Abstract
OBJECTIVES: Access to firearms among youth can increase the risk of suicide or other injury. In this study, we sought to estimate the population prevalence of adolescent perception of firearm access by demographic, geographic, and other individual health characteristics.
METHODS: The 2019 Healthy Kids Colorado Survey was an anonymous survey administered to a representative sample of high school students in Colorado. The survey was used to assess health behaviors and risk and protective factors. Analysis was conducted with weights to the state population of public high school students.
RESULTS: In total, 46 537 high school students responded (71% student response rate; 83% school response rate). One in 5 students said it was “sort of easy” (11.1%) or “very easy” (8.8%) to access a handgun, with higher prevalence among male and older-aged youth and differences in racial and/or ethnicity groups. There were geographic differences such that students in schools in more rural areas were more likely to report perceived easy access. Students who had felt sad or hopeless, attempted suicide, or been in a fight were more likely to say they had access to a handgun.
CONCLUSIONS: A relatively high proportion of youth have easy access to a firearm, with differences across age, sex, race and/or ethnicity, and geography. This highlights the need for efforts to address ways to reduce firearm access for youth, including secure storage at home, for the prevention of youth firearm suicide and other firearm injuries.
- HKCS —
- Healthy Kids Colorado Survey
- YRBS —
- Youth Risk Behavior Survey
What’s Known on This Subject:
Suicide is a leading cause of death among adolescents, and firearms are implicated in a majority of those deaths. Safe storage of firearms can prevent adolescent suicide, homicide, and unintentional firearm injuries and deaths.
What This Study Adds:
In a representative sample of high school students in Colorado, 20% reported easy access to a handgun. Students with mental health concerns or who had been in a fight were more likely to say they could access a handgun.
Suicide is the second leading cause of death for adolescents aged 15 to 19 years,1 and firearms are the leading method of these deaths.2 Furthermore, adolescent suicide rates have increased 76% for adolescents aged 15 to 19 years from 2007 to 2017, with a 10% annual increase for each year from 2014 to 2017.3 Especially concerning is the rise in firearm suicide among Black youth, a group that for many years had lower suicide rates compared with white youth.4–6 Among those younger than age 13 years, Black youth are now twice as likely as white youth to die by suicide. Among adolescents aged 15 to 19 who die by suicide, 51% used a firearm, which is approximately the same for white and Black youth.6
Reducing firearm access is an evidence-based, recommended strategy to prevent suicide deaths, as well as to prevent other intentional or unintentional firearm injuries.7 In the United States, youth may have easy access to firearms in their homes: 1 in 3 adults has a gun in their home, and 2 in 10 of these gun owners keep at least 1 gun loaded and unlocked.8 Firearms located in the home are the most common source for youth access, but youth may also access firearms at the homes of relatives of friends9 or may obtain firearms illegally.10 Yet the lack of consistent national surveillance means relatively little is known about firearm access among adolescents. Existing evidence about home access and storage of firearms is largely about adults11,12 or specific adolescent subpopulations,13 such as those seen in emergency departments.10,14
The purpose with this study was to (1) examine the population prevalence of perception of handgun access among adolescents in Colorado and (2) explore individual and geographic characteristics, as well as related health factors, associated with perceptions of handgun access. Understanding youth perceptions about ease of access has implication for injury prevention efforts related to reducing legal or illegal firearm access.
Methods
Participants and Procedures
Data were from the Healthy Kids Colorado Survey (HKCS), a biennial cross-sectional survey of Colorado public high school students. Schools were sampled and the survey was administered consistent with methods for Centers for Disease Control and Prevention Youth Risk Behavior Survey (YRBS).15 The HKCS sampling used a 2-stage stratified cluster design by using a sampling frame of all public high schools in Colorado.
The survey was self-administered in classrooms during a regular class period by using either a machine-scannable paper booklet or online, with mode of administration determined by the school. Teachers oversaw survey administration and were directed to read a script and show a short video providing instructions for students. Teachers were instructed not to circulate the room while students were completing the survey so that they could not see student responses. Participation was voluntary and approved by parents; no identifying information was collected from students. The study was approved by the Colorado Multiple Institutional Board.
Measures
The HKCS instrument consists primarily of questions from the YRBS, with additional questions added for Colorado from validated sources. There are 2 modules, consisting of a total of 123 and 126 questions. Because firearm access is a risk factor for suicide,16 the 2019 HKCS administration include a single new question: “If you wanted to get a handgun, how easy would it be for you to get one?” (response options: very hard, sort of hard, sort of easy, and very easy). For ease of presentation and analysis, we combined sort of easy and very easy.
Students were asked about their mental health with the YRBS question “during the past 12 months, did you ever feel so sad or hopeless almost every day for 2 weeks or more in a row that you stopped doing some usual activities?” with response options of yes or no. Students were also asked, “during the past 12 months, how many times did you actually attempt suicide?” and collapsed responses of 1 time and >1 vs 0 times. Physical fighting was assessed with the question “during the past 12 months, how many times were you in a physical fight?” and collapsed responses of 1 time and >1 vs 0 times.
Students were asked about demographic characteristics, including their sex, grade level in school, race and/or ethnicity, sexual orientation, gender identity, and highest level of their mother’s education. Schools were characterized as urban, suburban, and rural on the basis of classifications from the National Center of Education Statistics.
Analysis
Students were weighted to state enrollment in public high schools. The weights accounted for sampling design, school and student nonparticipation and nonresponse, and discrepancies in grade, sex, and race and/or ethnicity between the sample and the population. For analysis, we examined student characteristics among responding and nonresponding schools and found comparable distributions of sex and grade (Supplemental Table 3). Although the distribution of race and/or ethnicity differed between responding and nonresponding schools, there was no evidence of systematic differences. Among responding schools, ∼5% more were in urban areas versus nonresponding schools, and nonresponding schools tended to have lower student enrollment.
We conducted analyses in SAS (SAS Institute, Inc, Cary, NC) using design and poststratification weights to represent Colorado public high school enrollment. First, we examined weighted prevalence of perceived handgun access by student demographic characteristics and school location using the Rao-Scott χ2 test.17 We then examined perceived handgun access by indicators of suicidality or violence, adjusting for demographic and school characteristics.
Results
In total, 46 537 high school students responded (71% student response rate; 83% school response rate). In weighted analysis, students reported it was very hard (60.6%), sort of hard (19.4%), sort of easy (11.1%), and very easy (8.8%) to get a handgun, totaling 20.0% reporting ease of access (collapsing easy or very easy).
Observed differences among demographic groups included that more male than female high school students reported ease of access to a handgun, and there was an increasing prevalence of perceived access by grade (Table 1). There was no significant difference in reported ease of access to firearms by sexual orientation, and a significantly higher proportion of transgender youth (compared with cisgender youth) reported easy access to a handgun.
Description of the Overall HKCS Sample and the Weighted Prevalence of Colorado High School Students Who Perceived it Was Very Easy or Sort of Easy to Get a Handgun by Demographic Factors (Weighted N = 209 036; Unweighted N = 41 067)
By race and/or ethnicity, reported ease of access was highest among Native American (23.8%) and multiracial students (23.3%), followed by white students (21.3%); reported prevalence was significantly higher in these groups than among Hispanic (18.2%), Black or African American (16.9%), or Asian American students (12.2%). Perceived ease of handgun access was lowest among Asian American students, which was significantly lower than all other groups (Table 1).
Reported handgun access varied by reported level of maternal education, with the highest prevalence among those who reported their mother completed some college, which was significantly higher than the other 2 categories of less education or more education. There was also a significant difference by geography, with perceived access highest in rural areas, followed by suburban and then urban areas.
In Table 2, we present the prevalence of perceived access to a firearm by feeling sad or hopeless for ≥2 weeks, having attempted suicide in the past 12 months, and having been in a physical fight in the past 12 months. Students were significantly more likely to report easy handgun access if they felt sad or hopeless almost every day for 2 weeks (24.2%), had attempted suicide (30.1%), or had been in a physical fight in the past 12 months (31.8%; Table 2). For example, among the 7.6% (weighted n = 15 058) of high school students who reported attempting suicide in the past 12 months, 30.1% reported easy access to a handgun. After adjusting for individual and school characteristics presented in Table 1, there was a significant association between feeling sad or hopeless, having attempted suicide, and having been in a physical fight and perceived easy access to a handgun. Students who attempted suicide in the past 12 months were 1.83 times as likely to report easy access to a handgun, and students who had been in a physical fight were 2.21 times as likely to report access to a handgun.
The Weighted Prevalence of Colorado High School Students With Mental Health Concerns or Fighting Involvement and the Relationship Between Mental Health and Fighting Involvement Indicators and Perceptions That it is Very Easy or Sort of Easy to Get a Handgun (Past 12 Months)
Discussion
Efforts to estimate youth access to firearms are infrequent and inconsistent despite firearms representing a major source of mortality for adolescents.18 In this population-based study, 1 in 5 public high school students in Colorado reported easy access to a handgun. There was higher perceived ease of handgun access among male and older adolescents, consistent with firearm suicide fatality rates and overall firearm fatality rates.2 Given the increased risk of suicidal despair among lesbian, gay, bisexual, and transgender students identified in previous studies,19–21 the reported ease of handgun access observed among the transgender students in this study is particularly troubling.
In addition to differences by demographic characteristics, the most striking difference was that those youth at greater risk of harm to themselves or others were significantly more likely to report perceptions of easy access. This may reflect a more accurate perception of access, increasing the prevalence of easy access to >1 in 5 youth, or perhaps the increased perception of access among those at risk may reflect a greater willingness to contemplate accessing a firearm. In future research, researchers should seek to validate self-reports of firearm access with methods such as parental reports or home audits.
Reducing access to lethal means of suicide, such as access to firearms, is an evidence-based strategy to prevent suicide.22–24 Prevention approaches that address the risk and protective factors related to suicide, including reducing the accessibility of firearms for those at risk for suicide, have the potential to reduce suicide rates at the population level.25 Raising awareness about suicide risk factors and secure firearm storage as part of suicide prevention will be particularly important for firearm-owning parents. A newly released joint effort from the National Shooting Sports Foundation (trade association for the firearms industry) and American Foundation for Suicide Prevention may help fill this need.26 Engagement of firearm owners and organizations in the development of materials for parents may increase the credibility of the messaging and likelihood of actions to secure storage.25 Pediatricians and other health care providers also have a role to play, given evidence that provider-delivered counseling to parents about reducing firearm access for suicidal youth may result in changes in home storage.27,28
Firearms may also be accessible to youth outside of their own home. This may include other homes where they spend time (eg, legally owned firearms belonging to neighbors, relatives, or friends) or avenues for illegal firearm acquisition or access.9,10,29 In a rural county in Colorado, a broad coalition of law enforcement, public health professionals, schools, and other community services recently initiated a program targeting firearm theft as an avenue for youth firearm access, as well as promoting responsible, safe storage of firearms; encouraging youth reporting of guns at schools; and working with youth in the criminal justice system.29 Within urban areas, multifaceted strategies are necessary, such as reducing the diversion of firearms, improving relations between police officers and communities of color, and changing social norms related to firearms and violence.30
Limitations
A limitation of this study was that students were not asked where the handgun was located, such as where within a home or even if it was in the child’s home or another location. The specifics of the firearm location, as well as attempts to access a firearm, should be explored in future research. Given the question asked about perception of access, the adolescent may have an accurate or inaccurate perception of actual ease of access for firearms. In future studies, researchers should validate the accuracy of firearm availability and access.
Conclusions
These findings highlight the common perception among high school students in Colorado that it is relatively easy to access a handgun. This perception, combined with the high prevalence of feeling sad or depressed and suicide attempts, is concerning for the safety of adolescents. We can use these findings to inform strategies to educate parents on the importance of secure home firearm storage, particularly if an adolescent is at risk for suicide.
Footnotes
- Accepted January 6, 2021.
- Address correspondence to Ashley Brooks-Russell, PhD, MPH, Department of Community and Behavioral Health and Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO 80045. E-mail: ashley.brooks-russell{at}cuanschutz.edu
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: Data used for this study were collected under contracts with the Colorado Department of Public Health and Environment (Brooks-Russell, principal investigator).
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
References
- Copyright © 2021 by the American Academy of Pediatrics
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