Abstract
Objective.
To study the interaction between violence exposure and motivations for firearm ownership in their associations with firearm storage among caregivers of teens in the US.
Methods.
In June-July 2020, we conducted a national survey of 2,924 caregivers of US teens. We estimated multivariable logistic regressions among caregivers who owned a firearm (n=1,095) to evaluate associations between the exposures of community violence, interpersonal violence, and firearm ownership motivations (protection motivations versus non-protection motivations) and the outcome of firearm storage patterns (locked and unloaded versus unlocked and/or loaded). We assessed for a potential interaction between violence exposures and motivations for firearm ownership in their associations with firearm storage.
Results.
We observed no associations between community (adjusted OR [aOR]: 0.86; 95% CI [0.55 to 1.36]) or interpersonal violence exposure (aOR: 0.60; 95% CI [0.22 to 1.65]) and firearm storage behaviours, and these associations did not vary according to firearm ownership motivations (relative excess risk due to interaction: −0.09 [−1.90 to 1.73]; −2.04 [−6.00 to 1.92]). Owning a firearm for protection was associated with increased odds of storing at least one firearm unlocked and/or loaded (aOR: 3.48; 95% CI [2.11 to 5.75]), and this association persisted across all strata of violence exposures (aORs: 1.51–3.98; 95% CIs [0.52 to 8.31]–[1.96 to 8.08]).
Conclusions.
The motivation to own a firearm for protection was associated with storing a firearm unlocked and/or loaded. The results suggest the associations between violence exposure and firearm storage are more complicated than anticipated because (1) exposure to violence was not associated with firearm storage practices, and (2) motivations for firearm ownership do not appear to explain why people differ in firearm storage following violence exposure.
Keywords: firearms, nationally representative, violence, risk factors
Introduction
Owning a firearm for protection is a primary motivation for firearm ownership among adults in the United States,[1–3] and this includes caregivers of children and adolescents.[3] Owning a firearm for protection is also associated with storing firearms unlocked and/or loaded.[2,3] The presence of a firearm in a household substantially increases the risk of firearm injury and death among youth,[4–6] and these risks increase when owners store one or more firearms unlocked as opposed to locked, and/or store one or more firearms loaded as opposed to unloaded.[7–9]
Motivating adults to store household firearms unloaded and locked is the goal of many policies and interventions seeking to reduce firearm injuries and death among youth, including Child Access Prevention laws,[10,11] firearm safety counseling from healthcare providers,[12] and firearm lock distributions.[13,14] Simulation modeling has suggested that persuading 20% of households that store at least one firearm unlocked to begin storing all firearms locked could prevent 6% to 32% of youth firearm deaths.[9] The research regarding the effectiveness of existing strategies to improve firearm storage safety is ongoing,[11,14–16] but multiple approaches are likely needed to meaningfully increase the proportion of firearm-owning households that practice locked and unloaded firearm storage. Data from a 2015 national survey indicated that 71% of firearm-owning households reported storing at least one firearm unlocked and/or loaded,[17] and the likelihood of storing firearms unlocked and/or loaded was higher among caregivers who reported owning a firearm for protection (versus other reasons).[3,17] Effective interventions that motivate adults to store household firearms locked and unloaded requires attention to the individualized contexts in which caregivers own firearms.
Considering that owning a firearm for protection is a primary motivation for firearm ownership among adults in the United States,[1–3] interventions to reduce community and interpersonal violence exposure may increase caregivers’ safety perceptions, and thereby reduce their likelihood of storing firearms unlocked and/or loaded for ease of access purposes. Considering the path from violence exposure to firearm storage, a firearm owner may perceive threats in their environment due to prior interpersonal and community violence exposures. Likewise, they may store their firearms unlocked and/or loaded so that they can more quickly respond to future threats. In a competing hypothesis, however, firearm owners may store their firearms locked and unloaded following interpersonal and community violence exposures to prevent a potential aggressor from accessing firearms for use against the owner.
The Protection Motivation Theory could support either or both of these competing hypotheses.[18,19] Protection Motivation Theory describes how individuals react in protective manners toward perceived threats, and the resulting reaction is a weighting of: 1) threat appraisal, or the likelihood and severity of the threat, and; 2) coping appraisal, which involves an individual’s expectation that carrying out the action will remove the threat.[18,19] When applying Protection Motivation Theory to the association of community and interpersonal violence exposure with firearm storage, individuals may be appraising different potential threats (i.e., experiencing violence while unarmed versus someone accessing their firearm to use against them or their family/friends) as well as different coping mechanisms (i.e., storing firearms unlocked and/or loaded versus locked and unloaded). These threat and coping appraisals might differ according to motivation for firearm ownership. Specifically, we expect caregivers who are motivated to own a firearm for protection may appraise community and interpersonal violence as a threat of experiencing violence while unarmed and, in turn, will store firearms unlocked and/or loaded for easier access to mitigate this threat. In contrast, we also expect caregivers who are motivated to own a firearm for non-protection reasons may appraise community and interpersonal violence as a threat of someone accessing their firearm to use against them or their family/friends and, in turn, will store firearms locked and unloaded to mitigate this threat. Estimating the associations between motivation to own firearms for protection and firearm storage patterns according to violence exposure could offer preliminary insight regarding the potential effect of addressing violence on caregiver firearm storage across caregivers motivated to own a firearm for protection versus other motivations.
In this cross-sectional nationally representative observational study of caregivers of teens in the United States, we first estimated the association of community violence exposure and interpersonal violence exposure with firearm storage practices. We then estimated whether the interactions between community violence exposure and firearm ownership for protection, and interpersonal violence exposure and firearm ownership for protection, were associated with firearm storage practices (unlocked and/or loaded versus locked and unloaded). We hypothesized that caregivers motivated to own a firearm for protection would be more likely to store firearms unlocked and/or loaded following community or interpersonal violence exposure relative to caregivers motivated to own a firearm for non-protective reasons.
Methods
Data
In June and July 2020, the study team conducted the FACTS National Survey, which was a cross-sectional, web-based, and nationally representative survey of 2,924 U.S. caregivers and their high-school aged teens (ages 14–18 years) regarding firearm-related practices. The present analyses use data from the caregiver responses, only. We defined caregivers as the primary caregivers of teens (e.g., parent, stepparent, grandparent). Caregiver participants for the study were from the Gallup Panel, a probability-based panel constructed to be broadly representative of the U.S. adult population. Gallup invited 9,352 eligible caregivers from the Gallup Panel to complete the survey, and the survey achieved a response rate of 31%. The present analyses use data from the firearm-owning caregiver participants.
Measures
Personal firearm ownership.
To identify if someone owned a firearm, we asked all caregivers: “Do you personally own a gun?” Responding yes indicated personal firearm ownership.
Unlocked or loaded firearm storage.
We assessed whether caregivers stored at least one firearm unlocked and/or loaded. Among firearm-owning caregivers, we asked respondents if any of the firearms that caregivers personally own and keep on their property are regularly stored loaded or unloaded, and we also separately asked if any firearms that caregivers personally own and keep on their property are stored locked or unlocked. Responding yes to either storing at least one firearm on their property loaded or storing at least one firearm on their property unlocked indicated practicing unlocked and/or loaded firearm storage.
Protection motivation.
We asked firearm owning caregivers the extent to which protection served as a motivation for owning a handgun and a long gun, with response options including (1) a major reason, (2) a minor reason, or (3) not a reason at all for firearm ownership. We considered respondents that indicated protection was a major reason for owning a handgun or a long gun as owning a firearm for protection (versus owning a firearm for non-protection motivations).
Community violence exposure.
We operationalized community violence exposure via nine dichotomous items from the community violence sub-scale of the Things I Have Seen and Heard survey.[20] Originally a 15-item scale, we restricted the survey to the following items to focus on more serious violent behaviors: “In the past 12 months, which of the following things have you seen or heard in your neighborhood: 1) I have heard guns being shot; 2) I have seen somebody arrested; 3) I have seen drug deals; 4) I have seen somebody get beaten up; 5) I have seen somebody get stabbed; 6) I have seen somebody pull a knife on another person; 7) I have seen somebody pull a gun on another person; 8) I have seen somebody get shot; 9) My house has been broken into.” Given the high number of respondents with no exposure or one exposure to community violence (86%), we operationalized community violence exposure as having experienced any community violence exposure in the past twelve months versus not having experienced community violence exposure in the past twelve months.
Interpersonal violence exposure.
We defined caregivers’ interpersonal violence exposure according to the experience of non-partner and partner victimization and aggression. Caregivers’ non-partner violence victimization included three items adapted from the physical assault domain of the revised Conflict Tactics Scale [21]: “In the past 12 months, how many times has a friend, neighbor, coworker, or stranger done any of the following to you during any fights, conflicts, arguments or physical attacks?: 1) Twisted your arm, thrown something that could hurt you, pushed, shoved, grabbed, slapped, or slammed you against a wall?; 2) Kicked, bit, or hit you, beat you up, choked you, threatened you with a knife or used a knife on you?; 3) Threatened you with a gun or used a gun on you (e.g., shot at or around you)?” Partner victimization included three parallel items, with the aggressor being a partner (e.g., husband, wife, fiancé, boyfriend, girlfriend, domestic partner, or someone you were dating) rather than a friend, neighbor, coworker, or stranger. The questionnaire asked parallel questions regarding non-partner and partner aggression. We operationalized interpersonal violence exposure as having experienced any partner or non-partner violence victimization or aggression in the past twelve months versus not having experienced partner or non-partner victimization or aggression in the past twelve months.
Demographic characteristics.
We collected demographic variables including the caregiver’s biological sex, age, education, race, ethnicity, and geographic region.
Analysis
We conducted multivariable logistic regression analyses among caregivers that indicated they personally owned a firearm to estimate associations of violence exposures (community and interpersonal violence) and motivations to own a firearm (protection motivations versus non-protection motivations) with firearm storage. We then assessed for a potential interaction between violence exposures (community and interpersonal) and motivations for firearm ownership (protection motivations versus non-protection motivations) in their associations with caregiver firearm storage (unlocked and/or loaded versus locked and unloaded). The outcome was if the caregiver stored at least one firearm in the home unlocked and/or loaded (versus locked and unloaded), and the exposures were (1) community violence exposure, (2) interpersonal violence exposure, and (3) motivation for firearm ownership (for protection reasons versus for non-protection reasons). We included caregiver sex, age, education, race, and US census region as model covariates in all analyses, yielding adjusted odds ratios (aOR) to represent the associations between violence exposures, ownership motivation, and firearm storage. Given that 5% of firearm-owning respondents (n=62) were missing information for variables included in our analyses, we conducted complete case analysis among firearm-owning caregivers with complete information on covariates (n=1,095). We followed Knol and VanderWeele’s recommendations for presenting interaction analyses.[22] We conducted all analyses in RStudio® version 4.2 utilizing the interactionR package.[23] We weighted all descriptive statistics and analyses to be nationally representative of adults in the United States.
Results
Table 1 presents descriptive statistics for the analytic sample. The analytic sample of firearm-owning caregivers identified predominately as non-Hispanic White (78%) and male (63%). The most common level of educational attainment was a high school education or lower (37%) and the average age was 47.1 (s.e.=0.55). Sixty-eight percent of caregivers stored at least one firearm loaded or unlocked, 77% were motivated to own a firearm for protection, 55% were exposed to community violence, and 7% were exposed to interpersonal violence.
Table 1.
Descriptive statistics for the analytic samples of firearm-owning caregivers of teenage children (n=1,095).
| Mean (se) or percentage, weighteda | Mean (sd) or percentage, unweighted | |
|---|---|---|
|
| ||
|
Firearm storage behaviors
≥1 firearm unlocked and/or loaded |
68% | 65% |
|
| ||
| Exposure variables | ||
|
| ||
| Community violence exposure | 55% | 51% |
|
| ||
| Interpersonal violence exposure | 7% | 5% |
|
| ||
| Motivated to own firearm for protection | 77% | 71% |
|
| ||
| Demographic factors | ||
|
| ||
| Age | 47.1 (0.55) | 49.1 (8.02) |
|
| ||
| Biological sex | ||
| Male | 63% | 68% |
| Female | 37% | 32% |
|
| ||
| Education | ||
| Less than high school/High school | 37% | 7% |
| Some college/Trade school | 33% | 37% |
| College graduate | 14% | 26% |
| Post-graduate schooling | 16% | 29% |
|
| ||
| Race/ethnicity | ||
| Non-Hispanic White | 78% | 85% |
| Non-Hispanic Black | 10% | 5% |
| Non-Hispanic Asian | <1% | 1% |
| Hispanic | 11% | 7% |
| Other race/ethnicity | <1% | 2% |
|
| ||
| Geographic Region | ||
| Northeast | 10% | 12% |
| Midwest | 19% | 21% |
| South | 44% | 40% |
| West | 27% | 27% |
Estimates weighted to be nationally representative of adults in the United States.
In multivariable logistic regression analyses, neither community violence exposure (aOR: 0.86; 95% CI [0.55 to 1.36]) nor interpersonal violence exposure (aOR: 0.60; 95% CI [0.22 to 1.65]) were associated with firearm storage practices after adjusting for caregiver biological sex, age, education, race and ethnicity, and US census region (Table 2). Owning a firearm for protection was associated with an increased odds of storing at least one firearm unlocked and/or loaded (aOR: 3.48 [2.11, 5.75]) after adjusting for caregiver biological sex, age, education, race, and US census region (Table 2).
Table 2.
Multivariable logistic regression results for the associations between community violence exposure, interpersonal violence exposure, and firearm storage among U.S. caregivers of teens (n=1,095).
| Community violence exposure | Interpersonal violence exposure | Motivated to own firearm for protection | |
|---|---|---|---|
|
|
|||
| aOR (95% CI) for unsafe versus safe firearm storage | 0.86 (0.55, 1.36) | 0.60 (0.22, 1.66) | 3.48 (2.11, 5.75) |
|
| |||
| Model fit: Cox-Snell pseudo-R squared | 0.05 | 0.05 | 0.10 |
Notes: aOR = Adjusted odds ratio; CI = Confidence interval; unsafe storage: ≥1 firearm unlocked and/or loaded; safe storage: all firearms locked and unloaded; ORs are adjusted for caregiver biological sex, age, education, race, and US census region. Estimates weighted to be nationally representative of adults in the United States.
Table 3 provides the results of the analyses evaluating the potential interaction between community violence exposure and motivations for firearm ownership in their association with caregivers’ firearm storage. The relative excess risk due to interaction (RERI) was −0.09 (95% CI: −1.90, 1.73) and the measure of interaction on a multiplicative scale was 1.28 (95% CI 0.48, 3.40), indicating no additive or multiplicative interaction between community violence exposure and protection motivation in their association with firearm storage. Owning a firearm for protection was associated with storing a firearm unlocked and/or loaded regardless of if an individual was exposed to community violence or not (aORs: no exposure, 3.11[1.55, 6.23]; exposure, 3.98[1.96–8.08]). Among individuals exposed to community violence, 34% (n=188) practiced locked and unloaded storage for all firearms, and 66% (n=373) stored at least one firearm unlocked and/or loaded.
Table 3.
Interaction between community violence exposure and motivations for firearm ownership on firearm storage among U.S. caregivers of teens (n=1,095).
| No experience of community violence | Experienced community violence | ||||
|---|---|---|---|---|---|
|
| |||||
| N unsafe/safe firearm storage |
aOR (95% CI) |
N unsafe/safe firearm storage |
aOR (95% CI) |
aOR (95% CI) for experiencing violence within strata of ownership motivations | |
|
|
|||||
| Motivated to own firearm for non-protection reasons | 91/85 | 1 [Ref.] | 62/80 | 0.68 (0.30, 1.51) |
0.68 (0.30, 1.51) |
|
| |||||
| Motivated to own firearm for protection | 248/110 | 3.11 (1.55, 6.23) |
311/108 | 2.70 (1.39, 5.27) |
0.87 (0.49, 1.54) |
|
| |||||
| aOR (95% CI) for ownership motivations within strata of experiencing violence | 3.11 (1.55, 6.23) |
3.98 (1.96, 8.08) |
|||
Notes: aOR = Adjusted odds ratio; CI = Confidence interval; unsafe storage: ≥1 firearm unlocked and/or loaded; safe storage: all firearms locked and unloaded.
Measure of interaction on additive scale: relative excess risk due to interaction (RERI) (95% CI) = −0.09 (−1.90, 1.73).
Measure of interaction on multiplicative scale: ratio of aORs (95% CI) = 1.28 (0.48, 3.40). aORs are adjusted for caregiver biological sex, age, education, race, and US census region. Estimates weighted to be nationally representative of adults in the United States.
Table 4 provides the results of the analyses evaluating the potential interaction between interpersonal violence exposure and motivations for firearm ownership in their association with caregivers’ firearm storage. The relative excess risk due to interaction (RERI) was −2.04 (95% CI: −6.00, 1.92) and the measure of interaction on a multiplicative scale was 0.40 (95% CI 0.05, 3.38), indicating no additive or multiplicative interaction between interpersonal violence exposure and protection motivation in their association with firearm storage. Owning a firearm for protection was associated with storing a firearm unlocked and/or loaded among individuals who did not experience interpersonal violence (aOR: 3.75[2.23, 6.28]) and who did experience interpersonal violence (aOR: 1.51[0.52, 8.31]), though the odds ratio was imprecisely estimated in the latter group due to small sample size. Among individuals exposed to interpersonal violence, 27% (n=13) practiced locked and unloaded storage for all firearms, and 73% (n=36) stored at least one firearm unlocked and/or loaded.
Table 4.
Interaction between interpersonal violence exposure and motivations for firearm ownership on firearm storage among U.S. caregivers of teens (n=1,095).
| No experience of interpersonal violence | Experienced interpersonal violence | ||||
|---|---|---|---|---|---|
|
|
|||||
| N unsafe/safe firearm storage |
aOR (95% CI) |
N unsafe/safe firearm storage |
aOR (95% CI) |
aOR (95% CI) for experiencing violence within strata of ownership motivations | |
|
|
|||||
| Motivated to own firearm for non-protection reasons | 145/157 | 1 [Ref] | 7/8 | 1.38 (0.28, 6.71) |
1.38 (0.28, 6.71) |
|
| |||||
| Motivated to own firearm for protection | 526/213 | 3.75 (2.23, 6.28) |
29/5 | 2.08 (0.52, 8.31) |
0.56 (0.14, 2.17) |
|
| |||||
| aOR (95% CI) for ownership motivations within strata of experiencing violence | 3.75 (2.23, 6.28) |
1.51 (0.52, 8.31) |
|||
Notes: aOR = Adjusted odds ratio; CI = Confidence interval; unsafe storage: ≥1 firearm unlocked and/or loaded; safe storage: all firearms locked and unloaded.
Measure of interaction on additive scale: relative excess risk due to interaction (RERI) (95% CI) = −2.04 (−6.00, 1.92).
Measure of interaction on multiplicative scale: ratio of aORs (95% CI) = 0.4 (0.05, 3.38). aORs are adjusted for caregiver biological sex, age, education, race, and US census region. Estimates weighted to be nationally representative of adults in the United States.
Discussion
In the present analyses, we did not find evidence for our hypotheses that: 1) caregivers motivated to own a firearm for protection may appraise violence exposure as a threat of experiencing violence while unarmed and, in turn, will store firearms unlocked and/or loaded for easier access to mitigate this threat; and 2) caregivers motivated to own a firearm for non-protection reasons may appraise violence exposure as a threat of someone accessing their firearm to use against them or their family/friends and, in turn, will store firearms locked and unloaded to mitigate this threat. Yet, the idea that individuals appraise different potential threats (i.e., experiencing violence while unarmed versus someone accessing their firearm to use against them or their family/friends) as well as different coping mechanisms (i.e., storing firearms unlocked and/or loaded versus locked and unloaded) after being exposed to violence may still hold, as our analyses found heterogeneity in firearm storage practices among both individuals exposed to community violence and individuals exposed to interpersonal violence. These threat and coping appraisals in response to violence exposure, however, likely do not differ according to motivation for firearm ownership. Future analyses need to consider other baseline characteristics that may explain individual differences within these threat and coping appraisal stages of the Protection Motivation Theory, such as fear of community violence, safety perceptions, fear of unintentional injury, and social anomie.
Regardless of violence exposures, owning a firearm for protection was associated with storing a firearm unlocked and/or loaded. These findings are consistent with prior work that has found that owning a firearm for protection (versus non-protection motivations) is associated with storing firearms in an easy-to-access manner, i.e., unlocked and/or loaded.[2,3] Given that the associations between motivations to own a firearm for protection and unsafe firearm storage appear uninfluenced by community and interpersonal violence exposure, studying other factors that may moderate the strong association between owning a firearm for protection and firearm storage would help inform the development of safe storage interventions. Specifically, future analyses could include perceptions of safety—rather than violence exposure—as a potential interacting variable, as prior research has identified discrepancies between violence exposure and perceived safety.[24] Researchers could also explore factors or technologies that may promote locked and unloaded firearm storage among individuals with a motivation to own firearms for protection.
Experiencing community and interpersonal violence were not associated with the likelihood of storing firearms unlocked and/or loaded. We expected community and interpersonal violence exposure would be associated with unlocked and/or loaded storage among caregivers who were motivated to own a firearm for protection but associated with locked and unloaded firearm storage patterns among caregivers motivated to own firearms. Although we did not find evidence that the association of community and interpersonal violence exposure with firearm storage differed according to motivations for firearm ownership, the association between violence exposure and firearm storage may be related to other characteristics, such as owners’ self-efficacy to use a firearm for protection, fear of unintentional injury, or social isolation and anomie. An alternative explanation for our findings is that violence exposure is not associated with firearm storage behavior. It is possible, for example, that media exposure instigates vicarious fear or perceived (not experienced) violence that leads individuals to feel the need for self-protection, despite living in places or with people where violence is extremely unlikely. Researchers may need to conduct more in-depth qualitative studies to try to understand owner’s perspectives about their vulnerability and why an unlocked firearm (versus other preventive behaviors) is necessary to feel secure.
Limitations
Our nationally representative sample of caregivers of teenage children may not generalize to all US adults or to caregivers of all aged children (e.g., young children). Further, the survey achieved a response rate of 31%, but we do not know the extent to which responders may differ from non-responders in their violence exposures or firearm-related behaviors. An additional limitation of the present analyses involves our inability to infer causation; the team collected data from respondents at a single time point. Temporality of the evaluated associations, however, is plausible, given that respondents reported violence exposures for the prior twelve months, respondents established motivation for firearm ownership at the time of firearm purchasing (i.e., before the assessed firearm storage behavior), and respondents reported current firearm storage. Potential unobserved confounding variables, however, may bias the estimated associations. To reduce potential bias, we controlled for the caregiver’s biological sex, age, education, race, ethnicity, and geographic region, when estimating adjusted odds ratios. We also obtained large confidence intervals in analyses focused on interpersonal violence exposure due to the low prevalence of interpersonal violence exposure; future analyses should seek to estimate these associations in larger samples. Finally, the measure of firearm storage assumes storage is a static state, which may not be representative of the dynamic nature of firearm storage or if there are temporally oriented factors that motivate different storage patterns.
Conclusions
Exposure to violence was not associated with caregivers’ firearm storage practices. Regardless of violence exposure, being motivated to own a firearm for protection was associated with storing a firearm unlocked and/or loaded. Future research should consider other characteristics that might influence firearm storage, in addition to assessing why people who own a firearm for protection are less likely to store their firearms locked and unloaded, and if such behaviors are changeable.
What is already known on this topic –
Owning a firearm for protection is a primary motivation for firearm ownership among adults in the United States. This motivation for firearm ownership is associated with storing firearms unlocked and/or loaded, which increases the risk of firearm injury and death among youth.
What this study adds –
This study adds to our understanding of the associations of violence exposure and firearm ownership motivations with firearm storage; owning a firearm for protection is associated with increased odds of storing a firearm unlocked and/or loaded, regardless of exposure to violence.
How this study might affect research, practice, or policy –
Understanding the contexts in which caregivers own and store firearms can provide insights into approaches to increase the proportion of firearm-owning households that practice locked and unloaded firearm storage. Given that the motivation to own a firearm for protection is strongly linked to storing firearms in an unlocked and/or loaded state—irrespective of violence exposure—future research should explore other factors or technologies that promote locked and unloaded firearm storage among individuals with a motivation to own firearms for protection.
Funding/Support:
Data collection for this project was funded through the National Institutes of Health/National Institute of Child Health and Human Development (1R24HD087149–01A1).
Abbreviations:
- OR
odds ratio
- aOR
adjusted odds ratio
- CI
confidence interval
- RERI
relative excess risk due to interaction
Footnotes
Conflict of Interest Statement: The authors have no conflicts of interest to disclose.
References
- [1].Lyons VH, Haviland MJ, Azrael D, Adhia A, Bellenger MA, Ellyson A, et al. Firearm purchasing and storage during the COVID-19 pandemic. Inj Prev 2021;27:87–92. [DOI] [PubMed] [Google Scholar]
- [2].Carter PM, Losman E, Roche JS, Malani PN, Kullgren JT, Solway E, et al. Firearm ownership, attitudes, and safe storage practices among a nationally representative sample of older US adults age 50 to 80. Prev Med 2022;156:106955. [DOI] [PubMed] [Google Scholar]
- [3].Sokol R, Schmidt C, Miller AL, Walton MA, Zimmerman M, Resnicow K, et al. Motivations for firearm possession and storage practices among urban young adults: differences between parents and non-parents. Inj Prev 2020. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [4].Miller M, Azrael D, Hemenway D. Firearm availability and unintentional firearm deaths, suicide, and homicide among 5–14 year olds. J Trauma Acute Care Surg 2002;52:267–75. [DOI] [PubMed] [Google Scholar]
- [5].Miller M, Azrael D, Hemenway D, Vriniotis M. Firearm storage practices and rates of unintentional firearm deaths in the United States. Accid Anal Prev 2005;37:661–7. [DOI] [PubMed] [Google Scholar]
- [6].Anglemyer A, Horvath T, Rutherford G. The Accessibility of Firearms and Risk for Suicide and Homicide Victimization Among Household Members: A Systematic Review and Meta-analysis. Ann Intern Med 2014;160:101–10. 10.7326/M13-1301. [DOI] [PubMed] [Google Scholar]
- [7].Grossman DC, Mueller BA, Riedy C, Dowd MD, Villaveces A, Prodzinski J, et al. Gun storage practices and risk of youth suicide and unintentional firearm injuries. Jama 2005;293:707–14. [DOI] [PubMed] [Google Scholar]
- [8].Grossman DC, Reay DT, Baker SA. Self-inflicted and unintentional firearm injuries among children and adolescents: the source of the firearm. Arch Pediatr Adolesc Med 1999;153:875–8. [DOI] [PubMed] [Google Scholar]
- [9].Monuteaux MC, Azrael D, Miller M. Association of increased safe household firearm storage with firearm suicide and unintentional death among US youths. JAMA Pediatr 2019;173:657–62. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [10].Hamilton EC, Miller III CC, Cox CS Jr, Lally KP, Austin MT. Variability of child access prevention laws and pediatric firearm injuries. J Trauma Acute Care Surg 2018;84:613–9. [DOI] [PubMed] [Google Scholar]
- [11].Miller M, Zhang W, Rowhani-Rahbar A, Azrael D. Child access prevention laws and firearm storage: results from a national survey. Am J Prev Med 2022;62:333–40. [DOI] [PubMed] [Google Scholar]
- [12].Seewald LA, Myers M, Zimmerman MA, Walton MA, Cunningham RM, Rupp LA, et al. Firearm safety counseling among caregivers of high-school age teens: results from a national survey. Prev Med 2022;165:107285. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [13].McGee KS, Coyne-Beasley T, Johnson RM. Review of evaluations of educational approaches to promote safe storage of firearms. Inj Prev 2003;9:108–11. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [14].Anestis MD, Bryan CJ, Capron DW, Bryan AO. Lethal means counseling, distribution of cable locks, and safe firearm storage practices among the Mississippi national guard: a factorial randomized controlled trial, 2018–2020. Am J Public Health 2021;111:309–17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [15].Ngo QM, Sigel E, Moon A, Stein SF, Massey LS, Rivara F, et al. State of the science: a scoping review of primary prevention of firearm injuries among children and adolescents. J Behav Med 2019;42:811–29. 10.1007/s10865-019-00043-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [16].Rowhani-Rahbar A, Simonetti JA, Rivara FP. Effectiveness of interventions to promote safe firearm storage. Epidemiol Rev 2016;38:111–24. [DOI] [PubMed] [Google Scholar]
- [17].Azrael D, Cohen J, Salhi C, Miller M. Firearm storage in gun-owning households with children: results of a 2015 national survey. J Urban Health 2018;95:295–304. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [18].Rogers RW, Prentice-Dunn S. Protection motivation theory. 1997. [Google Scholar]
- [19].Rogers RW. A protection motivation theory of fear appeals and attitude change1. J Psychol 1975;91:93–114. [DOI] [PubMed] [Google Scholar]
- [20].Richters J, Saltzman W. Survey of Exposure to Community Violence: Self Report Version 1990. [Google Scholar]
- [21].Straus MA, Hamby SL, Boney-McCoy S, Sugarman DB. The revised conflict tactics scales (CTS2) development and preliminary psychometric data. J Fam Issues 1996;17:283–316. [Google Scholar]
- [22].Knol MJ, VanderWeele TJ. Recommendations for presenting analyses of effect modification and interaction. Int J Epidemiol 2012;41:514–20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [23].Alli BY. InteractionR: An R package for full reporting of effect modification and interaction. Softw Impacts 2021;10:100147. [Google Scholar]
- [24].Cammack NL, Lambert SF, Ialongo NS. Discrepancies between community violence exposure and perceived neighborhood violence. J Community Psychol 2011;39:106–20. [DOI] [PMC free article] [PubMed] [Google Scholar]
