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. Author manuscript; available in PMC: 2019 May 1.
Published in final edited form as: Drug Alcohol Depend. 2018 Mar 26;186:187–192. doi: 10.1016/j.drugalcdep.2018.01.032

Alcohol use and change over time in firearm safety among families with young children*

Alexa Martin-Storey a, Kate C Prickett b, Robert Crosnoe c
PMCID: PMC5916849  NIHMSID: NIHMS957688  PMID: 29604526

Abstract

Background

Improperly stored firearms pose a clear health risk to children. Previous research concurrently links alcohol use with lower levels of firearm safety. The objectives of this study were to assess (1) how families move from unsafe to safer firearm storage practices and (2) how parental drinking was associated with moving away from unsafe firearm storage practices.

Methods

This study used data from the Early Childhood Longitudinal Study-Birth Cohort, 2003 when children were two years old and again when they were four years old. Parents were asked about firearm storage practices, alcohol consumption, and information to measure other confounding variables. Their responses were used to identify families who engaged in unsafe firearm storage practices (n = 650) during the initial testing period and to assess how alcohol consumption and other variables were associated with moving to safer firearm storage practices at the second testing period.

Results

Families grew more likely to adopt safer firearm storage practices as their children aged, compared with continuing unsafe practices. Multivariate logistic regressions indicated that parental drinking, however, reduced the likelihood that parents moved to safer storage practices, controlling for covariates. Other families- and community-level variables, in particular, family structure, were also associated with the likelihood of moving to safer firearm storage behaviors.

Conclusions

Families with higher levels of alcohol use may need additional assistance in addressing firearm safety. The findings call for future research to better understand how physicians can counsel at-risk families to help them store firearms more securely.

Keywords: Firearm Safety, Alcohol Use, Child Injury Prevention, Longitudinal

1. Introduction

In the U.S., firearms can be found in a fourth to a third of families with children, and, in approximately 28–33% of these firearm-owning families (7–11% of all families), firearms are stored unlocked or loaded (Durant et al., 2007; Okoro et al., 2005; Schuster et al., 2005; Stennies et al., 1994). The American Academy of Pediatrics (2012) recommends that parents with young children keep firearms locked and unloaded, with ammunition stored and locked separately, and the NRA recommends that owners take precautions to keep firearms away from unauthorized users (National Rifle Association, 2018). These guidelines reflect the well-documented dangers that improperly stored firearms pose to children (Fowler et al., 2017; Hemenway and Solnick, 2015), and the underscore the importance of identifying the factors associated with safe firearm storage practices in general and moving to adopt such practices in particular. Although some research points to the concurrent correlate of firearm safety behaviors (e.g., Martin-Storey et al., 2015; Okoro et al., 2005), no research to date has explored what kinds of factors are associated with improvement in firearm safety over time. Moving from safe to unsafe firearm storage practices, however, ultimately reflects a series of decisions and actions within the family.

Heavy alcohol use is associated with reduced safety in general (Committee on Substance Abuse, 1998), and it may be an actionable leaver on which primary care health care providers can address the delicate issue of unsafe firearm storage. Using a nationally representative sample (the Early Childhood Longitudinal Study-Birth Cohort, or ECLS-B), this study sought to identify general trends in firearm storage safety and explore how alcohol use might be associated with parents of young children moving from unsafe to safe firearm storage strategies.

Research points to the particularly problematic link between heavy alcohol use and firearms. Heavy alcohol use is associated with an increased likelihood of firearms-related arrests, homicides, and suicides (Branas et al., 2016; Wintemute et al., 2017). These findings likely reflect the role of alcohol in exacerbating conflict, impairing judgment, and subsequently augmenting the probability of serious injury across a variety of contexts (Boden et al., 2012; Heinz et al., 2011). Within the home environment, higher levels of alcohol use are associated with greater risk for child injury more generally (Bijur et al., 1992; Phelan et al., 2007). Indeed, this greater likelihood of general pediatric injury associated with parental alcohol use likely reflects the role of parental supervision (which can be impaired by alcohol use: e.g., Harvey et al., 2011; Latendresse et al., 2008) in childhood injury prevention (Damshek and Kuhn, 2012; Schnitzer et al., 2014). Furthermore, research has concurrently linked alcohol use to lower levels of firearm safety (Martin-Storey et al., 2015; Wintemute, 2011). Although existing research has not isolated the mechanisms that link alcohol use to lower levels of firearm safety, there is a well-documented influence of alcohol on the cognitive processes associated with decision making (George, Rogers Duka, 2005; Montgomery et al., 2011), evidence of links among alcohol use, impulsivity, and injury more generally (Cherpitel, 1993), and the association between alcohol use and higher levels of family stress (Grekin et al., 2005). These factors, in turn, may negatively influence the organizational processes that support firearm safety, making alcohol use a plausible contributing explanation for unsafe firearm behaviors. Ultimately, existing research suggests several mechanisms for why alcohol use may be negatively associated with family firearm safety and indicates an urgent need for more information about how alcohol use is associated with a change in firearm safety over time.

Moving beyond extant cross-sectional research to explore these questions longitudinally is important for understanding how alcohol use hampers firearm safety in families with young children. First, cross-sectional research cannot account for the developmental change over time in the threat firearm pose to children. Physically, children’s capacity to injure themselves or others with an unsecured firearm increases over time (Naureckas et al., 1995), while the likelihood that parents will store firearms securely diminishes (Schuster et al., 2000; Johnson et al., 2006). These changes reflect parents’ unrealistic perceptions about children’s firearm safety capacities (Baxley and Miller, 2006; Connor and Wesolowski, 2003; Farah et al., 1999). Indeed, although cross-sectional research suggests that parents of older children may be less likely to secure firearms for younger children, no existing research has specifically explored patterns of change among families with firearms. On the one hand, changes in the development of the child may prompt families to move towards safer firearm storage strategies (e.g., Naurekas et al., 1995). On the other hand, over-estimation of children’s capacities to act responsibly in the presence of firearms (e.g., Baxley and Miller, 2006) may impede parents from moving to safer firearm storage practices. Second, family level (i.e., parental depression, white race/ethnicity, family structure, having some college experience, and lower incomes) and environmental factors (i.e., those factors reflective of a more general firearm culture) are associated with both firearm ownership (Okoro et al., 2002; Martin-Storey et al., 2015; Morrissey, 2016; Schwebel et al., 2014) and alcohol use (Cherpitel, 1999; Grant et al., 2004; Sullivan et al., 2005). Exploring how alcohol use is associated with not just unsafe firearm storage but also with the deterioration of safety over time is an opportunity to go beyond identifying the common correlates of firearm storage and alcohol use and provides insight into the mechanisms explaining this association.

1.1 Aims and Hypotheses

Unintentional firearm deaths are a concerning and avoidable cause of morbidity and mortality among young children (Fowler et al., 2017). For this reason, early childhood is an important developmental period for an understanding change in firearm safety more generally, and how this change is influenced by parental alcohol use more specifically. Using longitudinal data from ECLS-B, the objectives of this study were to assess (1) how families moved from unsafe to safer firearm storage practices over time and (2) how parental drinking was associated with moving away from unsafe firearm storage practices. We hypothesized that the majority of families with unsafely stored firearms would move to safer firearm storage practices over time and that higher alcohol use would reduce the likelihood that individuals would move to safer firearm storage practices. Understanding if and how parental alcohol use is associated with a change in firearm storage provides important information for primary care providers in identifying and counseling at-risk families.

2. Material and Methods

2.1 Sample

ECLS-B is a nationally-representative sample of U.S. children born in 2001. It followed 10,600 children from birth through kindergarten (Snow et al., 2009). In-home interviews were conducted with parents when the focal child was 9-months, 2-years, and 4-years old, and at kindergarten entry, with information collected on the child and parents, as well as in other settings. This study used the 2-year and 4-year interviews in which parents reported on firearm practices. Children who were not living with their mothers at the 2-year and 4-year interview were excluded from the analytical sample (n = 300). Children of mothers 15 years or younger (n = 50) were also excluded from the analytic sample because this group was not generalizable at the population level. An additional 2,100 children were excluded because their families did not participate in either or both of the 2-year and 4-year interviews. The final sample consisted of 650 cases in which parents reported owning firearms but did not keep them stored in a locked cabinet (i.e., unsafe firearm owners) at the 2-year interview. This selection excluded the 7,450 cases where families reported not owning firearms or owning firearms and storing them in a locked cabinet during the first assessment period. Despite its age, ECLS-B remains the best available data source for this study because it is the only study of which we are aware that provides nationally-representative, longitudinal data on firearm safety practices from families that also includes detailed information about alcohol consumption.

Descriptive statistics for the sample are presented in Table 1. Within the analytical sample, the majority (91.9%) had a family in which the male partner had always been in the home, or moved into the home, with 4.2% never having had a male partner in the home and 3.9% had a male partner move out of the home. The majority of families could be described as middle class, with 39.1% reporting incomes ranging between $50,001-$100,000 and 32.6% reporting incomes between $25,000 and $50,000. The largest group of participants reported: 1) maternal education of a high school diploma or GED (34.1%) or some college experience or an associate’s degree (34.1%); 2) a race/ethnicity of non-Hispanic White (88.6%); 3) living in urban areas (48.3%), with the remaining 35.7% in rural areas and 16.3% in urban clusters; and 4) living in the South (40.3%) followed by the Midwest (28.2%) and the West (22.83%). These descriptive statistics are in line with previous work looking at the demographic factors associated with firearm ownership (Okoro et al., 2005; Schuster, 2000).

Table 1.

Sample description (percentages presented in italics) of families with unsafely stored firearms at the 2-year wave according 4-year storage practices (2003–05)

Total Did not
move to
safer
storage/no
firearm		 Moved to
safer storage
or no firearm
n Mean Mean Mean
Alcohol consumption
  Parental drinking (scale 0–6) 650 1.43 1.66 1.22
  Change in parental drinking scale 650 0.20 0.22 0.18
  Prior parental substance abuse problem 100 14.30 14.33 14.32
Family-level factors
  Maternal depression (z-score) 650 0.00 −0.02 0.03
  Maternal depression change 650 −0.12 −0.16 −0.09
  Family structure
    Male partner always in the home/moved in (%) 550 91.90 96.83* 87.83
    Male partner never in the home (%) 50 4.22 2.66 5.62
    Male partner moved out between waves (%) 50 3.88 0.51* 6.55
  # of siblings in the home 650 0.95 0.91 0.99
  # sibling change 650 0.36 0.38 0.34
  Household income
    Less than $25,000 (%) 100 16.27 9.98* 21.56
    $25,001 – $50,000 (%) 200 32.44 33.80 31.35
    $50,001 – $100,000 (%) 250 39.05 44.45* 34.42
    More than $100,000 (%) 100 12.23 11.78 12.67
  Income change 650 0.25 0.26 0.20
  Maternal education
    Less than high school diploma/GED (%) 50 4.85 2.08* 6.98
    High school diploma/GED (%) 200 34.08 31.89* 36.11
    Some college/associate’s degree (%) 200 34.13 32.58 35.60
    College or more (%) 150 26.96 33.46* 21.33
  Maternal race/ethnicity
    Non-Hispanic white (%) 550 88.55 91.27 86.11
    Non-Hispanic black (%) <50 2.42 2.37 2.47
    Hispanic White (%) 50 5.44 3.05 7.56
    Other race/ethnicity (%) <50 3.60 3.32 3.86
Distal factors
  Residential move (%) 250 36.93 31.27* 41.69
  Perceived neighborhood safety scale 650 3.56 3.57 3.56
  Perceived neighborhood safety change 650 −1.30 −1.38* −1.24
  Urbanicity (ref: Urban area)
    Urban area (%) 300 48.32 44.53 51.50
    Rural area (%) 100 35.65 37.28 34.32
    Urban cluster (%) 200 16.03 18.19 14.18
Urbanicity change
  No change (%) 550 88.54 88.99 88.42
  Moved to rural area (%) 50 6.22 6.22 5.91
  Moved to urban area (%) <50 2.99 2.07 3.83
  Moved to urban cluster (%) <50 2.25 2.71 1.84
Region
  Northeast (%) 50 8.61 6.30 10.68
  South (%) 250 40.38 42.49 36.65
  Midwest (%) 200 28.17 27.87 28.21
  West (%) 150 22.83 23.33 22.47
    State household firearm ownership rate 650 39.19 40.12* 38.37
  Change in state household firearm ownership rate 650 0.14 0.55 −0.25
    State violent crime rate 650 4.55 4.56 4.54
  Change in state violent crime rate 650 −0.18 −0.18 −0.17
    State property crime rate 650 3.72 3.78 3.67
  Change in state property crime rate 650 −0.15 −0.15 −0.15
Total 650 100.00 350 300
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Note: Weighted %s. Unweighted Ns rounded to nearest 50th per NCES guidelines.

*

T-tests and chi2 tests indicating statistically different at p < .05 from those who did not move to safer storage or no firearms.

2.2 Measures

2.2.1 Firearm Ownership and Safety

Two questions from the 2- and 4- year interviews assessed parents’ firearm behaviors. Parents (among our analytical sample, always the mother) were asked: “do you have a gun in your home?” If parents responded affirmatively, they were asked: “do you keep all guns in a locked cabinet?” These two questions were used to identify parents at the 2-year interview who owned a firearm and did not keep the firearm stored safely. Parents were subsequently assigned to two groups at the 4-year wave, based on their responses to the same series of questions at the 4-year interview: 1) No firearm in the home, or a firearm in the home, stored in a locked cabinet (i.e., “safe” firearm owner); or 2) a firearm in the home, not stored in a locked cabinet (i.e., “unsafe” firearm owner).

2.2.2 Family Alcohol Use

Parent-level alcohol use was coded in two ways to capture two distinct aspects of this behavior. First, to assess current parental drinking, a number of alcoholic drinks in a week for the parent in the household with the heaviest drinking was assessed. This approach was taken to control for variation in family structure in the current study. As part of the larger survey on parental health behaviors, both mothers and fathers were asked if they currently drink any alcoholic beverages (yes/no). They were then subsequently asked to describe how many alcoholic drinks they consumed on average per week, choosing from six options (less than one drink, 1–3 drinks, 4–6 drinks, 7–13 drinks, 14–19 drinks, or 20 or more drinks), with their responses included as a continuous variable in line with recommendations on measuring alcohol use (Dawson, 2003). Second, history of substance abuse was included as a control variable. Parent substance abuse was a binary variable in which parents were asked if they “ever had a drinking or drug problem or have other people thought you had one?” This variable was coded as no (absent) or yes (present) for the current analyses.

2.2.3 Covariates

Because depression is associated with firearm storage (Morrissey, 2016) and with alcohol use (Churchill and Farrell, 2017; Sullivan et al., 2005), maternal depression was included as a covariate in the current analyses. Depression was measured in two ways. At the 2-year interview, a standardized z-score measure of maternal depression derived from mothers’ scores on the Composite International Diagnostic Interview short form was employed (CIDI-SF: Kessler et al., 1998). Mothers received a raw scale score between 0 and 8, which was determined from mothers’ responses to a variety of questions associated with mental health, including whether they felt sad/blue/depressed most days or ever lost interest in work or activities that give them pleasure (Cronbach’s alpha = .87) (Gigantesco and Morosini, 2008). At the 4-year interview, maternal depression was assessed with a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale (McLearn et al., 2006; Radloff, 1977), which indicated the average response to 12 questions about mothers’ reports of feeling anxious, bothered, or sad (1 = rarely or never through 4 = most or all days a week) (Cronbach’s alpha = .86). The raw scale was converted to a standardized z-score to allow for a comparative measure across waves.

A variety of sociodemographic covariates measuring family characteristics were included in the models based on their links with firearm ownership (Martin-Storey et al., 2015; Coyne-Beasley et al., 2005) and alcohol use (Grant et al., 2005). They included maternal education (four dummy variables: no high school diploma/GED, high school diploma/GED, some college experience or associate’s degree, or college degree and higher) and maternal race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic White, or other race/ethnicity). Family structure measured both stability and change in the presence of a male partner in the home (most often the child’s father). Thus, family structure was captured as three dummy variables indicating whether the male partner: 1) Was always in the home/moved into the home between waves (because very few families in the sample experienced a male partner moving into the home), 2) was never in the home, or 3) moved out between waves. The number of siblings in the home was a continuous variable. Annual household income was measured by four dummy variables based approximately on the quartile distribution ($25,000 or less, $25,001 to $50,000, $50,001 to $100,000, or more than $100,000).

Finally, environmental factors such as neighborhood, state residence, and urbanicity are associated with both firearm ownership (Schuster et al., 2000; Johnson et al., 2004) and alcohol use (Cherpitel, 1999; Theall et al., 2009). For perceived neighborhood safety, parents were asked how safe they considered their neighborhood from crime on a scale ranging from 0 (very unsafe) through 4 (very safe). Families were also classified as to whether they lived in an urban area (defined as having 50,000 or more people), an urban cluster (defined as having at least 2,500 and less than 50,000 people), or a rural area (defined as all other areas) (U.S. Census Bureau, 2010). State-level characteristics included the household firearm ownership rate, which was measured as the proportion of households owning a firearm in 2004 based on estimates by the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (CDC, 2003). Data from the U.S. Census Bureau were used to determine state violent crime rates (per 1,000 of the population) and property crime rates (per 100 of the population) in 2003 and 2005 (U.S. Census Bureau, 2006a; U.S. Census Bureau, 2006b). The region was categorized as Northeast, South, Midwest, and West.

2.3 A Note on Longitudinal Measurement

Where possible, variables measured change between interviews. Change in parental drinking was assessed via the scale at the 4-year interview minus the scale at the 2-year interview, with a positive value indicating heavier drinking compared to two years earlier. Among the covariates, change in maternal depression was the change in the z-score between the 2- and 4-year interviews. Among structural factors, income change, although categorized as a set of dummies for point-in-time measurement, was coded as a change score, indicating changes in income based on the original continuous scale income measure (1 = $5,000 or less through 13 = $200,001 or more). A continuous variable captured a change in the number of siblings in the home. Finally, change in distal factors included a binary variable indicating whether the family had a residential move between interviews, changes in the state-level property and violent crime rates and firearm ownership rate (rates at the 4-year interview minus the 2-year interview rate), and dummy variables indicating urbanicity change (no change, moved to a rural area, moved to an urban area, moved to an urban cluster).

2.4 Statistical Analysis

A mixed-effects multivariate logistic regression estimated the association between alcohol use, and family- and environmental-level factors and changes in firearm safety over time. To account for state-level clustering of respondents, these models employed second-level random intercepts of state residence at the 2-year wave. All analyses used the longitudinal sampling weight [W3R0] that were provided by NCES to account for non-response at baseline as well as the planned oversampling of select subgroups (e.g., racial minorities and low birth weight children). The model was estimated in Stata 14 using the suite of mi commands to estimate missing data (Statacorp, 2015). Multiple imputations by chained equations produced 100 replicate datasets, imputing missing values for parental substance abuse problems, maternal depression, change in maternal depression, and urbanicity change. In total, 1.0% of analytical data were imputed. All other variables with complete data were predictors in the imputation models.

3. Results

To address the first aim, among parents who owned firearms but did not store them in a locked cabinet at the 2-year interview, 53% of families moved to safer behaviors (i.e., reporting storing their firearms in a locked cabinet or no longer reporting owning firearms) by the 4-year interview. Furthermore, the bivariate associations presented in Table 1 suggested that there were no significant differences in the alcohol use or substance abuse among families who did and did not move to safer firearm behaviors. Differences did emerge, however, for the covariates, such that families who moved to safer firearm behaviors were more likely to experience a male partner moving out of the home, have lower household incomes, have less education, were more likely to move residences, and were more likely to live in a state with lower household firearm ownership rates.

To address the second aim, logistic regressions estimated the association between alcohol use and abuse and change in firearm storage after controlling for covariates (Table 2). Each additional increase in the level of parental drinking was associated with 18% lower odds (95% confidence interval [CI] 0.72–0.94) of moving to a safer firearm storage strategy. Several family and environmental factors were also strongly associated with moving to safer firearm storage practices. Having a male partner move out of the home was by far the most important predictor of change to safer storage behaviors. Having more children in the home also was associated with greater odds of moving to safer storage behaviors. College education decreased the likelihood of moving to safer firearm storage practices. Regarding environmental factors, living in states with higher rates of firearm ownership, as well as moving to a state with higher firearm ownership reduced the likelihood of moving to safer firearm storage practices over time.

Table 2.

Logistic regression predicting change from unsafe to safe firearm ownership from 2- to 4-year wave

Adj. OR CI
Alcohol consumption
  Parental drinking (scale 0–6) 0.82* 0.72, 0.94
  Change in parental drinking scale 0.85 0.72, 1.01
  Prior parental substance abuse problem 1.06 0.62, 1.82
Family-level factors
Maternal depression (z-score) 0.96 0.74, 1.25
  Maternal depression change 0.92 0.74, 1.13
Family structure (ref: male partner always in the home/moved in)
  Male partner never in the home 1.31 0.42, 4.12
  Male partner moved out between waves 8.64* 1.80, 41.39
  # of siblings in the home 1.23* 1.03, 1.47
# sibling change 1.03 0.69, 1.52
Household income (ref: < $25,001)
  $25,001 – $50,000 0.77 0.41, 1.47
  $50,001 – $100,000 0.67 0.33, 1.36
More than $100,000 1.13 0.45, 2.80
Income change 0.98 0.87, 1.10
  Maternal education (ref: < HS/GED)
    High school diploma/GED 0.59 0.24, 1.47
      Some college/associate’s degree 0.42 0.17, 1.07
      College or more 0.33* 0.13, 0.88
    Maternal race/ethnicity (ref: Non-Hisp White)
  Non-Hispanic black 0.51 0.19, 1.39
    Hispanic White 1.07 0.40, 2.82
  Other race/ethnicity 1.29 0.70, 2.39
Environmental factors
  Residential move 2.34 0.74, 7.40
  Perceived neighborhood safety scale 0.61 0.27, 1.38
  Perceived neighborhood safety change 0.86 0.54, 1.37
  Urbanicity (ref: Urban area)
    Rural area 0.87 0.54, 1.39
    Urban cluster 0.75 0.45, 1.27
  Urbanicity change (ref: no change)
    Moved to rural area 0.64 0.23, 1.76
    Moved to urban area 0.41 0.11, 1.55
    Moved to urban cluster 0.47 0.13, 1.73
  Region (ref: Northeast)
    South 1.10 0.29, 4.19
    Midwest 0.97 0.29, 3.19
    West 0.72 0.18, 2.84
  State household firearm ownership rate 0.97 0.94, 0.99
  Household firearm ownership rate change 0.93 0.87, 0.99
  Violent crime rate 0.91 0.76, 1.09
  Violent crime rate change 0.91 0.61, 1.36
  Property crime rate 0.97 0.61, 1.55
  Property crime rate change 1.05 0.41, 2.69
Constant 89.89 5.42, 1491.11
  Lnsig2u 0.43 0.22, 0.83
Total 650
Group n 50
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Note: Unweighted Ns rounded to nearest 50th per NCES guidelines.

Adj. OR = Adjusted Odds Ratio; CI = Confidence interval;

*

at least p < 0.05

Using the same modeling techniques, sensitivity analyses assessed if alcohol use was associated with general changes in firearm ownership status, versus specifically with firearm safety (e.g., increased likelihood of acquiring or longer reporting owning a firearm). These additional analyses revealed no significant association between acquiring or getting rid of firearms and alcohol use (results available by request from the first author). The role of alcohol use with regards to firearm ownership was particular to safety behaviors, but not general change in firearm ownership.

4. Discussion

Young children’s health is best served by keeping them away from firearms. In line with this common-sense approach to firearm safety, slightly over half of the families in this study who reported unsafe firearm storage practices when their children were two years old moved to safer practices by the time their children were four. Higher levels of alcohol use were associated with a decreased likelihood of moving from unsafe to safer firearms storage practices. These findings underscore that alcohol use is associated with reduced likelihood of moving towards safer firearm storage practices, accounting for previously examined covariates (Martin-Storey et al., 2015; Wintemute, 2011). Indeed, alcohol use was associated with firearm safety, but not with general patterns of acquiring or getting rid of firearms, suggesting the unique importance of alcohol use for safety-related concerns. These findings suggest that alcohol use may actively impede the family processes that encourage individuals to move towards safer firearm practices, much like heavy alcohol use impedes other family-level safety behaviors (Bijur et al., 1992; Phelan et al., 2007). Finally, recent levels of alcohol use and no history of abuse were associated with changes in firearm safety. This finding may suggest that the association between alcohol use and firearm safety reflects the day-to-day impact of drinking on safety behaviors, rather than the enduring psychobiological underpinnings of chronic or problem drinking. Ultimately, these findings suggest that families with higher levels of alcohol use may be at increased risk for unsafe firearm storage practices, providing an important starting point for informing physician-based counseling on this topic.

Although alcohol use was associated with changes in firearm safety, it was not the only factor linked to this change over time. Family (e.g., a man moving out of the home) and environmental (e.g., region of residence) factors were also associated with a change in firearm safety. With regards to family structure, these findings likely reflect gender differences with regards to firearm ownership, as men are significantly more likely to own firearms than women (Prickett et al., 2014; Schuster et al., 2000), and because women in homes with firearms generally report highly favorable attitudes towards safe firearm storage (Johnson et al., 2007). The importance of family structure or region of residence would be anticipated based on substantial literature focusing on how these broader social constructs influence firearm safety (Johnson et al., 2004; Schuster et al., 2000). Although understanding the processes that are more generally associated with firearm change is important, we also argue that these factors may be less malleable than alcohol use for promoting firearm safety.

Despite the many advantages of examining change in firearm safety in a dynamic change-on-change framework, the study also had some limitations that need to be addressed. First, parents were asked about their firearm storage in the context of a larger series of questions on safety behaviors. This kind of framing may have increased the likelihood of eliciting socially desirable answers. Sensitivity analyses tested for possible misclassification of firearms. Overall, 22% of the firearm owners who did not store their firearms in a locked cabinet at the 2-year interview but reported safer practices at the 4-year interview would have to have been misclassified to nullify the findings. Second, the findings were correlational and should not be interpreted causally. Third, two different instruments assessed depressive symptoms at the two different time points. Although the scores were standardized, future work should use more consistent assessments of depressive symptoms. Fourth, drug use was not temporally assessed in this survey, and future work may wish to verify if current drug use is associated with changes in firearm safety behavior among parents. Finally, these findings focus on families with young children. Alcohol use or the other factors identified as being associated with a change in firearm safety could function differently for other types of families.

5. Conclusions

This study’s findings make a case for focusing on families with higher levels of alcohol use when promoting firearm safety behavior, beyond the frequently identified family and environmental factors associated with firearm ownership. These findings add to growing literature linking heavy alcohol use with negative firearm outcomes and underline the importance of public health campaigns that address their problematic association. Physicians should be trained in discussing firearm storage in the context of alcohol use and should identify problematic firearm storage as something that may need to be addressed specifically in homes with high levels of alcohol consumption. Both a majority of alcohol-positive parents and a majority of firearms owning parents report being comfortable being screened and consulted about these issues by pediatricians in a clinical setting (Garbutt et al., 2016; Wilson et al., 2008). These findings suggest the feasibility of identifying parents most at risk for continuing with unsafe firearm storage and provides an entry point for discussing child injury risk, generally, and firearm safety, specifically. This study provides the basis for future research that suggests that while alcohol use is associated with some of the most serious firearms-related outcomes (e.g., homicide), it may also inhibit important day-to-day firearm safety decisions within the home.

Supplementary Material

supplement

Highlights.

  • Alcohol use is associated with worsened firearms-related outcomes.

  • The majority of families moved to safer firearm practices over time.

  • Higher alcohol consumption reduced the likelihood of moving to safer practices.

  • Firearm safety may be important to address in the context of alcohol use.

Acknowledgments

The authors acknowledge the support of a postdoctoral fellowship to the first author from The Social Sciences and Humanities Research Council of Canada (756-2012-0877-B99) and grants from the National Institute of Child Health and Human Development to the Population Research Center at the University of Texas at Austin (R24 HD42849 to PI: Mark Hayward; T32 HD007081-35, to PI: Kelly Raley) and the Harris School of Public Policy Studies at the University of Chicago (F32 HD086994-01, to PI: Kate C. Prickett). Opinions reflect those of the authors and not necessarily those of the granting agencies.

Authors Disclosures

Role of Funding Sources

The agencies that funded this project did not contribute to 1) study design; 2) the collection, analysis, and interpretation of data; 3) the writing of the report; and 4) the decision to submit the manuscript for publication.

Footnotes

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Contributors

All three authors developed the idea for the study. The second author performed the analyses. The first and second author wrote the initial draft of the manuscript, and all three authors participated in revising subsequent drafts of the manuscript. All authors have approved the final article.

Conflict of Interest

No conflict declared.

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