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

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.^28–30Briefly, 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

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).

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%).

Nationally, among adults with children and youth <18 years old, 5.5% (95% CI: 5.3–5.8%) reported having loaded household firearms and 2.5% (95% CI: 2.3–2.6%) reported having loaded and unlocked household firearms. Among adults with children and youth, the prevalence of loaded household firearms ranged from 1.0% in Massachusetts to 13.4% in Alabama (median: 5.3%), and the prevalence of loaded and unlocked household firearms ranged from 0.3% in Massachusetts to 7.3% in Alabama (median: 2.3%) (Table 2). In 7 states (Alabama, Alaska, Arkansas, Georgia, Louisiana, Mississippi, and Montana), the prevalence of loaded household firearms among adults with children and youth was ≥10%; in 6 states (Alabama, Alaska, Arkansas, Idaho, Montana, and Wyoming), the prevalence of loaded and unlocked household firearms among adults with children and youth was >5%.

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.^21–23According 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.^38–40For 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.^{5,45,46,49,50}Other 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 home^18,51; safe firearm-storage–promotion programs^52,53; 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.