PEDIATRICS Vol. 104 No. 5 November 1999, pp. 1059-1063

Firearms in the Home: Parental Perceptions

Mirna M. Farah, MD^*, Harold K. Simon, MD^*, and Arthur L. Kellermann, MD, MPh

From the ^* Department of Pediatrics, Division of Emergency Medicine, Egleston Children's Hospital, Emory University School of Medicine; and the  Department of Surgery and Medicine, Emory University School of Medicine and the Center for Injury Control, Rollins School of Public Health, Atlanta, Georgia.

	ABSTRACT

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Background.  Each year, thousands of children are injured or killed from unintentional gunshot wounds. Discovering a gun while playing in the home places children at risk of being injured by the firearm.

Objectives.  To determine parental firearm storage practices and parental perceptions of the behavior of their children around guns.

Methods.  Cross-sectional survey of parents of children from 4 to 12 years of age. A sample of 424 parents, bringing their children to one of five pediatric ambulatory care centers, were asked to complete a 20-point self-administered questionnaire at the time of their visit.

Results.  A total of 400 parents (94%) completed the questionnaire; 113 parents (28%) reported keeping a firearm (most often a handgun) in the home. Firearm owners were predominantly male, 30 years of age or older, white, and married. Of the gun owners, 52% stored their firearms loaded or unlocked, and 13% kept one or more guns loaded and unlocked. Three fourths of gun-owning parents believed that their 4- to 12-year-old child could tell the difference between a toy gun and a real gun, and 23% believed that their child could be trusted with a loaded gun. Although the majority of gun-owning parents (53%) endorsed safe storage as the best firearm injury prevention strategy, 61% of parents who do not own firearms endorse not owning guns as the best way to prevent pediatric firearm injuries.

Conclusion.  A majority of gun-owning parents store their firearms loaded or unlocked, substantially underestimating the risk of injury to their children. Many firearm-owning parents trust their child with a loaded gun and believe that their young child can tell the difference between a toy gun and a real gun.  Key words:  firearms, toy guns, children, unintentional injuries, storage.

Unintentional firearm injuries are a significant cause of morbidity and mortality among US children. Each year, ~500 children die from gunshot wounds inflicted unintentionally.^1,2 One third of these deaths involve children between 5 and 14 years of age. In this age group, unintentional firearm injury accounts for 20% of deaths from gunshot wounds.^1,2 Unfortunately, mortality is only the tip of the iceberg. For every child killed, a substantially greater number of children are injured seriously. Estimates of the ratio of nonfatal cases of unintentional gunshot injury to deaths range from 20:1 to 70:1.^3,4

The vast majority of unintentional shootings of children occur indoors.^4-9 The most common scenario involves an unsupervised boy, playing with friends or siblings, discovering a loaded handgun in the home.^4-7 The frequency and severity of unintended shootings of children has led the American Academy of Pediatrics and other groups to mount efforts to educate parents about the importance of securing their firearms or removing guns from the home entirely.^10-12

The need for parental education about firearm safety was underscored by a 1990 study conducted by Webster and colleagues.¹³ They surveyed a convenience sample of parents about their beliefs regarding child behavior around firearms. They reported that a majority of gun owners in Maryland believed that their child could tell the difference between a real gun and a toy gun by 6 years of age and that instructing their children not to play with guns is sufficient to prevent accidents. Nevertheless, these parents were generally amenable to their pediatrician's advice regarding firearm ownership and safe storage, but the vast majority of gun owners were not receptive to the idea of removing guns from the home.

To determine whether parental knowledge, attitudes, and self-reported behavior regarding guns have changed appreciably in the past 8 years, we surveyed parents of 4- to 12-year-old children at pediatric ambulatory care centers in Atlanta, Georgia. We were particularly interested in determining parental rates of gun ownership, patterns of firearm storage, and parental views about child behavior around guns.

	SUBJECTS AND METHODS

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The study was conducted in five pediatric ambulatory care centers located in northern suburban areas of Atlanta, Georgia. During 4 months in the fall of 1997, parents of 4- to 12-year-old children visiting one of these centers were approached and asked to complete a 20-point self-administered questionnaire at the time of the child's health care encounter. We developed the questionnaire with the help of a child psychologist (Table 1). One investigator (M.M.F.) distributed the questionnaires to all parents presenting to the centers during 40 randomly scheduled 12-hour blocks of time. Caregivers other than parents were excluded from the study.

Parents were informed that the survey was anonymous and that their answers would be kept confidential. They also were told that declining to participate in the study would not affect their child's treatment in any way. In a few instances, both parents accompanied their child. When this occurred, they completed the questionnaire together.

Completed questionnaires were placed in a box for data entry at a later time. To determine the rate of participation, questionnaires were numbered sequentially, and forms that were not found in the box were considered nonresponses. No effort was made to link the questionnaires with individual families. The Human Investigation Committee at our institution reviewed and approved the project.

After an initial series of questions to determine the age, gender, and race of the parents and their child, a series of questions solicited information about family firearm ownership and storage practices, the child's interest in real, as well as, toy guns, and parental perceptions of their child's physical and cognitive abilities around real guns.

Respondents were initially divided into two groups: those who keep one or more guns in the home and those who do not. Gun-owning parents were subdivided further into those who keep one or more unlocked or loaded guns in the home, and those who keep all guns unloaded and locked. Logistic regression was used to identify the characteristics of parents who own firearms, those who believe their child can tell the difference between a toy gun and a real gun, those who trust their child with a loaded gun, and those who think that their child would not touch a real gun if he or she found one. The logistic regression models included all the characteristics of the parents and children. A small number of participants declined to answer a particular question or stated that they did not know an answer. For the purposes of data analysis, cases with a missing value were excluded from logistic regression analyses.

	RESULTS

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Characteristics of the Respondents

Of the 424 parents who were asked to participate, 400 completed the questionnaire (95% response rate). The large majority of respondents (82%) were mothers with a mean age of 33 years. Of the respondents, 70% were married, and 92% had at least a high school diploma. Of the respondents, 48% were white, 47% were black, and 5% were members of other ethnic groups. Of the children addressed in the survey, 61% were boys, and 45% were <8 years of age.

Firearm Ownership

Of the respondents, 113 (28%) reported that one or more firearms are kept in their home. Of these households, 72% contain at least one handgun, and 48% contain at least one rifle. Fathers were more likely to report gun ownership than were mothers (48% vs 28%; P = .003). Parents 30 years of age or older and white parents were more likely to report firearm ownership than were younger parents and black parents (Table 2). Single-parent households, 94% of which were headed by the mother, were less likely to report firearm ownership than were 2-parent households. The parental level of education did not correlate with gun ownership. Less than half of the responding parents (43%) reported keeping toy guns in their homes. Of those who own a real firearm, 69% also own toy guns, compared with 34% of families who do not own a real firearm (P < .001).

Firearm Storage Practices

Less than half (48%) of gun-owning parents who responded to the survey reported storing all their firearms safely (ie, unloaded and locked), 52% keep one or more firearms stored unsafely (ie, either loaded or unlocked), 13% keep at least one firearm both loaded and unlocked (Fig 1). Handgun owners were 14 times more likely to report that they keep a firearm loaded and/or unlocked than were parents who own only long guns (P < .001). Handgun ownership and parental trust of children with loaded guns were the only characteristics that distinguished gun owners who store one or more firearms in an unsafe manner from those who do not.

View larger version (21K): [in this window] [in a new window]   Fig. 1.   Self-reported firearm storage by parents of children 4 to 12 years of age.

Parental Perceptions of Their Child's Behavior Around Guns

Seventeen percent of the parents reported that their child is interested in real guns. Perceived interest in real guns was higher among boys than among girls (23% vs 7%).

When asked whether they thought that their child could tell the difference between a toy gun and a real gun, 52% of non-gun-owning parents and 74% of gun-owning parents answered yes (Table 3). Fourteen percent of non-gun-owning parents, 23% of gun-owning parents, and 35% of parents who keep at least one firearm loaded reported that they trust their child with a loaded gun. Although the trust of the parents increased with the age of the child, 10% of non-gun-owning parents and 14% of gun-owning parents stated that they trust their 4- to 7-year-old child with a loaded gun. Gun ownership by the parent, child's age 8 years, and storage of a loaded firearm were the only variables associated significantly with increased trust of the child. Trust was not associated with the gender of the child or parent, parental age, parental level of education, or the interest of the child in real guns. Interestingly, parents were consistently less likely to trust other children with a loaded gun than their own child. The median age at which parents reported trusting their own child with a gun was 9 years. The median age at which parents reported trusting other children with a loaded gun was 21 years. Firearm owners believed that children could be trusted with a loaded gun at an earlier age compared with non-firearm owners (P = .03).

When asked what their child would do if he or she encountered a gun, 74% of parents said that he or she would not touch the gun or would tell an adult. Fewer than 1 parent in 5 thought that their child would play with the gun or shoot it. More firearm owners believed that their child would avoid real guns than did non-firearm owners (Table 3).

Sixty-one percent of non-gun owners, but only 26% of gun owners, agreed that the best way to prevent accidental shootings of children is to not own a gun (P < .001). Gun-owning parents were more likely to endorse safe storage and active parenting strategies such as education or close parental supervision rather than keeping firearms out of the home. Eighty-four percent of firearm owners and 65% of non-gun owners reported that they have discussed firearm safety with their child.

	DISCUSSION

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Many parents do not realize that children acquire the physical capacity to reach and discharge a firearm long before they acquire the cognitive ability to understand the potential consequences of these actions. As a result, children can shoot themselves, their friends, or their siblings without intending to cause harm. Recognition of this problem has led the American Academy of Pediatrics to recommend anticipatory guidance of parents to prevent firearm injuries. Included in this advice is: 1) store any firearms unloaded and securely locked with the ammunition stored and locked separately; or 2) remove firearms from the home if children are present. This advice is mirrored by experts in firearm injury prevention.^10-13

The prevalence of firearm ownership noted in our study is similar to that reported by Webster and colleagues¹³ in their 1990 study of suburban parents in Maryland (29% vs 27%, respectively). That study involved a convenience sample of 215 families from rural (40%), suburban (20%), and urban (40%) parts of the state. Striking differences were found between the perceptions of gun-owning and non-gun-owning parents about their child's and other children's ability to handle firearms safely. These findings highlighted the important role that pediatricians can play in educating families about firearm safety. Although the findings of Webster et al were noteworthy, they did not report the age of the children of survey respondents. The age of the child may influence a mother or father's estimate of the physical and cognitive capabilities of children in other age groups.

To overcome this problem, we surveyed parents from 400 families in the northern suburbs of Atlanta, Georgia. All our respondents had at least 1 child who was 4 to 12 years of age. Rather than asking respondents about all children, our questionnaire was directed toward the capabilities of their own child.

Our findings replicate those of Webster et al. They suggest strongly that many parents have an unrealistic view of their child's safety around guns. Three fourths of gun-owning parents reported that their 4- to 12-year-old child can tell the difference between a toy gun and a real gun. Of the gun-owning parents, 87% believe that their child would not touch a real gun if given the opportunity. Almost 1 in 4 parents reported that their 4- to 12-year old child could be trusted with a loaded gun. Those who reported trusting their child with a loaded gun were more likely to store one or more firearms loaded than those who did not report trusting their child with a loaded gun.

Experts in injury prevention and child development question this trust. Children are active explorers of their environment and may engage in risky behavior as part of personal and environmental exploration.¹⁴ Children also are exposed frequently to media, entertainment, and electronic games that portray shootings that do not result in death or permanent disability. To counter these effects, some groups believe that young children should be taught safe behavior around firearms. The core message of the National Rifle Association's Eddie Eagle Gun Safety Program is "Stop! Don't touch! Go tell a grownup." The wisdom of this message is clear enough, but there is no evidence that it alters the behavior of children. Hardy et al¹⁵ have reported that when young children are unsupervised, they frequently touch and play with real guns, even after clear and specific instructions not to do so.

Therefore, rather than relying on teaching children the principles of gun safety, pediatricians should concentrate on teaching their parents how to more reliably prevent firearm injuries. Anticipatory guidance is vital to give parents the information that they need to make smart choices for themselves and their children. In light of the fact that many gun owners (especially owners of handguns) acquire firearms primarily for protection, physicians should be prepared to discuss the true balance of benefits and risks that are associated with keeping a gun in the home.^916-20 Parents who insist on keeping guns in the home should be urged strongly to store their firearms unloaded and locked in a secure container. Measures like these have the potential to reduce unintentional shootings of children substantially.

Our study is limited in several aspects. Instead of obtaining a fully random sample of responses, we approached blocks of parents at different practices on randomly ordered shifts. We know of no reason why the responses of these parents would differ in any systematic way from all parents visiting these practices. Some parents may have withheld or misreported information about gun ownership because of social acceptability bias, but there is no reason to suspect that this was a problem. Although every parent had an opportunity to decline participation, to terminate participation at any time, or to refuse to answer a particular question, few chose to do so. In addition, surveys were completed and returned in an anonymous manner. The rates of gun ownership and the pattern of storage reported by our participants are similar to those reported by respondents to national surveys.^21,22

	CONCLUSION

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Despite the American Academy of Pediatrics' guidelines regarding safe firearm storage in homes with children, less than half of gun-owning parents who participated in our study reported storing their firearms safely. Many parents underestimate the risk of leaving their children in the home with an unlocked and loaded firearm. The gap between perception and reality is particularly great for gun-owning parents. More gun-owning parents trust their child with a loaded gun and believe that their young child can tell the difference between a toy gun and a real gun. Given the significant morbidity and mortality caused by firearms, our findings point to the pressing need for parental education about firearm safety and storage.

	ACKNOWLEDGMENTS

This study was supported in part by a grant from the Child Advocacy Center at Egleston Children's Hospital.

We thank the child psychologist Ann Hazzard, PhD; the director of the Office of Health Promotion Donna Jones, MD; and the statisticians Kevin Sullivan, PhD, and Huaqing Zhao for their tremendous efforts in the development of the questionnaire and the analysis of the data.

	FOOTNOTES

Received for publication Jul 16, 1998; accepted Apr 14, 1999.

Reprint requests to (M.M.F.) Children's Hospital of Philadelphia, Division of Emergency Medicine, 34th St and Civic Center Blvd, Philadelphia, PA 19104. E-mail: farah{at}email.chop.edu

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