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Examples of Behavioral Insights to Enhance Safe Firearm Storage
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Behavioral economics applies key principles from psychology and economics to address obstacles to behavior change. The important topic of pediatric firearm injuries has not yet been explored through a behavioral economic lens. Pediatric firearm-related injuries are a significant public health problem in the United States. Despite American Academy o...
Context in source publication
Context 1
... other constructs from behavioral science may impact parental decision-making around firearm storage (Table 1). For example, the overconfidence effect is the misreckoning of probabilities in which an individual's subjective confidence in their ability (ie, adeptness, skill) is greater than their actual performance. ...Similar publications
RÉSUMÉ
Mots clés: rupture diaphragmatique, nourrisson, chirurgie.
Les ruptures diaphragmatiques traumatiques sont exceptionnelles chez les nourrissons, nous rapportons ce cas survenu à la suite d’un accident domestique chez un nourrisson de 20 mois. Le diagnostic clinique et radiologique a été précoce, la rupture était isolée et de grande taille av...
Citations
... This confirms and supports the need for firearms in the home to be safely stored and locked and away from children [44][45][46]. It has been estimated that even in 2020 that 4.6 million US children live in homes with at least one loaded and unlocked firearm [47]. The issue of gun ownership is very emotional in the US population, and in a recent study [48] gun owners with children were more likely than those without children to feel that guns make them feel more valuable to their families. ...
The purpose of this study was to investigate fracture patterns due to pediatric firearm injuries. The data used was from the US Firearm Injury Surveillance Study 1993–2019. Over these 27 years, there were 19,033 children with fractures due to firearm activity with an average age of 12.2 years; 85.2% were boys and the firearm was a powder type in 64.7%. The finger was the most common fracture location, while the tibia/fibula was the most common location for those admitted to the hospital. Children ≤ 5 years of age sustained more skull/face fractures; most spine fractures occurred in the 11–15-year age group. The injury was self-inflicted in 65.2% of the non-powder and 30.6% of the powder group. The injury intent was an assault in 50.0% of the powder and 3.7% of the non-powder firearm group. Powder firearms accounted for the majority of the fractures in the ≤5 and 11–15 year-olds, non-powder firearms accounted for the majority of the fractures in the 6–10 year-olds. Injuries occurring at home decreased with increasing age; there was an increase in hospital admissions over time. In conclusion, our findings support the need for safe storage of firearms in the home away from children. This data will be helpful to assess any changes in prevalence or demographics with future firearm legislation or other prevention programs. The increasing acuity of firearm-associated injuries seen in this study is detrimental to the child, impacts familial wellbeing, and results in significant financial costs to society.
... 28,29 The application of successful behavioral economics principles 30 to firearm injury prevention includes addressing parental beliefs regarding their child's firearm injury risk and the immediate inconvenience versus likely future benefits of safe gun storage. 31 Anticipatory guidance is an important component of every well-child visit, with firearmrelated anticipatory guidance included in the American Academy of Pediatrics (AAP) Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescent, 4th Edition for well-child care. 32 Several interventional studies have examined the effectiveness of firearm safety anticipatory guidance, 22,33-35 and overall, provision of firearm safety storage devices is associated with safer storage practices. ...
Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States. They are also an important cause of injury with long-term physical and mental health consequences. A multipronged approach with layers of protection focused on harm reduction, which has been successful in decreasing motor vehicle-related injuries, is essential to decrease firearm injuries and deaths in children and youth. Interventions should be focused on the individual, household, community, and policy level. Strategies for harm reduction for pediatric firearm injuries include providing anticipatory guidance regarding the increased risk of firearm injuries and deaths with firearms in the home as well as the principles of safer firearm storage. In addition, lethal means counseling for patients and families with individuals at risk for self-harm and suicide is important. Community-level interventions include hospital and community-based violence intervention programs. The implementation of safety regulations for firearms as well as enacting legislation are also essential for firearm injury prevention. Increased funding for data infrastructure and research is also crucial to better understand risks and protective factors for firearm violence, which can then inform effective prevention interventions. To reverse this trend of increasing firearm violence, it is imperative for the wider community of clinicians, public health advocates, community stakeholders, researchers, funders, and policy makers to collaboratively address the growing public health crisis of firearm injuries in US youth.
... (35) Despite this increased risk, and the evidence supporting lethal means safety as an effective suicide prevention strategy, (36)(37)(38) homes with higher risk youth are not more likely to store firearms in safer ways compared to homes without higher-risk youth (32,39,40). This is likely due to caregivers underestimating their child's risk of suicide (41) or access to home firearms. (40) J o u r n a l P r e -p r o o f For suicide prevention, "means safety" is preferred to "means restriction," with improved intended uptake with the former. ...
... Each of these BE strategies-accountable justifications and peer comparisons-reduced inappropriate antibiotic prescribing by primary care physicians. 7 Perhaps these BE strategies could be successfully altered for a different pur-pose, namely, promoting lethal means restriction by parents. Families of adolescents who are at heightened risk for a future suicide attempt (eg, youth recently discharged from inpatient psychiatric hospitalization) might be particularly worthy candidates for such nudges. ...
In the United States, suicide is the second leading cause of death among adolescents aged 14-18 years, and the rate of suicide increased 61% from 2009 to 2018.1 During that period, 15,951 14- to 18-year-olds died by suicide, with 6,794 deaths (42.6%) occurring with a firearm.1 Most firearm suicide deaths in adolescents occur in the home with a firearm owned by the parent.2 An aspirational goal of the National Strategy for Suicide Prevention is to reduce access to lethal means that people use to attempt suicide. The American Foundation for Suicide Prevention has identified firearms as one of 4 critical areas to address in Project 2025, the nationwide initiative to reduce the suicide rate 20% by 2025.3.
Background and objectives:
Limiting firearm access is essential to decreasing teen suicide. Previous efforts have focused on household firearms; however, less is known about firearm access and possession among teens at increased suicide risk. Our objective was to estimate prevalence of firearm possession and access among high school-aged teens with recent depression and/or lifetime history of suicidality (DLHS).
Methods:
We conducted a probability-based, cross-sectional Web survey of 1914 parent-teen dyads between June 24, 2020, and July 22, 2020, with data weighted to generate a nationally representative sample of US teenagers (aged 14-18). Logistic regression analyses examined the difference between teens with and without DLHS for: (1) personal firearm possession, (2) perceived firearm access, and (3) method of firearm attainment.
Results:
Among high school-aged teens, 22.6% (95% confidence interval [CI], 19.4-25.8) reported DLHS, 11.5% (95% CI, 8.7-14.3) reported personal firearm possession, and 44.2% (95% CI, 40.2-48.2) endorsed firearm access. Teens experiencing DLHS had increased perceived access (adjusted odds ratio, 1.56; 95% CI, 1.07-2.28) compared with non-DLHS peers. There was no association between DLHS and personal firearm possession (adjusted odds ratio, 0.97; 95% CI, 0.47-2.00). Among teens reporting firearm possession, those with DLHS were more likely to have acquired it by buying/trading for it (odds ratio, 5.66; 95% CI, 1.17-27.37) and less likely receiving it as a gift (odds ratio, 0.06; 95% CI, 0.01-0.36).
Conclusions:
High school-aged teens experiencing DLHS have higher perceived firearm access compared with lower-risk peers. Providers should speak directly to high school-aged teens at increased suicide risk about firearm access, in addition to counseling parents.
Objective:
To examine risk factors related to death by suicide among Installation, Maintenance, and Repair (IMR) workers compared to workers in other occupational groups.
Methods:
National Violent Death Reporting System (NVDRS) data for the years 2013 to 2018 was used to identify suicide deaths. Circumstance variables were used to examine differences between IMR workers and other workers.
Results:
Having a physical health problem (1.13, 95% CI: 1.03-1.23) or diagnosis of post-traumatic stress disorder (1.24, 95% CI: 1.03-1.50) were more likely to contribute to IMR worker suicide compared to other occupations. IMR workers were less likely to receive treatment for a mental health diagnosis or substance use disorder (0.88, 95% CI: 0.81-0.94).
Conclusions:
Additional support for physical health problems, PTSD diagnoses, and mental health care access among IMR workers may reduce suicide deaths.
Guns are present in many households in the U.S., including those with children. Safe storage of guns at home can mitigate the increased risks of both the unintentional and intentional injury that in-home gun access presents; yet estimates suggest fewer than half of gun owners store their weapon(s) safely. Unsafe storage in homes with children is especially problematic given that gun-owning parents make incorrect assumptions about both children’s awareness of firearm storage locations, and their actions upon encountering an unsecured gun. There is limited identification and understanding of why some parents do not engage in safe storage practices. Using 2019 survey data from an internet-based sample of gun-owning adults with children at home, this study explores various potential correlates of unsafe storage. Findings suggest that unsafe storage occurs not in response to crime/victimization fears, but from broader, group- and status-based threats. Understanding the complex factors preventing gun-owning parents from implementing safe storage practices has important implications for both victimization scholarship and public health/injury prevention efforts.
Objective:
The presence of unlocked firearms in the home is associated with increased risk of suicide and unintentional injury in youth. We adapted an evidence-based program for promoting safe firearm storage, Safety Check, to enhance its acceptability as a universal suicide prevention strategy in pediatric primary care.
Methods:
We applied ADAPT-ITT, an established adaptation framework, to guide iterative program adaptation with ongoing input from key stakeholders. The present study describes two phases of ADAPT-ITT: the Production phase (generating adaptations) and the Topical Experts phase (gathering stakeholder feedback on adaptations). After generating proposed program adaptations based on three inputs (stakeholder feedback collected in a prior study, the behavioral science literature, and best practices in pediatric medicine), we elicited feedback from stakeholders with firearm expertise. The adaptations included changes such as clarifying firearm ownership will not be documented in the medical record and offering follow-up reminders. We also crowdsourced feedback from 337 parents to select a new name and program logo.
Results:
Saturation was reached with 9 stakeholders. Feedback confirmed the value of adaptations that: a) considered context (e.g., reason for ownership), b) promoted parent autonomy in decision-making, and c) ensured privacy. The most preferred program name was Suicide and Accident prevention through Family Education (SAFE) Firearm.
Conclusions:
Guided by an established adaptation framework that prioritized multi-stage stakeholder feedback, adaptations to the original Safety Check were deemed acceptable. We plan to test the SAFE Firearm program as a universal suicide prevention strategy in pediatric primary care via a hybrid effectiveness-implementation trial.
