Household firearms are associated with an elevated risk of firearm death to occupants
in the home. Many organizations and health authorities advocate locking firearms and
ammunition to prevent access to guns by children and adolescents. The association
of these firearm storage practices with the reduction of firearm injury risk is unclear.
To measure the association of specific household firearm storage practices (locking
guns, locking ammunition, keeping guns unloaded) and the risk of unintentional and
self-inflicted firearm injuries.
Case-control study of firearms in events identified by medical examiner and coroner
offices from 37 counties in Washington, Oregon, and Missouri, and 5 trauma centers
in Seattle, Spokane, and Tacoma, Wash, and Kansas City, Mo. CASES AND CONTROLS: Case
firearms were identified by involvement in an incident in which a child or adolescent
younger than 20 years gained access to a firearm and shot himself/herself intentionally
or unintentionally or shot another individual unintentionally. Firearm assaults and
homicides were excluded. We used records from hospitals and medical examiners to ascertain
these incidents. Using random-digit dial telephone sampling, control firearms were
identified by identification of eligible households with at least 1 firearm and children
living or visiting in the home. Controls were frequency matched by age group and county.
The key exposures of interest in this study were: (1) whether the subject firearm
was stored in a locked location or with an extrinsic lock; (2) whether the firearm
was stored unloaded; (3) whether the firearm was stored both unloaded in a locked
location; (4) whether the ammunition for the firearm was stored separately; and (5)
whether the ammunition was stored in a locked location. Data regarding the storage
status of case and control guns were collected by interview with respondents from
the households of case and control firearms.
We interviewed 106 respondents with case firearms and 480 with control firearms. Of
the shootings associated with the case firearms, 81 were suicide attempts (95% fatal)
and 25 were unintentional injuries (52% fatal). After adjustment for potentially confounding
variables, guns from case households were less likely to be stored unloaded than control
guns (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.16-0.56). Similarly,
case guns were less likely to be stored locked (OR, 0.27; 95% CI, 0.17-0.45), stored
separately from ammunition (OR, 0.45; 95% CI, 0.34-0.93), or to have ammunition that
was locked (OR, 0.39; 95% CI, 0.23-0.66) than were control guns. These findings were
consistent for both handguns and long guns and were also similar for both suicide
attempts and unintentional injuries.
The 4 practices of keeping a gun locked, unloaded, storing ammunition locked, and
in a separate location are each associated with a protective effect and suggest a
feasible strategy to reduce these types of injuries in homes with children and teenagers
where guns are stored.