firearm safety if their patient or their patient's family member (is at risk of suicide; has mental health or behavioral problems; is abusing or addicted to alcohol or drugs; is a victim of domestic violence; has Alzheimer's disease or another dementia; is going through a hard time)?" Across the six contexts, 76-89% of adults reported that clinicians should "sometimes" or "always" discuss firearm safety with patients. These findings demonstrate that a large majority of U.S. adults who live in households with firearms believe that clinicians should discuss firearm safety when patients or their family members are experiencing specific clinical scenarios. Clinicians' and healthcare systems' concerns that patients might object to discussing firearm safety in these contexts should not impede efforts to integrate such interventions into routine care.

Hospital visit histories of suicide decedents: a study in Utah.

The study aims to describe the 3-year hospital visit histories of suicide decedents in Utah grouped by the suicide method they used. Hospital visit histories from the Utah Office of Health Care Statistics were linked to a census of suicide mortality data from the National Violent Death Reporting System in 2014 and 2015. Overall, 14% of suicide decedents had visited a hospital for deliberate self-harm (DSH) and 49% for a behavioural health issue (BHI), including DSH, suicidal ideation, mental health and substance abuse, prior to their death. Firearms suicide decedents made up over half of all suicides but were the least likely to have a history of DSH or BHI prior to their death (8% and 41%, respectively). Few suicide decedents visited a hospital for DSH prior to their death, although half had visits for BHI. Hospital-based interventions that aim to prevent suicide should not be limited to visits for DSH.

Black Household gun ownership and black suicide rates across U.S. States.

INTRODUCTION: Ecologic studies have examined the relationship across states between levels of household gun ownership and suicide rates using household gun ownership data from the Behavioral Risk Factor Surveillance System (BFRSS) or proxies. However, no study has examined how race-specific survey-based or proxy measures of gun ownership are related to race-specific suicide rates. METHODS: We use cross-sectional state-level race-specific data to examine how well various proxies correlate with race-specific BRFSS gun ownership rates. We examine whether BRFSS measures of household gun ownership are correlated with firearm suicide, non-firearm suicide, and total suicide rates, for Black and for White adults, and repeat these assessments with select proxies. The core BRFSS only included gun questions in 2001, 2002, and 2004, but not since; mortality data are collapsed 2001-2010. RESULTS: Among a set of proxies, the race-specific fraction of suicides that are firearm suicides (FS/S) is the measure most highly correlated with BRFSS household gun ownership. Across states, White adult BFRSS household gun ownership levels are highly correlated with White adult firearm suicide rates (correlation coefficient .82) and moderately correlated with White overall suicide rates (.63). However, for Black adults, we find that while the state-level Black gun ownership levels are moderately correlated with Black firearm suicide rates (.67)-more strongly for older (.70) than for younger (.47) Black adults-Black BRFSS gun ownership levels are only weakly correlated with Black overall suicide rates (.17) owing to a moderate inverse correlation with Black non-firearm suicide rates (-.45). For Black adults, the relationship between FS/S and suicide is similar to the relation between BRFSS and suicide. CONCLUSION: For White adults, states with higher levels of measured household gun ownership have higher overall suicide rates. This relationship does not hold for Black adults, largely due to a more attenuated correlation between these measures of firearm availability and firearm suicide rates coupled with a more substantial countervailing (inverse) relationship between these measures and non-firearm suicide rates. Future efforts using individual level data might help determine why this puzzling difference exists, especially for young Black adults.

Identifying Occupation Groups for Suicide Prevention: A Statewide Data Linkage Study.

OBJECTIVE: To identify suicide rates by occupation category in Utah and describe the hospital history and circumstances of suicide decedents in the occupation category that had the state's highest rate and highest number of suicides: Construction and Extraction. METHOD: We used data on suicide decedents from the National Violent Death Reporting System (NVDRS) for 2005-2015 (n = 4,590) to calculate sex- and occupation-specific suicide rates among adults 18-65 years old in Utah. For working-age men who died by suicide during the years 2014-2015 (n = 623), we linked NVDRS data with decedents' hospital histories. RESULTS: One in five working-age men who took their life in Utah worked in Construction and Extraction, the single Bureau of Labor Statistics occupation category with both the highest number (n = 719) and rate of suicides (86.4/100,000 men vs. a range of 15.3-66.2 for other occupations). For females, there was no occupation group that had both high rates of suicide and high numbers of suicides compared with other occupations, so there was no clear occupation group to focus on in the same way there was for men. Using linked data for 2014-2015 deaths, 58% of men in Construction and Extraction who died by suicide had been diagnosed in the hospital in the past three years with a substance abuse or mental health problem, and a quarter (25%) tested positive for opioids on post-mortem examination. Nearly half (48%) of 2014-2015 male suicide decedents in Construction and Extraction were reported to have intimate partner problems, about a quarter (26%) had a criminal problem, a quarter (25%) were unemployed, and over half (54%) died by gunshot. CONCLUSIONS: Linked data identified Construction and Extraction as a potentially high-impact occupation group for suicide prevention and suggested potential contexts for intervention.HIGHLIGHTSConstruction and Extraction stands out as an occupation group with a very high number and rate of suicides.Two-thirds of male decedents in Construction and Extraction had a substance abuse problem.For Utah females, there were no occupations with both high rates and high numbers of suicides.

Receipt of clinician-delivered firearm safety counseling among U.S. Veterans: Results from a 2019 national survey.

OBJECTIVE: Seventy percent of suicides among U.S. veterans are due to firearm injury. Because discussions about firearm access are an important component of evidence-based suicide prevention programs, we sought to quantify the proportion of U.S. veterans who have discussed firearm safety with a healthcare provider. METHODS: Data come from a probability-based, nationally representative online survey of U.S. adults living in households with firearms in 2019 (response 65%). In this study, we include only self-identified veteran firearm owners. Respondents were asked, "Has a physician or other healthcare practitioner ever spoken to you about firearm safety?" Analyses were stratified by self-reported use of Veterans Health Administration (VHA) healthcare services. RESULTS: Overall, 31.5% (95% CI 27.5-35.8) reported using VHA services and 9.2% (95% CI 6.8-12.3) reported that a clinician had ever spoken with them about firearm safety (14.3% among VHA users, 6.8% among non-users). Of those who reported a discussion, nearly three quarters reported it was with an outpatient primary care physician or medical specialist. CONCLUSIONS: A large majority of veteran firearm owners have not had, or do not recall having had, a firearm safety discussion with a clinician, suggesting that additional efforts to facilitate such discussions in the VHA and elsewhere are needed.

Child Access Prevention Laws and Firearm Storage: Results From a National Survey.

INTRODUCTION: Child Access Prevention Negligent Storage (CAP-NS) laws seek to reduce pediatric firearm injury by imposing sanctions on gun owners if children gain access to unlocked guns. Whether these laws affect the storage behavior they aim to encourage is not known because historical panel data on firearm storage do not exist. As a result, assessing how much, if at all, firearm storage changed because of CAP-NS laws requires an indirect approach. METHODS: Data for this study came from a web-based survey conducted by the research firm Ipsos from July 30, 2019 to August 11, 2019. Respondents were adult gun owners drawn from an online sampling frame comprising approximately 55,000 U.S. adults recruited using address-based sampling methods to be representative of the U.S. POPULATION: The primary outcome was the proportion of gun owners in CAP-NS versus non-CAP-NS states who had ≥1 unlocked firearm. Estimates are presented by CAP-NS status, for gun owners overall and for those who live with children, before and after adjusting for potential confounders. Data were analyzed in 2021. RESULTS: In adjusted analyses, gun owners in CAP-NS states were no more likely to lock firearms than were those in states without these laws. In addition, most gun owners reported not knowing whether they lived in a state with a CAP-NS law. CONCLUSIONS: CAP-NS laws have at best modest effects on firearm storage. If the storage effect is as small as this study indicates, the mortality benefits previously attributed to CAP-NS laws are overstated. As such, developing interventions that effectively reduce firearm mortality by reducing access to firearms remains an urgent clinical and public policy priority.