pediatrics
September 2005, VOLUME116 /ISSUE 3

# Prevalence of Household Firearms and Firearm-Storage Practices in the 50 States and the District of Columbia: Findings From the Behavioral Risk Factor Surveillance System, 2002

1. Catherine A. Okoro, MS*,
2. David E. Nelson, MD, MPH*,
3. James A. Mercy, PhD,
4. Lina S. Balluz, ScD*,
5. Alex E. Crosby, MD, MPH,
1. *National Center for Chronic Disease Prevention and Health Promotion
2. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia

## Abstract

Objectives. To examine the prevalence of household firearms and firearm-storage practices in the 50 states and the District of Columbia and estimate the number of children exposed to unsafe storage practices.

Methods. We analyzed data from the 2002 cross-sectional Behavioral Risk Factor Surveillance System survey of 240735 adults from randomly selected households with telephones in the 50 states and the District of Columbia.

Conclusions. Substantial state variations exist in the prevalence of household firearms and firearm-storage practices. It is vital that surveillance systems such as the Behavioral Risk Factor Surveillance System continue to monitor the prevalence of household firearms and firearm-storage practices so that future interventions to promote safe storage of firearms can be evaluated and more widely implemented based on their efficacy.

• firearms
• children
• youth
• behavior
• risk taking
• telephone
• BRFSS

Firearm-related injuries remained the second leading cause of injury mortality in 2002, accounting for 30242 firearm-related deaths.1Of all firearm injury deaths, 56.6% were suicides, 39.1% were homicides, 2.5% were unintentional, and an additional 1.8% were legal interventions or of undetermined intent.1Furthermore, ∼1400 firearm deaths were among persons <18 years old.2In addition, for every firearm-related death, ∼4.6 persons in this same population received nonfatal firearm-related injuries.3In 1997, the estimated lifetime costs of medically treated gunshot injuries in the United States totaled $1.9 billion, of which$0.9 billion was paid by the US government.4

Unintentional injuries, suicide, and homicide among youth may happen because young persons are able to access an improperly stored household firearm.510Approximately 90% of fatal firearm incidents involving children occur within the home, and according to a study of children and youth aged 0 to 14 years by Wintemute et al8, 40% of firearm incidents involve a firearm stored in the room in which the shooting occurs. Miller et al7found that twice as many firearm deaths among children and youth <18 years old occur in states with the highest proportion of people living in households with loaded firearms. In addition, Grossman et al9reported that safe storage practices, including keeping firearms stored unloaded, locked, or separate from ammunition, are associated with significant reductions in the risk of unintentional injuries and suicides among children and youth. The National Rifle Association,11medical organizations,1215and public health agencies16,17all support safe firearm-storage practices in homes with children and youth. For example, the American Academy of Pediatrics recommends that if families must have firearms in their homes, the firearms should be stored locked, unloaded, and separate from locked ammunition.12Efforts to promote proper storage of firearms in homes may help reduce the risk of both fatal and nonfatal injury.6,7,9,10,16,1821

Despite the fact that national estimates on the prevalence of household firearms and their manner of storage are available,2123limited information exists regarding these estimates at the state level.22,2427Thus, the purposes of this study were threefold: to estimate (1) the prevalence of adults with household firearms and their firearm-storage practices at the state level; (2) the prevalence of loaded and of loaded and unlocked household firearms among adults with children and youth <18 years old at the state level; and (3) by state the number of children and youth exposed to these firearm-storage practices.

## METHODS

The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based surveillance system operated by state health departments in collaboration with the US Centers for Disease Control and Prevention. A detailed description of the survey methods used by BRFSS is available elsewhere.2830Briefly, the primary purpose of BRFSS is to provide state-specific estimates of behaviors that relate to the leading causes of morbidity and mortality in the United States. Trained interviewers collect data on a monthly basis by using an independent probability sample of households with telephones among the noninstitutionalized US population aged ≥18 years. Individual respondents are selected randomly from all adults living in a household. All BRFSS questionnaires and data are available on the Internet (www.cdc.gov/brfss). Because the BRFSS is a surveillance system, the Centers for Disease Control and Prevention's Institutional Review Board has determined that the BRFSS is exempt from its review.

In 2002, all 50 states and the District of Columbia participated, and 240735 persons aged ≥18 years completed the interview. Firearm-storage questions were added to the BRFSS for the first time in all 50 states and the District of Columbia in 2002. We limited our analyses to the 223819 BRFSS respondents (88928 men and 134891 women) who answered all survey questions on household firearms and who reported whether their households included children and youth <18 years old. Respondents were excluded if they had unknown responses or refused to answer the questions. The median response rate, based on the number of individuals actually reached by telephone, was 76.7% (range: 62.5% [in California] to 99.8% [in Minnesota]).31The more conservative response-rate formula based on Council of American Survey and Research Organizations' guidelines produced a median response rate of 58.3% (range: 42.2% [in New Jersey] to 82.6% [in Minnesota]).31

### Survey Questions and Definitions of Firearm-Storage Practices

The interviewer began the firearm section of the survey by first informing the respondent that “the next three questions are about firearms. We are asking these in a health survey because of our interest in firearm-related injuries. Please include weapons such as pistols, shotguns, and rifles; but not BB guns, starter pistols, or guns that cannot fire. Include those kept in a garage, outdoor storage area, or motor vehicle.” Presence of firearms in the home was assessed by asking the respondent, “Are any firearms kept in or around your home?” Firearm-storage patterns were derived from 2 questions: “Are any of these firearms now loaded?” and “Are any of these loaded firearms also unlocked? By ‘unlocked’ we mean you do not need a key or combination to get the gun or to fire it. We don't count a safety as a lock.” We created 3 firearm-storage pattern categories: “any household firearm” (yes/no), “loaded household firearm” (yes/no), and “loaded and unlocked household firearm” (yes/no). However, the state of California used a different set of firearm questions than the other states, and as a result, we were only able to create 2 categories for California: “any household firearm” and “loaded and unlocked household firearm.”

### Statistical Analyses

Both SAS (SAS Institute, Cary, NC) and SUDAAN (Research Triangle Institute, Research Triangle Park, NC) were used in all analyses to account for the complex sampling design and to calculate 95% confidence intervals (CIs). BRFSS data were directly weighted for the probability of selection of a telephone number, the number of adults in a household, and the number of telephones in a household. Finally, data were poststratified to adjust for nonresponse and noncoverage of households without telephones and to force the sum of the weighted frequencies to equal each state's adult population (ie, final weight). These data are representative of >200 million US adults in 2002 (117 million adults without children and youth <18 years old and 83 million adults with children and youth <18 years old). Data from all states are pooled to produce nationally representative estimates.

## RESULTS

Nationally, 32.6% (95% CI: 32.2–32.9%) of adults reported that firearms were kept in or around their home. The prevalence of adults with household firearms ranged from 5.2% in the District of Columbia to 62.8% in Wyoming (median: 40.8%) (Table 1).

TABLE 1.

Prevalence Estimates of Adults With Household Firearms, Loaded Household Firearms, and Loaded and Unlocked Household Firearms, 2002

The national prevalence of adults with loaded household firearms and with loaded and unlocked household firearms was 7.6% (95% CI: 7.5–7.8%) and 4.3% (95% CI: 4.2–4.5%), respectively. The prevalence of adults with loaded household firearms ranged from 1.6% in Hawaii, Massachusetts, and New Jersey to 19.2% in Alabama (median: 7.0%), and the prevalence of adults with loaded and unlocked household firearms ranged from 0.4% in Massachusetts to 12.7% in Alabama (median: 4.2%).

TABLE 2.

Prevalence Estimates of Loaded Household Firearms and Loaded and Unlocked Household Firearms Among Adults With Children and Youth <18 Years Old and the Estimated Number of Children and Youth Living With Loaded and Loaded and Unlocked Firearms, 2002

Although household firearms were less likely to be stored loaded or loaded and unlocked among adults with children and youth than among adults overall, an estimated 1692610 children and youth (95% CI: 1569320–1815910) in the United States were living in households with loaded and unlocked firearms (Table 2). The 6 states with >75000 children and youth living in households with loaded and unlocked firearms were Alabama, California, Florida, Georgia, North Carolina, and Texas.

## DISCUSSION

To our knowledge, this is one of the first studies to comprehensively examine both the prevalence of adults with household firearms and firearm-storage patterns at the state level. Our study findings are similar to national studies that have shown that, regardless of whether children and youth live in the home, approximately one third of US homes contain firearms.2123According to our study, during 2002, an estimated 33% of all adults lived in households with firearms, and an estimated 4% of adults lived in households with firearms stored in the least safe manner (ie, loaded and unlocked). Household firearms were less likely to be stored in an unsafe manner by adults with children and youth <18 years old; nonetheless, >1.6 million children lived in households with loaded and unlocked firearms.

We found substantial state variations in the prevalence of adults with household firearms, from 10% in Hawaii to 63% in Wyoming (the prevalence in the District of Columbia was 5%). Furthermore, among adults with children and youth, a >24-fold difference was found between Massachusetts and Alabama in the percentage of loaded and unlocked household firearms. Few national studies have reported population-based representative estimates of firearm-storage patterns. In a 1993 report, the US Department of Justice estimated that 49% of homes in the United States had household firearms,32a level of firearm ownership typically reported in the 1980s and early 1990s.23,33Using this national estimate and data from his study, Hemenway et al34estimated that 10% of US homes had a firearm that was currently loaded and unlocked; this finding is more than double our estimate using a more direct approach (4.3%). The difference between our estimates may be a result of a secular decline in the proportion of households that reported having firearms and, hence, the proportion of households that were likely to engage in unsafe storage practices. In addition, it is also possible that a proportion of the households that formerly stored firearms loaded and unlocked have since implemented safe storage practices in their homes.

These findings are consistent with an earlier BRFSS study conducted using 1991–1995 data from 21 states.26Specifically, Powell et al26reported that the prevalence of adults with household firearms ranged from 12% in New Jersey to 57% in Idaho. For these 21 states, our 2002 prevalence estimates ranged from 11% in New Jersey to 58% in West Virginia (Idaho: 57%). For 18 states, the authors reported that the prevalence of children living in households with a loaded firearm ranged from 2% in Connecticut and Delaware to 12% in Mississippi. For these same states, our prevalence estimates ranged from 1% in New Jersey to 11% in Mississippi.

Our study had some limitations. First, because BRFSS excludes households without telephones, our findings may have overestimated the prevalence of firearms in households, because low income is associated with both lack of telephone service and a lower prevalence of firearms.35Second, although the validity of self-reported firearm storage is not known, previous studies suggest that self-reports of firearm ownership are valid.36,37However, our findings represent self-reports of the presence of a household firearm, not firearm ownership. Nevertheless, the interviews were conducted with a randomly selected adult in the home. As a result, some participants may not have known about a firearm that was kept by another household member.3840For example, female respondents in particular have been shown to underreport firearms in the home. Likewise, female respondents who are aware of a household firearm kept by their spouse may be less likely to know how it is stored.38,39Thus, we may have underestimated firearm prevalence and unsafe storage practices in US households.

Our estimates on the prevalence of household firearms also lacked an appraisal of the types of firearms available (ie, handgun or long gun). For example, adults keeping a handgun for protection may be more apt to store it loaded, whereas adults keeping a rifle for sport may keep it locked and unloaded until needed.34,41,42The population characteristics of adults owning only a handgun may also differ from adults owning only a long gun. In addition, as mentioned previously, California used a different set of questions to assess both firearm prevalence and loaded and unlocked firearms. Thus, comparison of California's firearm prevalence estimates to that of the other 49 states and the District of Columbia should be done cautiously.

These results demonstrate the wide range of household firearm prevalence and storage of household firearms among the states, and we estimate that >1.6 million children live in homes with firearms stored in the least safe manner. A better understanding of firearm owners' attitudes, beliefs, and gun-storage behaviors is needed to effectively develop and evaluate community-based education programs that promote safe firearm storage.43In addition, there is an absence of direct empirical evidence on how firearm safety technologies (ie, locking, protection, sensor and tracking technology) impact injury.27These state-level prevalence estimates of household firearms and storage practices will permit future assessment of changes in the risk profile of US households as firearm safety technologies and strategies to encourage safe firearm storage are developed, implemented, and evaluated.22,27

Public health measures are needed to encourage the safe storage of household firearms. Such measures could include counseling of parents by primary care providers, especially pediatricians, regarding safe firearm storage.12,15,44However, although studies have shown that parents are open to screening and counseling about firearm storage and safety,5,45,46these services are rarely performed.47,48There is also conflicting evidence on the effectiveness of parental safe–firearm-storage counseling.5,45,46,49,50Other strategies to decrease child access to firearms in the home may include child-access–prevention laws, currently in place in 18 states, specifically designed to limit children's access to and use of firearms in the home18,51; safe firearm-storage–promotion programs52,53; and the provision of safety devices.43,54These and other measures may help reduce the number of children exposed to unsafe firearm-storage practices and, in turn, decrease the number of firearm-related injuries and deaths among children and youth. However, many of these prevention strategies have not been based on preliminary effectiveness data, nor have they been evaluated adequately, generally because of scant funding for evaluation of these programs.27It is crucial that firearm-injury-prevention programs incorporate evaluation into implementation efforts and that a sustained body of research be developed to study the effects of prevention programs on the rates of firearm-related morbidity and mortality.27

It is important to identify, implement, and evaluate effective methods to prevent firearm-related morbidity and mortality—from counseling youth and adults with depressive symptoms, to evaluating firearm safety technologies, to a variety of safe storage options. This is of utmost importance for the most vulnerable segments of our population—children and youth, persons with depressive symptoms, and those who have threatened suicide. Surveillance systems such as the BRFSS can be used to effectively monitor the prevalence of household firearms and firearm-storage practices so that future interventions to promote safe storage of firearms can be evaluated and more widely implemented based on their efficacy.

## Acknowledgments

We thank the state Behavioral Risk Factor Surveillance System coordinators for help in collecting the data used in this analysis; members of the Behavioral Surveillance Branch for assistance in developing the database; Henry Roberts, PhD, and Tara Strine, MPH, for statistical expertise; and Lynda Doll, PhD, for constructive review of this manuscript. We also thank 3 anonymous reviewers for insightful comments that contributed to the final version of this manuscript.

## Footnotes

• Accepted April 8, 2005.
• Address correspondence to Catherine A. Okoro, MS, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Mailstop K66, Atlanta, GA 30341. E-mail: cokoro{at}cdc.gov
• The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

No conflict of interest declared.

PEDIATRICS (ISSN 0031 4005). Published in the public domain by the American Academy of Pediatrics.

BRFSS, Behavioral Risk Factor Surveillance SystemCI, confidence interval