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HomeMy WebLinkAbout231-25 RESOLUTION Page 1 113 West Mountain Street Fayetteville, AR 72701 (479) 575-8323 Resolution: 231-25 File Number: 2025-1761 A RESOLUTION TO ENCOURAGE SECURE FIREARM STORAGE AND GUN SAFETY AWARENESS FOR ALL RESIDENTS WHEREAS, evidence strongly suggests that secure firearm storage is an essential component to any effective strategy to keep schools and students safe; and WHEREAS, an estimated 4.6 million American children live in households with at least one loaded, unlocked firearm; and WHEREAS, every year, roughly 350 children under the age of 18 unintentionally shoot themselves or someone else, that’s nearly one unintentional shooting per day, and 70 percent of these incidents take place inside a home; and WHEREAS, another 1,200 children and teens die by gun suicide each year, most often using guns belonging to a family member and among children ages 1 – 17 years old, firearms have been the leading cause of death in Arkansas; and WHEREAS, research shows that secure firearm storage practices are associated with up to an 85 percent reduction in the risk of self-inflicted and unintentional firearm injuries among children and teens; and WHEREAS, the U.S. Secret Service National Threat Assessment Center recommends the importance of appropriate storage of firearms because 76 percent of school shooters used firearms acquired from the homes of parents or close relatives; and WHEREAS, across the country, lawmakers, community members, and local leaders are working together to implement public awareness campaigns, such as the BE SMART program, which is endorsed by the National PTA and which encourages secure gun storage practices and highlights the public safety risks of unsecured guns; and WHEREAS, school districts across the country have begun to proactively send materials home to parents and guardians informing them of applicable firearm storage laws and firearm secure storage best practices; and WHEREAS, in order to continue with preventative measures to increase community safety we must promote safe gun storage education in the City of Fayetteville. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE, ARKANSAS: Section 1: That the City Council of the City of Fayetteville, Arkansas is committed to Safe Gun Storage Education in the City of Fayetteville and encourages agencies throughout the City of Fayetteville to collaborate with local law enforcement agencies, health agencies, and non-profits to inform parents and guardians about secure storage of Resolution: 231-25 File Number: 2025-1761 Page 2 firearms in their homes. Section 2: That the City Council of the City of Fayetteville, Arkansas encourages community organizations, youth groups, non-profits, and pertinent local agencies to create an appropriate letter, in English and Spanish, to parents and guardians that explains the importance of secure gun storage in preventing minors from accessing guns, and that the best practice for secure gun storage is to keep all guns unloaded, locked up, and separate from ammunition. PASSED and APPROVED on October 7, 2025 Approved: _______________________________ Molly Rawn, Mayor Attest: _______________________________ Kara Paxton, City Clerk Treasurer Mailing address: 113 W. Mountain Street Fayetteville, AR 72701 www.fayetteville-ar.gov CITY COUNCIL MEMO 2025-1761 MEETING OF OCTOBER 7, 2025 TO: Mayor Rawn and City Council THRU: Kara Paxton, City Clerk Treasurer FROM: Chanci Fondren, Deputy City Clerk - Codifier SUBJECT: Approve a resolution for the City of Fayetteville, Arkansas to encourage Safe Gun Storage Education. RECOMMENDATION: Staff recommends approval of the attached Secure Firearm Storage Notification Resolution to encourage gun safety and awareness for all residents. BACKGROUND: This issue was brought forward to the Fayetteville Youth Advisory Council by the Students Demand Action Club at Fayetteville High School. The Fayetteville Youth Advisory Council felt this was a pertinent issue to the youth and voted to bring the item forward to City Council with a vote of 6-0. DISCUSSION: The resolution would allow for the City of Fayetteville to commit to Safe Gun Storage Education and encourage agencies throughout the City of Fayetteville to collaborate on safe gun storage education. BUDGET/STAFF IMPACT: N/A ATTACHMENTS: 3. Staff Review Form, 4. Fayetteville Youth Adivsory Council - Forwarded & Approved Legislation Text, 5. Additional Information - Safe Storage Research Page 1 City of Fayetteville, Arkansas Legislation Text 113 West Mountain Street Fayetteville, AR 72701 (479) 575-8323 File #: 2025-1761 A RESOLUTION TO ENCOURAGE SECURE FIREARM STORAGE AND GUN SAFETY AWARENESS FOR ALL RESIDENTS WHEREAS, evidence strongly suggests that secure firearm storage is an essential component to any effective strategy to keep schools and students safe; and WHEREAS, an estimated 4.6 million American children live in households with at least one loaded, unlocked firearm; and WHEREAS, every year, roughly 350 children under the age of 18 unintentionally shoot themselves or someone else, that’s nearly one unintentional shooting per day, and 70 percent of these incidents take place inside a home; and WHEREAS, another 1,200 children and teens die by gun suicide each year, most often using guns belonging to a family member and among children ages 1 – 17 years old, firearms have been the leading cause of death in Arkansas; and WHEREAS, research shows that secure firearm storage practices are associated with up to an 85 percent reduction in the risk of self-inflicted and unintentional firearm injuries among children and teens; and WHEREAS, the U.S. Secret Service National Threat Assessment Center recommends the importance of appropriate storage of firearms because 76 percent of school shooters used firearms acquired from the homes of parents or close relatives; and WHEREAS, across the country, lawmakers, community members, and local leaders are working together to implement public awareness campaigns, such as the BE SMART program, which is endorsed by the National PTA and which encourages secure gun storage practices and highlights the public safety risks of unsecured guns; and WHEREAS, school districts across the country have begun to proactively send materials home to parents and guardians informing them of applicable firearm storage laws and firearm secure storage best practices; and WHEREAS, in order to continue with preventative measures to increase community safety we must promote safe gun storage education in the City of Fayetteville. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE, ARKANSAS: Resolution: 231-25 File Number: 2025-1761 Page 2 Section 1: That the City Council of the City of Fayetteville, Arkansas is committed to Safe Gun Storage Education in the City of Fayetteville and encourages agencies throughout the City of Fayetteville to collaborate with local law enforcement agencies, health agencies, and non-profits to inform parents and guardians about secure storage of firearms in their homes. Section 2: That the City Council of the City of Fayetteville, Arkansas encourages community organizations, youth groups, non-profits, and pertinent local agencies to create an appropriate letter, in English and Spanish, to parents and guardians that explains the importance of secure gun storage in preventing minors from accessing guns, and that the best practice for secure gun storage is to keep all guns unloaded, locked up, and separate from ammunition. City of Fayetteville Staff Review Form 2025-1761 Item ID 10/7/2025 City Council Meeting Date - Agenda Item Only N/A for Non-Agenda Item Chanci Fondren 9/5/2025 CITY CLERK (051) Submitted By Submitted Date Division / Department Action Recommendation: Staff recommends approval of a resolution for the City of Fayetteville, Arkansas to encourage Safe Gun Storage Education. Budget Impact: Account Number Fund Project Number Project Title Budgeted Item?No Total Amended Budget $- Expenses (Actual+Encum)$- Available Budget $- Does item have a direct cost?No Item Cost $- Is a Budget Adjustment attached?No Budget Adjustment $- Remaining Budget $- V20221130 Purchase Order Number:Previous Ordinance or Resolution # Change Order Number:Approval Date: Original Contract Number: Comments: CITY OF FAYETTEVILLE SECURE FIREARM STORAGE NOTIFICATION RESOLUTION TO ENCOURAGE GUN SAFETY AND AWARENESS FOR ALL RESIDENTS WHEREAS, evidence strongly suggests that secure firearm storage is an essential component to any effective strategy to keep communities safe; and WHEREAS, an estimated 4.6 million American children live in households with at least one loaded, unlocked firearm; and WHEREAS, every year, roughly 350 children under the age of 18 unintentionally shoot themselves or someone else, that’s nearly one unintentional shooting per day, and 70 percent of these incidents take place inside a home; and WHEREAS, another 1,200 children and teens die by gun suicide each year, most often using guns belonging to a family member and among children ages 1 – 17 years old, firearms have been the leading cause of death in Arkansas; and WHEREAS, research shows that secure firearm storage practices are associated with up to an 85 percent reduction in the risk of self-inflicted and unintentional firearm injuries among children and teens; and WHEREAS, the U.S. Secret Service National Threat Assessment Center recommends the importance of appropriate storage of firearms because 76 percent of school shooters used firearms acquired from the homes of parents or close relatives; and WHEREAS, across the country, lawmakers, community members, and local leaders are working together to implement public awareness campaigns such as the BE SMART program which encourages secure gun storage practices and highlights the public safety risks of unsecured guns; and WHEREAS, school districts across the country have begun to proactively send materials home to parents and guardians informing them of applicable firearm storage laws and firearm secure storage best practices; and WHEREAS, in order to continue with preventative measures to increase community safety we must promote safe gun storage education in the City of Fayetteville. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE, ARKANSAS: Section 1: That the City Council of the City of Fayetteville, Arkansas is committed to Safe Gun Storage Education in the City of Fayetteville and encourages agencies throughout the City of Fayetteville to collaborate with local law enforcement agencies, health agencies, and non-profits to inform parents and guardians about secure storage of firearms in their homes. Section 2: That the City Council of the City of Fayetteville, Arkansas encourages community organizations, youth groups, non-profits, and pertinent local agencies to create an appropriate letter, in English and Spanish, to parents and guardians that explains the importance of secure gun storage in preventing minors from accessing guns, and that the best practice for secure gun storage is to keep all guns unloaded, locked up, and separate from ammunition. Additional Information Received Date Received: MM/DD/YYYY Time: 00:00 (AM/PM) From: Name & Title To: Name & Title Agenda Meeting Date: MM/DD/YYYY Civic Clerk Number: Ex. 2025-994 Forwarded to City Attorney’s Office and Department Head Fayetteville Youth Advisory Council 4:30 PM City Council 09/30/2025 Agenda Session Handout 09/30/2025 2025-1761 Home (/) News & advocacy (/news) Press room (/news/press) Press releases (/news/press/releases) 2024 (/news/press/releases/2024) Date created: February 29, 2024 APA adopts resolution on secure firearms storage to prevent suicides Notes effectiveness of placing time, distance between individuals and firearms to save lives WASHINGTON — The American Psychological Association has taken a significant step toward addressing the public health crisis of suicide by adopting a resolution calling for secure firearms storage (/about/policy/firearm- safety-prevent-suicide) . Recognizing the urgent need to address the high prevalence of firearm-related suicides in the United States, APA’s governing Council of Representatives approved, by a vote of 157-6, a resolution aimed at promoting secure firearms storage practices. This resolution underscores the critical role psychologists and health care providers can have in preventing suicides (/topics/suicide) by advocating for secure firearm storage and safety strategies. Firearms were used in 54.6% of suicides in 2022, according to the Centers for Disease Control and Prevention. Moreover, 72% of suicides completed by veterans in 2021 were attributed to firearms, according to the resolution. The measure emphasizes the effectiveness of actions such as the voluntary secure storage of firearms during a mental health crisis, highlighting research indicating that such steps can prevent suicides by creating time and distance between individuals and lethal means. 2/12/25, 11:43 AM APA adopts resolution on secure firearms storage to prevent suicides https://www.apa.org/print-this?url=https://www.apa.org/news/press/releases/2024/02/securing-firearms-storage-prevent-suicides 1/2 Find this article at: https://www.apa.org /news/press/releases/2024/02/securing-firearms-storage-prevent- suicides “The adoption of this resolution reflects APA’s commitment to addressing the complex issue of suicide prevention,” said APA President Cynthia de las Fuentes, PhD. “By promoting the knowledge of secure firearms storage practices and increasing awareness of lethal means safety, we can save lives and make meaningful progress in reducing suicide rates.” The resolution also advocates for increased funding at federal, state and local levels to support initiatives aimed at preventing suicides through secure firearms storage practices. And it calls on psychologists, health care professionals, policymakers and the public to support efforts to implement evidence-based strategies outlined in the resolution to prevent suicides and promote mental health and safety in communities across the nation. Finally, it encourages graduate clinical and counseling psychology programs and continuing education programs to train psychology students, psychologists and other public health providers in secure firearms storage strategies to prevent suicide. 2/12/25, 11:43 AM APA adopts resolution on secure firearms storage to prevent suicides https://www.apa.org/print-this?url=https://www.apa.org/news/press/releases/2024/02/securing-firearms-storage-prevent-suicides 2/2 Effectiveness of Interventions to Promote Safe Firearm Storage Ali Rowhani-Rahbar*, Joseph A. Simonetti, and Frederick P. Rivara *Correspondence to Dr. Ali Rowhani-Rahbar, Box 357236, Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195 (e-mail: rowhani@uw.edu). Accepted for publication July 27, 2015. Despite supportive evidence for an association between safe firearm storage and lower risk of firearm injury, the effectiveness of interventions that promote such practices remains unclear. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, we conducted a systematic review of ran- domized and quasi-experimental controlled studies of safe firearm storage interventions using a prespecified search of 9 electronic databases with no restrictions on language, year, or location from inception through May 27, 2015. Studyselection and data extraction were independently performed by 2 investigators. The Cochrane Col- laboration’s domain-specific tool for assessing risk of bias was used to evaluate the quality of included studies. Sevenclinic- andcommunity-based studies publishedin 2000–2012 usingcounseling with or without safety device provision met the inclusion criteria. All 3 studiesthat provided a safety device significantly improved firearm storage practices, while 3 of 4 studies that provided no safety device failed to show an effect. Heterogeneity of studies pre- cluded conducting a meta-analysis. We discuss methodological considerations, gaps in the literature, and recom- mendations forconducting future studies. Although additional studies are needed, the totalityof evidence suggests that counseling augmented by device provision can effectively encourage individuals to store their firearms safely. firearms; program evaluation; safety Abbreviations: DVRO, domestic violence restraining order; IPH, intimate partner homicide; IPV, intimate partner violence. INTRODUCTION According to the Centers for Disease Control and Preven- tion, about 118,000 Americans including 18,000 individuals younger than 20 years of age sustained fatal or nonfatal fire- arm injuries in 2013 (1). Such injuries lead to substantial mortality, psychological and physical morbidity, and high costs resulting from medical expenses, reduced productivity, and diminished quality of life (2–7). Gun ownership is an in- dependent risk factor for firearm injury (8–16), and estimates indicate that guns are present in about one third of US house- holds (17,18). However, only a few interventions aimed at limiting firearmownershiphavebeentested(19–21),andsuch prevention strategies remain socially and politically conten- tious.Somestudieshavealsosuggestedthatgunownersprefer not to be asked to remove firearms from their homes (22,23). Notably, more than one half of US households store a gun unlocked and/or loaded (17,24), which provides an opportu- nity topursue otherstrategiesto prevent firearm injuries. Safe storage, including methods such as keeping guns unloaded, locked, and separate from locked ammunition, has been widely endorsed as a firearm injury prevention strategy by medical professional societies(25–27).Several firearm advocacy orga- nizations have also encouraged some form of safety practices as an integral element of responsible gun ownership (28–30). Importantly, adult patients and parents of pediatric patients do not seem to be bothered by conversations about guns (22,23, 31), and the concept of safe firearm storage has enjoyed broad public support (32). Case-control and cross-sectional studies among children and adults have consistentlyshown a lower riskof self-inflicted firearm injuries and deaths in households that practice safe storage compared with those in which guns are stored un- locked and/or loaded (9–11,13,15,33,34), although some of those studies were limited by insufficient statistical power (9,10,34). In addition, a study of a nationally representative sample of suicide decedents found that individuals living in households with safe storage practices were less likely to commit suicide using a firearm (35). This finding is notable because of the importance of specifically preventing firearm- related suicide attempts since the case fatalityof those (85%) isgreaterthanthatofothermethodssuchassuffocation(69%) 111 Epidemiol Rev 2016;38:111–124 Epidemiologic Reviews © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Vol. 38, 2016 DOI: 10.1093/epirev/mxv006 Advance Access publication: January 13, 2016 Do w n l o a d e d f r o m h t t p s : / / a c a d e m i c . o u p . c o m / e p i r e v / a r t i c l e / 3 8 / 1 / 1 1 1 / 2 7 5 4 8 6 2 b y U n i v e r s i t y o f A r k a n s a s L i b r a r i e s u s e r o n 1 2 F e b r u a r y 2 0 2 5 or poisoning (2%) (36). Given that suicide attempts are com- monly impulsive acts (37,38), safe firearm storage may miti- gatetheriskoffatalself-harmbyreducingimmediateaccessto lethal means. Our knowledge on the association between safe firearm storage practices and risk of unintentional or assault- related firearm injuries is somewhat limited. Nonetheless, a few studies have indeed observed a lower risk of uninten- tional and assault-related firearm injuries among individuals living in households that practice safe firearm storage (13, 14,39). Several community- or clinic-based interventions have been conducted to promote safe firearm storage practices. A systematic review of such interventions that included 1 ran- domizedcontrolledtrialand6before-afterorafter-onlystudies was published in 2003 and found that 4 of 7 studies demon- strated effectiveness in improving household firearm storage practices (40). Considering methodological limitations of included studies, the authors concluded that it was not clear what types of interventions or which specific components of those may encourage gun owners to securely store their fire- arms(40).Wesoughttosystematicallyreviewallrandomized and quasi-experimental controlled studies that tested the effectiveness of community- or clinic-based safe firearm storage interventions. METHODS Data sources and search strategy ThePreferredReportingItemsforSystematicReviewsand Meta-Analyses (PRISMA) guidelines (41) were followed in the conduct and reporting of this systematic review. A broad search strategy was used to encompass the full range of safe firearm interventions. Published studies were identified and cross-checked by 2 reviewers (A.R.R. and J.A.S.) through a systematicsearchofthePubMed,CochraneLibrary,Embase, Web of Science, PsycINFO, Scopus, Cumulative Index to Nursing and Allied Health Literature, Campbell Collabora- tion, and Education Resources Information Center databases. Using prespecified terms, we conducted electronic searches from inception through May 27, 2015, with no restrictions on language or setting (Web Appendix 1 and Web Table 1 Records Identified Through Database Searching (n = 5,477) Records After Duplicates Removed (n = 4,111) Records Screened (n = 160)Excluded (n = 142) Full-Text Articles Assessed for Eligibility (n = 18) Excluded (n = 11) Before-after or after-only design without a control group (n = 10) No firearm storage component (n = 3) Studies Included in Qualitative Synthesis (n = 7) Figure 1.Flow diagram for identification, screening, and selection process of studies published in 2000–2012 and included in this review. Study selection was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. For excluded studies, the subtotals exceed the total number because of overlapping features of studies. 112 Rowhani-Rahbar et al. Epidemiol Rev 2016;38:111–124 Do w n l o a d e d f r o m h t t p s : / / a c a d e m i c . o u p . c o m / e p i r e v / a r t i c l e / 3 8 / 1 / 1 1 1 / 2 7 5 4 8 6 2 b y U n i v e r s i t y o f A r k a n s a s L i b r a r i e s u s e r o n 1 2 F e b r u a r y 2 0 2 5 available at http://aje.oxfordjournals.org/). Citations of iden- tified papers and reviews were then hand searched to identify eligible records to supplement the electronic searches. Study selection The following eligibility criteria were used to select stud- ies: 1) The study used a randomized or quasi-experimental controlled design; 2) the intervention included a component that promoted safe firearm storage by any means; and 3) the outcome included a measurable firearm storage practice such as keeping guns locked, storing guns unloaded, keeping am- munition locked, and/or storing ammunition in a separate lo- cation from guns. A “secure gun storage or safety device”is defined under 18 USC §921(a)(34) as 1) a device that, when installed on a firearm, is designed to prevent the firearm from beingoperatedwithout firstdeactivatingthedevice(e.g.,trig- ger lock, cable lock); 2) a device incorporated into the design of the firearm that is designed to prevent the operation of the firearm by anyone not having access to the device; or 3) a safe, gun safe, gun case, lockbox, or other device that is de- signed to be or can be used to store a firearm and that is de- signedtobeunlocked onlybymeans ofakey,acombination, orothersimilarmeans(42).Studiesthatusedabefore-afteror after-only design without a control group were excluded. Identified records were first assessed for eligibility on the basis of title and abstract. Full manuscripts of potentially eligible abstracts and articles were then evaluated to deter- mine whether the inclusion criteria were met. Study selec- tion was performed independently by 2 reviewers (A.R.R. and J.A.S.). Data extraction and study quality assessment By use of a prespecified data extraction form, detailed information from all studies that met the inclusion criteria was collected and characterized largely in accord with the Cochrane Handbook for Systematic Reviews of Interventions (43) with the following items: 1) authors; 2) year of publica- tion; 3) design; 4) unit of intervention; 5) setting; 6) popula- tion; 7) experimental intervention; 8) control intervention; 9) duration of follow-up; 10) outcomes; 11)findings; and 12) key conclusions. We evaluated the quality of studies on the basis of the Cochrane Collaboration’s domain-specific tool for assessing riskofbias(44).Usingthistool,whichisneitherascoresheet nor a checklist, we made critical assessments for different quality domains, including selection, performance, detec- tion,attrition, reporting, and othertypesofbias(WebAppen- dix 2). Although such biases are typically classified under 1 of 3 main groups of bias in epidemiologic research (i.e., se- lection bias, measurement error, and confounding), we use the terms proposed by the Cochrane Collaboration for con- sistency in language throughout this article. Results of qual- ity assessment are presented as “low,”“high,”or “unclear” riskof bias foreach domain separatelyon the basis of the fol- lowing items: 1) random sequence generation; 2) allocation concealment; 3) blinding (separately for participants, study personnel, and outcome assessors); 4) incomplete outcome data; 5) selective reporting; and 6) other sources of bias. Two investigators (A.R.R. and J.A.S.) independently re- viewed each article for quality and discussed discrepancies to reach a consensus in consultation with a third reviewer (F.P.R.). Data synthesis and analysis A 3-level cross-classification scheme was developed to categorize included studies. We used this classification to give a structured overview of all studies and to enhance the qualitative synthesis of information. First, studies were clas- sified into 1 of the following 2 mutuallyexclusive categories: 1)thosethatusedarandomizedcontrolleddesignand2)those that used a quasi-experimental controlled design. Second, within each of those categories, studies were classified into 1ofthefollowing2mutuallyexclusivecategories:1)thosethat used individuals as the unit of intervention (e.g., individually randomized controlled trials) and 2) those that used groups of individualsastheunitofintervention(e.g.,cluster-randomized controlled trials). We use the term “unit of intervention”in- stead of “unit of randomization”as not all included studies were randomized controlled trials. Third, within each of the 4 aforementioned categories, studies were further classified into 1 of the following 3 mutually exclusive categories (40): 1)thosethatprovidedbothcounselingandasafe firearmstor- age device; 2) those that provided counseling without a safe firearm storage device; and 3) those that provided a safe fire- arm storage device without counseling. We define the term “counseling”throughout this article as a structured set of ed- ucational messages or campaigns about safe firearm storage Table 1.Cross-Classification of Included Studies Published in 2000–2012 First Author, Year (Reference No.) Type of Intervention Study Type Carbone, 2005 (21) Counseling with safe storage device provision Group, quasi-experimental a Barkin, 2008 (46) Counseling with safe storage device provision Group, randomized Grossman,2000(20) Counseling without safe storage device provision Individual, randomized a Stevens, 2002 (49) Counseling without safe storage device provision Group, randomized Albright, 2003 (45) Counseling without safe storage device provision Individual, quasi-experimental Sidman, 2005 (48) Counseling without safe storage device provision Group, quasi-experimental Grossman,2012(47) Safe storage device provision without counseling Group, randomized a “Individual”and “group”refer to the unit of intervention. Safe Firearm Storage Interventions 113 Epidemiol Rev 2016;38:111–124 Do w n l o a d e d f r o m h t t p s : / / a c a d e m i c . o u p . c o m / e p i r e v / a r t i c l e / 3 8 / 1 / 1 1 1 / 2 7 5 4 8 6 2 b y U n i v e r s i t y o f A r k a n s a s L i b r a r i e s u s e r o n 1 2 F e b r u a r y 2 0 2 5 Table 2.Description and Findings of Included Studies Published in 2000–2012 by Type of Intervention First Author, Year (Reference No.) Study Design Unit of Intervention Study Setting Study Population Intervention Group Control Group Duration of Follow-up for Primary Analysis Primary Outcomes Findings Key Conclusions Counseling With Safe Storage Device Provision Carbone, 2005 (21) Two-arm, nonparallel group, quasi-experimental controlled trial Family Pediatric clinic located in an urban community health center in Tuscon, Arizona Predominantly Hispanic families of children and adolescents attending clinic visits. Mean ages of children in the intervention and control groups were 6.5 and 5.9 years, respectively. Study was restricted to gun-owning families Physician-delivered 1- to 2-minute gun safety verbal counseling+ gun safety brochure+provision of free gunlock with instructions (n =73 families) Usual anticipatory guidance (n =78 families) One month. A total of 2,649 families completed the baseline survey; about 8% had firearms. Study was completed on 73%oforiginal gun-owning families Removal of all guns from home. Improvement in safe gun storage among households with guns at follow-up. Improvement in overall gun safety practices among all households Removal of all guns from home: 22% intervention, 17% control; RR= 1.3 (95% CI: 0.7, 2.5). Improvement in safe gun storage among households with guns at follow-up: 51% intervention, 12% control; RR=4.1 (95% CI: 2.1, 8.3). Improvement in overall gun safety practices among all households: 62% intervention, 27% control; RR=2.3 (95% CI: 1.5, 3.4) Office-basedsafe gun storage counseling supported with written information and a free gunlock resulted in significant improvements in safe gun storage behaviors but did not affect removal of firearms from home Barkin, 2008 (46) Two-arm, parallel group, randomized controlled trial Practice Pediatric clinics in 41 US states, Canada, and Puerto Rico participating in the practice-based research network of the American Academy of Pediatrics Families (90% mothers) of children aged 2–11 years attending well-child pediatric clinic visits. Study was not restricted to gun owners, but safe firearm storage outcomeswere analyzed only among gun owners Physician-delivered, office-based violence prevention intervention using motivational interviewing with a component on safe firearm storage and provision of free cable gunlocks (n =68 practices) Usual care regarding injury/violence prevention+ literacy promotion handout (n =69 practices) One and 6 months. Greater than 80% of eligible families participated across all sites Change over time in self-reported use of firearm cable locks among gun owners Using firearm cable locks—1 month: 64% intervention, 59% control; RD=12% (P =0.006); 6 months: 68% intervention, 54% control; RD= 22% (P < 0.001) Office-based counseling supported with provision of free cable gunlocks significantly increased safe firearm storage among gun-owning families Counseling Without Safe Storage Device Provision Grossman, 2000 (20) Two-arm, parallel group, randomized controlled trial Practitioner Nine urban and suburban family medicine and pediatric practices at Group Health Cooperative (a staff-model health maintenance organization)in western Washington Gun-owning and non-gun- owning families of children and adolescents attending well-child visits. Mean ages of children in the intervention and control groups were 3.5 and 4.0 years, respectively Practitioner-delivered verbal and written gun safety counseling and provision of coupons for obtaining 1 trigger lock and 1 lockbox at a discount for gun-owning families, and provided counseling to not acquire a gun for non-gun-owning families (n =29 practitioners) Usual practice (n =28 practitioners) 3 months. A total of 2,082 eligible households approached; 1,673 (80%) kept appointment with practitioner during study period; of those, baseline and follow up data were collected on 1,292 (77%) Removal of firearms from households among gun-owning families. Acquisition of a safe firearm storage device among gun-owning families. Acquisition of firearm among nongun- owning families Removal of firearms from households: 6.7% intervention, 5.7% control; RD=1.1% (95% CI:-0.4, 5.9). Acquisition of a safe firearm storage device: 27% intervention, 21% control; RD=6.3% (95% CI:-1.3, 17.2). Acquisition of firearm among the entire study population: 1.3% intervention, 0.9% control (P = 0.44) A single counseling session delivered during well-child visits combined with economic incentives to purchase safe storage devices did not lead to changes in householdgun ownership or storage patterns Table continues 11 4 Ro w h a n i - R a h b a r e t a l . Ep i d e m i o l R e v 20 1 6 ; 3 8 : 1 1 1 –12 4 Do w n l o a d e d f r o m h t t p s : / / a c a d e m i c . o u p . c o m / e p i r e v / a r t i c l e / 3 8 / 1 / 1 1 1 / 2 7 5 4 8 6 2 b y U n i v e r s i t y o f A r k a n s a s L i b r a r i e s u s e r o n 1 2 F e b r u a r y 2 0 2 5 Table 2.Continued First Author, Year (Reference No.) Study Design Unit of Intervention Study Setting Study Population Intervention Group Control Group Duration of Follow-up for Primary Analysis Primary Outcomes Findings Key Conclusions Stevens, 2002 (49) Two-arm, parallel group, randomized controlled trial Practice Twelve pediatric primary care practices in mostly rural areas of New England, United States Gun-owning and non-gun- owning families of fifth andsixth grade children attending pediatric well-child visits Practitioner-delivered counseling about safety (including safe gun storage, seatbelts, and bicycle helmets); clinic site support (site visits, telephone calls, newsletters, and informational materials); and regularly scheduled printed materials mailed to families (n =6 practices) Practitioner-delivered counseling about alcoholandtobacco use; clinic site support (site visits, telephone calls, newsletters, and informational materials); and regularly scheduled printed materials mailed to families (n =6 practices) Visits at 12, 24, and 36 months; 90% (n = 3,145) of eligible families returned baseline survey with only 4% lost to follow-up and 1% withdrew over 36 months Guns in home in locked storage For storing guns unlocked, at 12 months: OR=1.3 (95% CI: 0.9, 1.8); at 24 months: OR=1.2 (95% CI: 0.8, 1.6); at 36 months: OR=1.2 (95% CI: 0.9, 1.7) Office-basedsafe gun storage counseling supported with long-term reinforcement did not improve locking of household guns Albright, 2003 (45) Three-arm, parallel group, quasi-experimental controlled trial Patient Urban, community- based, university- affiliated, family practice residency teaching clinic in Corpus Christi, Texas Adults or families (mostly female and Hispanic; mean age=45 years) of children attending clinic visits. The study was restricted to gun owners Group intervention 1: gun ownership survey and verbal counseling on safe gun storage (n =36 patients). Group intervention 2: gun ownership survey, verbal counselling, and written counseling on safe gun storage (n =52 patients) Gun ownership survey only (n =39 patients) 60–90 days.Less than 0.5% of those with firearms in home refused participation Improvement or decrement in safe gun storage practices as indicated by a change in practices from baseline to follow-up: locked guns, unloadedguns, no child access, or moving guns to a safer place Made a safe change: 33% control, 64% group intervention 1, 58% group intervention 2. Made an unsafe change: 31% control, 22% group intervention 1, 31% group intervention 2 Office-based verbal counseling with or without written materials made a positiveimpact on safe firearm storage habits Sidman, 2005 (48) Two-arm, parallel group, quasi-experimental controlled trial County King County, Washington, and 9 other counties outside of Washington without child access prevention laws in 1996 Study area handgun- owning households with children in home Gun safe storage community educational campaign consisting of television and radio announcements, billboards, community- distributed educational materials, and discount coupons for lockboxes (n =1 county) A total of 9 counties were combined into 1 group to serve as the referent Two cross- sectional assessments in 1996 and 2001.Atotalof 13% of those contacted refused, 85% not eligible in 1996; similar numbers in 2001 Handgun-related outcomes: all stored with formal locking devices (trigger locks, lockboxes, or gun safes); all stored in lockboxes or gun safes; any stored loaded; any stored loaded without a formal locking device; any stored loaded and not in a lockbox or gun safe Interyear odds ratios comparing 2001 vs. 1996—all stored with formal locking devices: ORs=1.5 among intervention and 1.3 among control groups; all stored in lockboxes or gun safes: ORs=1.7 among intervention and 1.7 among control groups; any stored loaded: ORs= 0.7 among intervention and 1.1 among control groups; any stored loaded without a formal locking device: ORs= 0.5 among intervention and 0.9 among control groups; any stored loaded and not in a lockbox or gun safe: ORs= 0.6 among intervention and 0.7 among control groups A broad, educational community- based safe firearm storage campaign combined with economic incentives to purchase lockboxes did not improve safe storage practices Table continues Sa f e F i r e a r m S t o r a g e I n t e r v e n t i o n s 11 5 Ep i d e m i o l R e v 20 1 6 ; 3 8 : 1 1 1 –12 4 Do w n l o a d e d f r o m h t t p s : / / a c a d e m i c . o u p . c o m / e p i r e v / a r t i c l e / 3 8 / 1 / 1 1 1 / 2 7 5 4 8 6 2 b y U n i v e r s i t y o f A r k a n s a s L i b r a r i e s u s e r o n 1 2 F e b r u a r y 2 0 2 5 delivered at the individual or community level. The counsel- ing could be of any length, from minutes to months, depend- ing on the study design. No attempt to conduct a meta-analysis was made because of notable between-study heterogeneity in settings, popula- tions, and interventions. This decision does not indicate that included studies had no commonalities. For instance, the majority of included studies used health-care provider- delivered messages among children, adolescents, and their families during clinic visits. Nonetheless, differences were sufficiently meaningful that we deemed a pooling of effect measures across studies unwise and uninformative. RESULTS Identified studies Of 18 articles identified through the search followed by screening, 7 studies met all the inclusion criteria and were in- cluded in this review (Figure 1)(20,21,45–49). The 11 ex- cluded articles had used a before-after or after-only design without a control group (19,50–58) and/or lacked a firearm storage component (19,54,59). In addition, 2 articles were linked to the same quasi-experimental study (54,56). Table 1 presents the included studies using the 3-level cross-classification scheme. Four randomized controlled tri- alsand3quasi-experimentalcontrolledstudieswereincluded in this review (classification level 1). Two studies used indi- viduals and 5 studies used groups as the unit of intervention (classification level2).Twostudies providedbothcounseling and a safe firearm storage device, 4 studies provided counseling without a safe firearm storage device, and 1 study provided a safe firearm storage device without counseling (classification level 3). Intervention characteristics Six studies provided a form of counseling. Five of those studies included health-care provider-delivered messages at family medicine or pediatric practices among adult patients orchildren,adolescents,andtheirfamiliesduringclinicvisits (Table 2). Such counseling typically included brief verbal and/or written messages; however, the content of those mes- sages differed between studies. Three studies adapted material fromtheStepstoPreventFirearmInjuriesintheHomeprogram (20,21,45).TheStepstoPreventFirearmInjuriesintheHome program, developed jointly by the American Academy of Pediatrics and the Brady Center to Prevent Gun Violence, is an educational program designed to facilitate health-care provider-deliveredcounselingtopatientsregardingtheinher- ent riskof guns in households and the community. The Steps to Prevent Firearm Injuries in the Home program kit included a health-care provider manual, family brochures, and educa- tional posters. All 3 studies focused solely on safe firearm storage practices and provided 1- or 2-minute-long messages as part of the intervention. In the study by Grossman et al. (20), families without household firearms were counseled about the risks associated with access to household firearms and discouraged from introducing firearms into their house- hold in the future. Families with household firearms wereTa b l e 2 . Co n t i n u e d Fi r s t A u t h o r , Ye a r ( R e f e r e n c e No . ) St u d y D e s i g n Un i t o f In t e r v e n t i o n St u d y S e t t i n g S t u d y P o p u l a t i o n I n t e r v e n t i o n G r o u p C o n t r o l G r o u p Du r a t i o n o f Fo l l o w - u p f o r Pr i m a r y A n a l y s i s Pr i m a r y O u t c o m e s F i n d i n g s K e y C o n c l u s i o n s Sa f e S t o r a g e D e v i c e P r o v i s i o n W i t h o u t C o u n s e l i n g Gr o s s m a n , 20 1 2 ( 47 ) Tw o - a r m , p a r a l l e l g r o u p , ra n d o m i z e d c o n t r o l l e d tr i a l Ho u s e h o l d S i x v i l l a g e s i n 2 di f f e r e n t re g i o n s i n we s t e r n Al a s k a , U n i t e d St a t e s Gu n - o w n i n g Al a s k a N a t i v e s (7 4 % m a l e ) , 73 % w i t h ch i l d r e n i n ho m e , a n d a l l 19 y e a r s o f a g e or o l d e r In s t a l l a t i o n o f f r e e l o n g gu n c a b i n e t a n d sa f e t y m e s s a g e a b o u t ke e p i n g a l l g u n s a n d am m u n i t i o n l o c k e d i n th e c a b i n e t ( n = 1 2 9 ho u s e h o l d s ) Us i n g a “wa i t l i s t ” de s i g n , t h e c o n t r o l gr o u p r e c e i v e d t h e in t e r v e n t i o n 1 2 mo n t h s a f t e r ba s e l i n e ( n = 1 2 6 ho u s e h o l d s ) 12 m o n t h s . O f 25 9 e l i g i b l e ho u s e h o l d s , 25 5 a g r e e d t o pa r t i c i p a t e ; ap p r o x i m a t e l y 84 % a n d 8 1 % of h o u s e h o l d s re c o n t a c t e d a t 12 - a n d 18 - m o n t h fo l l o w - u p , re s p e c t i v e l y An y g u n s un l o c k e d . Am m u n i t i o n un l o c k e d . A n y gu n s l o a d e d an d u n l o c k e d . Bo t h g u n s a n d am m u n i t i o n un l o c k e d An y g u n s u n l o c k e d : 35 % i n t e r v e n t i o n , 89 % c o n t r o l ( P < 0. 0 0 1 ) . Am m u n i t i o n un l o c k e d : 3 6 % in t e r v e n t i o n , 8 4 % co n t r o l ( P < 0 . 0 0 1 ) . An y g u n s l o a d e d an d u n l o c k e d : 2 % in t e r v e n t i o n , 9 % co n t r o l (P = 0 . 0 6 5 ) . B o t h gu n s a n d am m u n i t i o n un l o c k e d : 2 3 % in t e r v e n t i o n , 7 8 % co n t r o l ( P < 0 . 0 0 1 ) In s t a l l a t i o n o f f r e e lo n g g u n ca b i n e t s su p p o r t e d w i t h sa f e g u n st o r a g e me s s a g e s im p r o v e d t h e sa f e s t o r a g e o f gu n s a n d am m u n i t i o n am o n g r u r a l Al a s k a n ho u s e h o l d s Ab b r e v i a t i o n s : C I , c o n f i d e n c e i n t e r v a l ; O R , o d d s r a t i o ; R D , r i s k d i f f e r e n c e ; R R , r i s k r a t i o . 116 Rowhani-Rahbar et al. Epidemiol Rev 2016;38:111–124 Do w n l o a d e d f r o m h t t p s : / / a c a d e m i c . o u p . c o m / e p i r e v / a r t i c l e / 3 8 / 1 / 1 1 1 / 2 7 5 4 8 6 2 b y U n i v e r s i t y o f A r k a n s a s L i b r a r i e s u s e r o n 1 2 F e b r u a r y 2 0 2 5 counseled that the safest action for the entire family would be to remove guns from the household, and if they decided to keep firearms in their home they could reduce the risk of injury by storing them unloaded and in locked position. Additionally, coupons for obtaining 1 trigger lock and 1 lockbox at a discount were provided. The other 2 studies (21,45) restricted attention to families with household fire- arms only and delivered the aforementioned message. In the study by Carbone et al. (21), participants in the intervention group received a free gunlock that was able to fitallhand- guns and long guns in all calibers and came with illustrated instructions. Barkin et al. (46) specifically used motivational interview- ing techniques to discuss children’s access to firearms when parents expressed concern or if the provider was concerned after reviewing family behaviors. Motivational interviewing is a patient-centered counseling style that assesses interest and confidence in changing and elicits behavior change by helping patientsexploreandresolveambivalence.Inthisstudy,motiva- tional interviewing was part of a multicomponent intervention that was guided by social cognitive theory and emphasized modifying behavior through skills building for both the pro- vider (counseling behavior) and patient (behaviors at home). Providers were specifically trained to apply motivational inter- viewingaspartoftheintervention.Safe firearmstoragepractice was only 1 of several behaviors assessed in this investigation as it also targeted other outcomes such as media use and dis- cipline approaches. Providers offered tangible tools (minute timersfordisciplinarytimeoutsandlimitingmedia,aswellas cable locks (as many as were requested), to store firearms more safely) to participants in the intervention arm. The study by Stevens et al. (49) included both clinical prac- tice and home interventions and was unique in that it was de- livered overa 36-month period.The investigatorsmodified the focus ofwell-child visits from screening and providing factsto engaging the child and parent in a joint conversation and en- couraging communication about safe firearm storage. Study staff provided ongoing support to clinical sites after the initial office-based intervention using site visits, telephone calls, newsletters, and information materials and with regularly scheduled visual and printed materials mailed to the families. Safe firearm storage practice was 1 of several behaviors as- sessed in this investigation as it additionally targeted alcohol consumption, smoking, and bicycle helmet use. The study by Sidman et al. (48) was the only investigation included in this review that focused on a community cam- paign.Itusedtelevisionandradioannouncements,educational materials, and billboards to promote safe firearm storage. The campaign centered on the slogan,“Buy a Box for Your Gun, Not Your Kid.”Educational materials bearing the slogan were often accompanied by a picture of an empty child-sized coffin or an unlocked cabinet containing a handgun and were dis- tributedtophysicians,clinics,nursingorganizations,churches, schools, parent-teacher associations, and law enforcement of- fices. In addition, $10 coupons were provided for the purchase of $80 Cannon lockboxes (Cannon Safe, Inc., Las Vegas, Nevada) stocked by a major regional department store chain. The experimental community was King County, Washington, and the control communities included 9 counties outside of Washington State and west of the Mississippi River. In the study by Grossman et al. (47), the intervention cen- tered on the installation of a free long gun cabinet in house- holdsinruralvillagesinwesternAlaska.Upto2guncabinets were installed along with instructions and a handout on use, a brief safety message about keeping all guns and ammunition locked in the cabinet, and instructionsto keep the cabinet key in a secure location. The installer observed and certified that all guns and ammunition were secured in the cabinet after demonstrating its use. We did not consider this intervention to have included a form of counseling as previously defined; as such, it served as the only investigation in which the observed effect, if any, could reasonably be attributed to the provision of a safety device and not counseling in our opinion. Intervention effects A range ofoutcomeswasevaluatedinthestudies (Table 2) mainly due to heterogeneity in the nature of interventions, as well as differences in the study populations and settings. Most studies restricted attention to gun-owning families and examined changes over time in safe firearm storage prac- tices, such as keeping guns unloaded and locked, keeping ammunition locked and separate from firearms, removing ac- cess to guns by children, and moving guns to a safer place including removing them entirely from the household. There were investigations, however, in which the study pop- ulation included non-gun-owning families (20); because out- comes pertaining to removal of guns from the household or use of a safety device did not apply to this subgroup, other outcomes such as acquisition of guns over the course of the study were assessed. All 3 studies (21,46,47)inwhichafreesafefirearm storage device was provided showed a significant improvement in safe storage practices (Table 2). In the study by Carbone et al. (21), families in the intervention group were more likely than those in the control group to have improved overall gun safety prac- tices over the follow-up period (relative risk=2.29, 95% con- fidence interval: 1.52, 3.44). In the study by Barkin et al. (46), households in the intervention group substantially increased (9.7%) in storing firearms with cable locks, while those in the control group decreased (-11.7%) their use of that device overthefollow-upperiod(riskdifference=22%;P <0.001).In the study by Grossman et al. (47), 35% of homes in the inter- vention group and 89% of those in the control group reported having any guns unlocked at follow-up (P < 0.001). An im- portant feature of this study was that, unlike other investiga- tions in which the outcomes were ascertained mainly by self-report, the outcome was also examined through direct observation;interviewersobservedwhetheranygunsoram- munition was visible outside a safe orcabinet around the in- terior of the home. Among 4studies (20,45,48,49)in whichno free safe fire- arm storage device was provided, only 1 (45) showed a sig- nificant improvement in safe firearm storage practices. Notably, 2 of those 4 studies (20,48) provided economic in- centives such as coupons for purchasing a safe firearm stor- age device; however, devices were not available for free and required the study participants to take additional steps to re- ceive them, such as calling a toll-free number. Safe Firearm Storage Interventions 117 Epidemiol Rev 2016;38:111–124 Do w n l o a d e d f r o m h t t p s : / / a c a d e m i c . o u p . c o m / e p i r e v / a r t i c l e / 3 8 / 1 / 1 1 1 / 2 7 5 4 8 6 2 b y U n i v e r s i t y o f A r k a n s a s L i b r a r i e s u s e r o n 1 2 F e b r u a r y 2 0 2 5 Table 3.Risk of Bias in Included Studies Published in 2000–2012 Using Cochrane Collaboration’s Domain-Specific Tool for Quality Assessment First Author, Year (Reference No.) Random Sequence Generation Allocation Concealment Blindinga Incomplete Outcome Data Selective Reporting Other Sources of Bias Counseling With Safe Storage Device Provision Carbone, 2005 (21) High. Nonrandom component based on a preselected order for intervention High. Nonconcurrent groups with explicitly unconcealed procedures Unclear. Insufficient information on whether outcome assessment was blinded Unclear. Insufficient information on handling missing outcome data Low. Published report includes all expected outcomes Low.Otherimportantsources of bias unlikely; specific analyses conducted to account for differences in safe storage between comparison groups at baseline Barkin, 2008 (46) Low. Computer-generated random assignment list Low. Central allocation Low. Unblinded but outcome assessment likely not influenced Unclear. A large fraction of practices discontinued or were excluded; however, they were mostly balanced in numbers across 2 arms with somewhat similar, but not highly specific reason (“due to failure to collect eligible data”) Unclear. Published report includes information on main outcome (use of cable locks); however, a number of other safe firearm storage outcomes were measured and not reported Low.Otherimportantsources of bias unlikely Counseling Without Safe Storage Device Provision Grossman, 2000 (20) Low. Computer-generated random number Unclear. Insufficient information on method of concealment Unclear. Unblinded to participants and personnel but insufficient information on whether outcome assessment was blinded Unclear. Equal proportions of intervention and control groups lost to follow-up, but reasons unclear Unclear. Published report includes all expected primary outcomes; however, reporting of gun acquisition was not restricted to nongun owners (i.e., the third indicated outcome was not reported) Low.Otherimportantsources of bias unlikely Stevens, 2002 (49) Low. Computer-generated random number Unclear. Insufficient information on method of concealment Unclear. Insufficient information on whether outcome assessment was blinded Unclear. Insufficient information on handling missing outcome data Low. Published report includes all expected outcomes Unclear. Insufficient information on strategies to minimize residual confoundingbydifferences between comparison groups at baseline Albright, 2003 (45) High. Systematic nonrandom component based on preselected survey days High. Rotation of survey days Low. Outcome assessment was blinded Low. 29 patients were lost to follow-up; sensitivity analyses did not materially change the results Low. Published report includes all expected outcomes Unclear. Insufficient information on strategies to minimize residual confoundingbydifferences between comparison groups at baseline Table continues 11 8 Ro w h a n i - R a h b a r e t a l . Ep i d e m i o l R e v 20 1 6 ; 3 8 : 1 1 1 –12 4 Do w n l o a d e d f r o m h t t p s : / / a c a d e m i c . o u p . c o m / e p i r e v / a r t i c l e / 3 8 / 1 / 1 1 1 / 2 7 5 4 8 6 2 b y U n i v e r s i t y o f A r k a n s a s L i b r a r i e s u s e r o n 1 2 F e b r u a r y 2 0 2 5 Quality assessment Overall, the included studies were of sufficiently high quality. Nonetheless, a wide range of risk of bias in different quality domains was observed (Table 3). Risk of selection bias was generally high for quasi-experimental controlled studies as the treatment assignment was not truly a random process and that allocation was not concealed (21,45,48). The risk of detection bias was unclear for several studies be- cause the available information on blinding of outcome as- sessment was insufficient (20,21,48,49). Some studies failed to report how incomplete outcome data were handled, leading to an unclear riskof attrition bias (20,21,46–49). Fi- nally, afew investigations did not report characteristics of the study groups at baseline in sufficient detail leading to con- cerns about residual confounding, especially considering their relatively small sample size (45,48,49). Despite these limitations, we believe that the large effect measures observed in studiesthat showed significant improve- ments in safe firearm storage practices make it unlikely that biascouldexplaintheentiretyofsuchassociations.Somestud- ies provided specific information to improve judgment about the potential effect of bias. For instance, Carbone et al. (21) acknowledged the limitations of a nonconcurrent design; nonetheless,theywerenotawareofanysignificantcommunity gun-relatedprogramoreventoccurringduringthestudyperiod that may have notably influenced their results. Likewise, some investigators noted the possibility of social desirability bias generated by participants’tendency to respond in an “accept- able”manner; however, the setting and nature of interventions coupled with the strength and direction of observed effects led them to conclude that their findings would be unlikely to have been dramatically distorted by such bias (45,46). DISCUSSION Four of the 7 clinic- or community-based interventions in- cluded in this systematic review were effective at promoting safe firearm storage practices. A central finding of this sys- tematic review is that all 3 studies (21,46,47)inwhich free devices were provided improved safe firearm storage practices. On the other hand, 2 interventions that provided economic incentives to acquire safe firearm storage devices were ineffective (20,48). A serious need exists foradditional high-quality randomized controlled trials of such interven- tions to inform policy and practice. Studiesincludedinthissystematicreviewrepresentsubstan- tial progress over the past decade in the methodology used to designandevaluatesafe firearmstorageinterventions.Another systematic review of safe firearm storage interventions pub- lishedin2003(40)includedonly1randomizedcontrolledtrial and 6 before-after or after-only studies with no control group that had a number of methodological limitations. In that sys- tematic review, 2 of 3 before-after studies (51,52,55) that as- sessedsafe firearmstorageinterventionswereeffective,while another study (19) that evaluated firearm removal and acqui- sition among families with a depressed adolescent was inef- fective. Both after-only studies (50,53) demonstrated some firearm storage practices among participants; however, they were limited by small sample sizes.Ta b l e 3 . Co n t i n u e d Fi r s t A u t h o r , Ye a r (R e f e r e n c e No . ) Ra n d o m S e q u e n c e Ge n e r a t i o n Al l o c a t i o n Co n c e a l m e n t Bl i n d i n g a In c o m p l e t e O u t c o m e D a t a S e l e c t i v e R e p o r t i n g O t h e r S o u r c e s o f B i a s Si d m a n , 20 0 5 ( 48 ) Hi g h . N o n r a n d o m co m p o n e n t b a s e d o n a pr e s e l e c t e d s i t e f o r in t e r v e n t i o n Hi g h . E x p l i c i t l y un c o n c e a l e d pr o c e d u r e s Un c l e a r . U n b l i n d e d an d i n s u f f i c i e n t in f o r m a t i o n o n wh e t h e r i t a f f e c t e d ou t c o m e as s e s s m e n t Un c l e a r . I n s u f f i c i e n t i n f o r m a t i o n on h a n d l i n g m i s s i n g o u t c o m e da t a Lo w . P u b l i s h e d r e p o r t in c l u d e s a l l e x p e c t e d ou t c o m e s Un c l e a r . I n s u f f i c i e n t in f o r m a t i o n o n s t r a t e g i e s t o mi n i m i z e r e s i d u a l co n f o u n d i n g b y d i f f e r e n c e s be t w e e n c o m p a r i s o n gr o u p s a t b a s e l i n e ; pr e s e n c e o f l o c a l f i r e a r m sa f e t y i n i t i a t i v e s i n c o n t r o l co u n t i e s d u r i n g t h e s t u d y pe r i o d Sa f e S t o r a g e D e v i c e P r o v i s i o n W i t h o u t C o u n s e l i n g Gr o s s m a n , 20 1 2 ( 47 ) Lo w . C o m p u t e r - g e n e r a t e d ra n d o m n u m b e r Lo w . C e n t r a l al l o c a t i o n Lo w . U n b l i n d e d b u t ou t c o m e as s e s s m e n t l i k e l y no t i n f l u e n c e d Un c l e a r . I n s u f f i c i e n t i n f o r m a t i o n on h a n d l i n g m i s s i n g o u t c o m e da t a ; 1 9 % i n t e r v e n t i o n a n d 13 % c o n t r o l h o u s e h o l d s l o s t t o fo l l o w - u p a t 1 2 m o n t h s b u t re a s o n s u n c l e a r Lo w . P u b l i s h e d r e p o r t in c l u d e s a l l e x p e c t e d ou t c o m e s Lo w . O t h e r i m p o r t a n t s o u r c e s of b i a s u n l i k e l y a As r e c o m m e n d e d b y t h e C o c h r a n e C o l l a b o r a t i o n , s e p a r a t e d f o r 1 ) p a r t i c i p a n t s a n d p e r s o n n e l d u r i n g t h e s t u d y a n d 2 ) o u t c o m e a s s e s s o r s . Safe Firearm Storage Interventions 119 Epidemiol Rev 2016;38:111–124 Do w n l o a d e d f r o m h t t p s : / / a c a d e m i c . o u p . c o m / e p i r e v / a r t i c l e / 3 8 / 1 / 1 1 1 / 2 7 5 4 8 6 2 b y U n i v e r s i t y o f A r k a n s a s L i b r a r i e s u s e r o n 1 2 F e b r u a r y 2 0 2 5 Throughourliteraturesearch,wealsoidentified 3safe fire- arm storage interventions (56–58) that were not included in either review (Web Table 2). Two after-only studies (56, 57) assessed firearm storage practices among adult gun own- ersexposedtoa firearm-relatedpublicsafetycampaign,and1 before-after investigation (58) examined a school-based pro- gram targeting gun-owning adults with children in the home. All 3 interventions were found to be effective. Overall, among all studies intheliteraturetodate thatassessed firearm storage interventions, 7 of 8 in which a free safe firearm de- vice was provided were found to be effective (21,46,47,51, 52,56,58).Notably,the eighth study(50)assessed theuse of afreetriggerlockwithoutmeasuringoverallsafe firearmstor- age practices among law enforcement officers. Considerations for future studies That most studies offering a free safe firearm storage device were effective is consistent with an abundance of evidence re- garding effectiveness of other health-care interventions (e.g., promoting medication or immunization adherence) in which removing economic and time barriers to follow clinical and public health recommendations has been shown to improve adherence (60–62). Given the relatively small cost of devices suchastriggerlocks,someofwhichareavailableforaslittleas $10, future interventions should strongly consider providing themtostudyparticipants.Knowledgeregardingtheimpactof safe firearm storage promotion by type of device provision strategy(e.g.,installing,handingout,mailing)ortypeofdevice (e.g.,firearm cabinets, lockboxes, orcable or trigger locks) is quite limited and can be enhanced only through future com- parative effectiveness studies. Results from a 2004 survey showed that more than 20% of US individuals and households report owning more than 1 firearm, and approximately one half of firearm owners report owning more than 3 firearms (63). Interventions that do not provide a sufficient number of devices to secure all house- hold firearms may find that individuals in the experimental group continue to report unsafe storage of some household firearms even if improvements in safe storage were made due to the intervention. This is particularly relevant given that the risk of self-inflicted firearm injuries is probably most dependent on the availability of a single firearm (64). Thus, interventions aimed at improving safe storage among only a limited number of household firearms may find that improvements in safe firearm storage do not ultimately lead to lower risk of firearm-related injury. The safety of household firearm storage can be improved by keeping firearms unloaded and separate from locked am- munition, or locked, by using firearm cabinets, lockboxes, or cable or trigger locks. Future studies should develop and im- plement baseline and follow-up instruments that capture changes ineach of those behaviors, as well as cumulative and overall improvements in safe firearm storage practices. Strat- egies to control for differences in baseline storage practices between study groups, especially in quasi-randomized and small randomized studies, are of utmost importance. Another consideration for future studies is whether to recommend the removal of firearms from the household, especially in house- holds with individuals at high risk for self-inflicted injury (e.g., those with substance use disorders or other suicide risk factors) (65,66). Removal of household firearms likely confers the greatest firearm-related injury risk reduction given that several studies have suggested that firearm avail- ability is more strongly associated with injury than firearm accessibility (64,67). One potential method for promoting a balanced message is using materials from the Steps to Pre- vent Firearm Injuries in the Home program, as demonstrated in 3 of the studies included in this review (20,21,45). In those studies, families were counseled that the safest action would be to remove guns from the household, and if they chose to keep firearms in their home they could reduce the risk of injury by storing them unloaded and in locked posi- tion. However, recommendations to remove firearms from the home may enjoy less success than those promoting con- tinued ownership with safe firearm storage (19,20), and care should be taken in these discussions considering some fire- arm owners may prefer not to be asked to remove firearms from their homes (22,23). The effect of firearm interventions on non-firearm-owning individuals and families is also of importance. Firearm inter- ventions may reinforce previous decisions not to acquire fire- arms or, as noted by Grossman et al. (20), may convince nonowners that safely storing firearms sufficiently decreases the risk of ownership thereby prompting a gun purchase. The outcome of interest in such studies would be the acquisition of firearms by nonowners and safe storage practices around newlyacquired firearms.However,giventhatthoseoutcomes are likely to be rare events, studies will require substantially larger study groups to have sufficient power to detect signifi- cant intervention effects. An important aspect of the clinic-based intervention stud- ies included inthis review isthat some individuals inthe con- trolgroup alsoreceived advicetosafelystoretheir firearms as a component of “usual care.”For instance, 51% of control families in the study by Barkin et al. (46) discussed safe fire- arm storage with their provider. This is not surprising given that surveys have shown that firearm counseling is acommon topic of discussion in some clinics, particularly in pediatrics (68,69). Safe firearm storage intervention studies are typi- cally pragmatic rather than explanatory in nature; therefore, the inclusion of a usual care arm is common and indeed de- sirable.This isanimportant consideration affectingdecisions on sample size in safe firearm storage trials because the re- ceipt of safety messages by control groups may result in a smaller intervention effect measure as a reflection of dimin- ishing contrasts between study groups. Motivations for firearm acquisition, ownership, and stor- agemethodsarecomplex,andlittle isknownaboutsuchcon- textual factors or how they help to explain the effectiveness (or lack thereof) of safe firearm storage interventions. Most states have enacted some legislation mandating safer firearm storageinhouseholdswithchildren(70);however,ourknowl- edge on whether such laws and regulations truly influence storage practices is limited. Also, a large proportion of gun owners report keeping firearms for protection and voice con- cerns about delays in accessing a safely stored firearm during threatening situations (21,51,63). Additional studies are needed to determinewhether the effectiveness of safe firearm storage interventions is modified by reasons forownership or 120 Rowhani-Rahbar et al. Epidemiol Rev 2016;38:111–124 Do w n l o a d e d f r o m h t t p s : / / a c a d e m i c . o u p . c o m / e p i r e v / a r t i c l e / 3 8 / 1 / 1 1 1 / 2 7 5 4 8 6 2 b y U n i v e r s i t y o f A r k a n s a s L i b r a r i e s u s e r o n 1 2 F e b r u a r y 2 0 2 5 perceived neighborhood safety. If such characteristics are shown to modify the intervention effect, future studies may consider the potential benefitofnewlyemerging“smart”fire- arm technologies, such as bracelets, watches, and implantable chips,that restrict the abilitytodischarge a firearm specifically to the owner (71), thereby allowing more immediate access to firearms while also reducing firearm-related injury risk to oth- ersinthehousehold.Importantly,whilesmarttechnologyisan encouraging developmentinthe field of firearm safety, studies have not assessed whether using such technology decreases risk of firearm-related injury or whether such devices confer unique risks to firearm owners (e.g., device malfunction). The widespread acceptability of such technology to firearm owners is also unknown. Studies promoting safe firearm storage may benefit from including theme analyses aimed at improving our under- standing of the complex reasons for firearm ownership, how patients perceive study interventions, and the credibility of intervention staff. Such mixed-method studies mayalso be helpful in improving our understanding of how participants perceivediscussions aboutrisksassociatedwith firearmown- ership and access, and if such perceptions differ by whether children are present in the household. For instance,firearm owners without children may be less likely to be convinced of personal risk rather than risk forchildren. Given that a ma- jority of firearm owners are male (63), including in dual- parenthouseholds(72),andthatmostparticipantsinpediatric clinic-based intervention studies in this review were mothers, improving our understanding of household dynamics after firearminterventionsmaybeenlightening.Thatthereappears to be a gender gap in awareness of household firearm owner- ship and storage practices introduces yet another layer of complexity faced by firearm storage interventions (72,73). Modifying firearm storage behaviors may require ap- proaching firearm owners using a framework similar to that used in addressing other complex health behaviors, such as chronic disease management and substance use disorders. Withthatinmind,safe firearmstorageinterventionsmayben- efit from moving beyond basic safety messages by adopting motivational interviewing techniques similar to those used in the study by Barkin et al. (46), in which patient-centered counseling is used to elicit behavior change by exploring ambivalence surrounding behavior change and promoting patient-centeredsolutions.Althoughsuchstrategiesmayprove to be more effective than basic safety messages, implement- ing motivational interviewing strategies is likely to be sub- stantially more time and resource intensive as they often require provider training sessions and greater time commit- ment during clinical encounters; these are barriers that have impeded the implementation of motivational interviewing in other settings (74). This systematic review included studies that sought to ex- amine the effectiveness of safe firearm storage interventions withoutspecificationofthetargetpopulation.However,ofthe 7includedstudies,5specifically targeted households with children, and 41%–73% of households inthe remaining stud- ies had children present. This focus on children likely stems fromapublic consensus regarding theconsequencesofunsu- pervised access to firearms by children and a preexisting em- phasis oninjury preventionamong pediatric practitionersand researchers.However,thatsafestorageisalsoassociatedwith a lower risk of self-inflicted firearm injuries among adults (11,15) suggests the need for studies to address safe firearm storage in households without children. Additionally, most studies in this systematic review targeted the general popula- tion in terms of participants’likelihood of safe firearm stor- age and overall suicide risk. Future studies may consider specifically testing such interventions among populations most likely to store firearms unsafely (e.g., individuals with substance use disorders) or those who may be most likely to benefit from firearm safety interventions (e.g., individuals with riskfactorsforself-inflictedorunintentional injury).Al- thoughobservationalstudieshavedemonstratedthatsafe fire- arm storageis associated with lowerriskof firearm injuryand death (11,13,15,35), a crucial next step is to assess firearm injuryoutcomes following safe firearm storage interventions. Inthemeantime,additionalobservationalstudiestoassessthe association between safe firearm storage and less frequently studied outcomes, such as unintentional or assault-related firearm injuries and deaths, would be valuable. Additional opportunities for improvement in the methodo- logical quality of studies that seek to examine safe firearm storage interventions do exist. Such studies should use a ran- domized controlled design whenever possible. To the extent possible, studies should be designed to be pragmatic in nature, utilizing nonrestrictive screening and inclusion criteria, and take into account issues of crossover, contamination, and the content of usual care. The conduct and reporting of such stud- iesneedtocloselyfollowConsolidatedStandardsofReporting Trials guidelines to ensure comprehensiveness and allow for comparison across studies (75). Several studies included in this systematic review failed to provide information on blind- ing of outcome assessment and did not report how incomplete outcome data were handled, leading to concerns about mea- surement error and selection bias. Studies that provide a safe firearm storage device typically rely on self-report of storage practicesthatmayinturnintroduceastrongpotentialforsocial desirability bias (a form of measurement error). Such bias is likely above and beyond a “baseline”social desirability asso- ciated with reporting firearm storage in general considering that those study participants indeed received a free device. Fu- ture studies can benefit from objective measurement of such practices (e.g., household inspection) as was done in the study byGrossmanetal.(47)andbymeasuringthetypesof firearms presentineachhousehold(e.g.,handgun,shotgun),asthismay be indicative of reasons for firearm ownership (e.g., handgun for protection) and may help to explain intervention effective- ness. We call for creating a set of standards in measuring base- line and follow-up safe firearm storage practices in future trials. The number of household firearms and all components of safe firearm storage practice need to be accurately measured at base- line and follow-up points using the same instrument and asses- sors to allow for the comparison of participants’characteristics at baseline and alleviation of concerns about residual confound- ing. Such a measurement scheme would naturally lend itself to an appropriate analysis of change in each group that could in turn have desirable effects on the precision of effect measures. Wefacedsomelimitationsintheconductofthissystematic review. The number of studies meeting our inclusion cri- teria was small, as we included only studies that used a Safe Firearm Storage Interventions 121 Epidemiol Rev 2016;38:111–124 Do w n l o a d e d f r o m h t t p s : / / a c a d e m i c . o u p . c o m / e p i r e v / a r t i c l e / 3 8 / 1 / 1 1 1 / 2 7 5 4 8 6 2 b y U n i v e r s i t y o f A r k a n s a s L i b r a r i e s u s e r o n 1 2 F e b r u a r y 2 0 2 5 randomized or quasi-experimental controlled design; how- ever, it is notable that we found only a small number of stud- ies of safe firearm storage interventions that used other designs (e.g., before-after, after-only). These small sample sizes highlight an urgent need to improve the current state of knowledge regarding safe firearm storage. The included studies varied in both design and risk of bias. Our cross- classification of studies according to their design was an at- tempt to organize the available information; however, the small numberof studies included in each subgroup precluded ourabilitytocomparetheeffectivenessin1subgroupofstud- iesversusothers.Forthesamereason,itwasalsonotpossible to examine the intervention effect measures stratified by the methodological quality of the included studies. Finally, the considerable heterogeneity of safe firearm storage interven- tions conducted to date precluded a meaningful pooling of findings across them. Considering the nature of such inter- ventional studies, it is unlikely that an effect measure from a single firearm storage intervention can be readily applied to the variety of settings and populations in which firearm storage is relevant. This systematic review meaningfully contributes to the evi- dence base regarding the effectiveness of interventions that promote safe firearm storage. Findings from additional meth- odologically sound randomized controlled trials are needed to inform evidence-based policy and practice for public health practitioners and clinicians in the future. The further develop- ment and implementation of effective gun safety interventions may require approaching firearm storage behaviors with the sameattentiontocomplexityasotherhealth-careinterventions addressing chronic disease management or substance use dis- orders. Future studies will benefitfromfocusingonindividu- alized strategies to address firearm behavior change through acknowledging and addressing complex motivations for gun ownership and storage, removing economic and time barriers through providing free safe firearm storage devices directly, andadhering torigorous methodologicalprinciples inthecon- duct and reporting of trials. ACKNOWLEDGMENTS Author affiliations: Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington (Ali Rowhani-Rahbar, Frederick P. Rivara); Department of Medicine, School of Medicine, University of Washington, Se- attle, Washington (Joseph A. Simonetti); Department of Pedi- atrics, School of Medicine, University of Washington, Seattle, Washington (Ali Rowhani-Rahbar, Frederick P. Rivara); and HarborviewInjuryPreventionandResearchCenter,University of Washington, Seattle, Washington (Ali Rowhani-Rahbar, Joseph A. Simonetti, Frederick P. Rivara). Conflict of interest: none declared. REFERENCES 1. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System.http://www.cdc.gov/injury/ wisqars. Updated July 13, 2015. Accessed July 20, 2015. 2. Children’s Safety Network. 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Epidemiol Rev 2016;38:111–124 Do w n l o a d e d f r o m h t t p s : / / a c a d e m i c . o u p . c o m / e p i r e v / a r t i c l e / 3 8 / 1 / 1 1 1 / 2 7 5 4 8 6 2 b y U n i v e r s i t y o f A r k a n s a s L i b r a r i e s u s e r o n 1 2 F e b r u a r y 2 0 2 5 Responsible gun ownership is not only about how, where, and when a person uses their firearm; it’s also about how they store it when not in use. However, only about half of gun owners practice safe and secure firearm storage. Cassandra Crifasi, PhD ’14, MPH (https://publichealth.jhu.edu/faculty/3089/cassandra-crifasi), co-director of the Johns Hopkins Center for Gun Violence Solutions (https://publichealth.jhu.edu/departments/health-policy-and-management/research-and-practice/center-for-gun-violence- solutions) and a gun owner herself, explains best practices for safely and securely storing firearms and how doing so reduces injuries, homicides, and suicides, and mass shootings. How safe and secure gun storage reduces injury, saves lives | Johns Hopkins | Bloomberg School of Public Health Locked and UN-loaded: The Importance of Safe and Secure Firearm Storage Safely and securely storing firearms can reduce gun injuries and deaths, and is a practice supported by researchers, health care professionals, and gun owners alike. Published May 25, 2023 By Aliza Rosen GUN VIOLENCE INJURY PREVENTION Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe Street, Baltimore, MD 21205 (https://publichealth.jhu.edu) Johns Hopkins University https://publichealth.jhu.edu/2023/how-safe-and-secure-gun-storage-reduces-injury-saves-lives 1/4 When we say safe and secure gun storage, what exactly does that mean? Safe and secure are two complementary components: Safe means unloaded, and secure means locked up. Putting these two together, the most quintessential safe and secure storage (https://publichealth.jhu.edu/departments/health-policy-and-management/research- and-practice/center-for-gun-violence-solutions/solutions/safe-and-secure-gun-storage) is a gun being unloaded, locked in a gun safe or lockbox, and the ammunition is stored separately. Each step closer to the gun being ready to fire introduces opportunities for unintentional injury. So ideally, ammunition is stored in a dierent lockbox, but for some people who own guns for home- or self-defense, the idea of storing ammunition separately is not appealing. If that’s the case, guns should be locked in a quick-access safe, preferably unloaded. The ammunition can be in the magazine in the same lockbox, but not loaded. If it does have to be loaded, it shouldn’t have a round chambered. What are some other ways to store a firearm? Firearm storage is a spectrum. At one end is the least safe and secure: having a loaded, unsecured handgun somewhere in the house. At the other end is the preferred method: unloaded and locked up. Between those are various ways people can practice some level of gun storage, including trigger locks, which prevent the trigger from being pulled, and metal cable locks, which go through the magazine well or ejection port and lock with a key. Cable locks typically prevent guns from being loaded while locked. These methods generally don't meet best practices for safe and secure storage, and they can even create a false sense of security. Trigger locks still allow a gun to be loaded, and applying one to an already loaded gun has caused people to unintentionally discharge the firearm. A cable lock can be cut o with everyday tools. But at the end of the day, we have to meet people where they are; something is better than nothing when it comes to firearm storage. What if someone doesn’t have a place in the house to safely and securely store a firearm? We need to challenge the notion that it isn’t possible or convenient to safely and securely store a firearm in a home. There are lots of high-quality safes that are the size of an encyclopedia, and it’s easy to install a safe that’s bolted to your bed frame, the floor, or the wall. That said, there may be times when people want to store guns outside of the home, and there are locations across states that oer temporary osite gun storage. Our Center has worked with partners in Maryland (https://mdpgv.org/safestoragemap/) to create a map of all of these places—including gun shops, armories, gun ranges, and law enforcement agencies—based on a similar project in Colorado (https://coloradofirearmsafetycoalition.org/gun-storage-map/). Some places allow you to rent a locker, others will take the gun into their inventory, but it’s entirely voluntary, no questions asked, and the owner can retrieve it at any time. What are some common mistakes people make when it comes to gun storage? Mistakes are often rooted in misconceptions. For example, that safe and secure storage is costly, burdensome, inconvenient, or not conducive to home defense. In fact, a high-quality quick-access safe can cost as little as $50, and they’re designed to allow the contents to be accessible within seconds. How safe and secure gun storage reduces injury, saves lives | Johns Hopkins | Bloomberg School of Public Health Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe Street, Baltimore, MD 21205 (https://publichealth.jhu.edu) Johns Hopkins University (https://www jhu edu/) https://publichealth.jhu.edu/2023/how-safe-and-secure-gun-storage-reduces-injury-saves-lives 2/4 Another common mistake is assuming that it’s sucient to put a gun up high, out of reach of small children, or believing that kids don’t know where a gun is stored. In fact, the majority of children know exactly where a gun is stored (https://pubmed.ncbi.nlm.nih.gov/16651499/) and how to access it within minutes. The third mistake is not taking storage as seriously out in public as one might at home. Let's say I have a concealed carry license. There are still places where I can't legally carry a gun and have to leave it in my car to enter. If that gun isn’t stored in a car- compatible safe, there’s an increased likelihood it could be stolen and used to harm someone. Guns stolen from vehicles and homes (https://injepijournal.biomedcentral.com/articles/10.1186/s40621-017-0109-8) are a major source for the underground gun market, and they contribute to interpersonal violence in a lot of minoritized communities. How do we know that safe and secure gun storage is eective? One of the core tenets of injury prevention (https://publichealth.jhu.edu/center-for-injury-research-and-policy) is that to prevent injury, we separate—in time and space—the harm from that which is to be protected. We know that the use of a firearm to harm oneself or others can sometimes be impulsive. If my gun is stored loaded in a nightstand drawer, there's very little to slow me down and allow me to question whether I should use it in a given circumstance. But if my gun is in a gun safe, I have to open the safe. And if my gun is stored unloaded, as recommended, I have to separately access ammunition. Even just a few seconds’ delay is time I can reconsider or someone can intervene. We also see that in homes where youth are dying from firearm suicide (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085447/), those guns are far more likely to be stored loaded and unlocked. And in cases of youth and adolescents committing school shootings, the vast majority of them have gotten guns from their home or the home of a family member (https://www.secretservice.gov/sites/default/files/2020-04/Protecting_Americas_Schools.pdf). When we have safe and secure gun storage that is required by law through child access prevention laws, we see lower rates of youth and adolescent suicide. In all of these cases, the data show that harm is reduced when we require that guns be stored in a way that minimizes unsupervised or unauthorized access. What factors influence whether someone practices safe and secure storage? Individuals whose storage behaviors were influenced by participating in firearm safety training are more likely to store their guns safely (https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.304262). Gun owners with young kids in the home have higher rates— though still too low—of safe and secure storage than those without young kids. People who have concerns around self-defense, on the other hand, are less likely to store all their guns safely and securely. Overall, not nearly enough gun owners practice safe and secure storage. Through our survey work, we’ve found that only about half of all gun owners practice safe and secure storage (https://publichealth.jhu.edu/2018/survey-more-than-half-of-u-s-gun-owners-do-not-safely- store-their-guns) for all of their guns. Other research has found that around 4–5 million kids live in homes with at least one gun that is not stored safely and securely. That’s 4–5 million kids who could very quickly gain access to a loaded and unlocked firearm. How do we encourage more people to store their guns safely and securely? It all comes back to messaging. We need to challenge the narrative that safe and secure gun storage and home defense are inconsistent with each other. It just isn’t true. How safe and secure gun storage reduces injury, saves lives | Johns Hopkins | Bloomberg School of Public Health Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe Street, Baltimore, MD 21205 (https://publichealth.jhu.edu) Johns Hopkins University (https://www jhu edu/) https://publichealth.jhu.edu/2023/how-safe-and-secure-gun-storage-reduces-injury-saves-lives 3/4 We also need to push back against a common talking point by the gun industry and gun manufacturers that you don't want to be a victim because you didn't have a gun at the ready. The reality is that if you don't have a firearm physically on your person, having it stored in a gun safe or a lockbox is a much better option: Not only is the likelihood of needing to use a firearm in self-defense exceptionally low, but it’s also far more likely that a gun in the home will be used to harm a household member. Bringing a gun into the home can increase the risk of homicide and suicide by as much as threefold (https://www.acpjournals.org/doi/10.7326/M13-1301). Storing guns safely and securely can minimize that risk. Aliza Rosen is a digital content strategist in the Oce of External Aairs at the Johns Hopkins Bloomberg School of Public Health. RELATED: Yes, You Should Ask If Someone Has Guns in the Home. Here’s How. (https://publichealth.jhu.edu/2023/why-and-how-you-should- ask-other-parents-if-they-own-guns) Intimate partner violence, guns and the courts (https://johnshopkinssph.libsyn.com/597-intimate-partner-violence-guns-and-the- courts) (Podcast) How Pediatricians Can Promote Gun Safety (https://magazine.jhsph.edu/2021/how-pediatricians-can-promote-gun-safety) How safe and secure gun storage reduces injury, saves lives | Johns Hopkins | Bloomberg School of Public Health Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe Street, Baltimore, MD 21205 (https://publichealth.jhu.edu) Johns Hopkins University (https://www jhu edu/) https://publichealth.jhu.edu/2023/how-safe-and-secure-gun-storage-reduces-injury-saves-lives 4/4 QUICK FACTS FROM ARTICLES: ● Alathari et al. (2019) (U.S. Secret Service report) found that in nearly three-quarters of school shootings, the firearm used came from the shooter ’s home or a relative’s home. ○ “Nineteen attackers (76%) acquired a firearm from the home of a parent or another close relative. In half of the firearms cases (n = 12, 48%), evidence indicates the firearm was either readily accessible, or it was not secured in a meaningful way. For example, some firearms had been kept locked in accessible wooden or glass cabinets, locked in vehicles, or hidden in closets.” ● Kivisto et al. (2021) and Johnson et al. (2010) found that adolescents who die by suicide often use firearms owned by parents or relatives that were not securely stored. ● Rowhani-Rahbar et al. (2016) found that public awareness campaigns and school-based interventions are effective at increasing safe storage practices. ○ School districts can play a critical role in educating parents about the risks of unsecured firearms and providing guidance on best practices. Secure Storage or Child Access Prevention Required | Everytown Research & Policy ● Massachusetts, New Jersey, New York, Rhode Island, and Hawaii have lowest gun violence rates in the U.S. ○ These states all employ safe storage laws when children have/are likely to come into contact with firearms New study shows up to 43% of US households are not storing guns securely - ABC News “If 20% of parents changed their current storage practices to storing firearms unloaded and with the ammunition locked away separately "there would be an estimated decrease of up to 122 pediatric firearm-related fatalities and 201 injuries annually." ” Evaluating the Use of a Pamphlet as an Educational Tool to Improve Safe Firearm Storage in the Home - Katherine E. M. Hoops, Emily Hernandez, Susan Ziegfeld, Isam Nasr, Cassandra Crifasi, 2021 APA adopts resolution on secure firearms storage to prevent suicides “By promoting the knowledge of secure firearms storage practices and increasing awareness of lethal means safety, we can save lives and make meaningful progress in reducing suicide rates.” (APA President Cynthia de las Fuentes, PhD) “The resolution also advocates for increased funding at federal, state and local levels to support initiatives aimed at preventing suicides through secure firearms storage practices.” (just from the article) 10 Things You Can Do to Prevent Violence in Your School Community Here is article from this summer from surgeon general putting out warning that gun violence is an epidemic: Surgeon general advisory lays out plan to tackle gun violence | The Nation's Health New Articles to check for validity-found 10/17/24 https://www.rand.org/pubs/research_reports/RRA243-5.html https://publichealth.jhu.edu/2023/how-safe-and-secure-gun-storage-reduces-injury-saves-lives https://publichealth.jhu.edu/center-for-gun-violence-solutions/solutions/safe-and-secure-gun-stor age This one says that though data is limited, it shows letters help parents comply with safety regulations: https://journalistsresource.org/health/child-access-prevention-research/ Misc. Parental Involvement in Your Child’s Education - The Annie E. Casey Foundation The Effect of Teacher-Family Communication on Student Engagement: Evidence from a Randomized Field Experiment Matthew A. Kraft Better Communication Systems https://pmc.ncbi.nlm.nih.gov/articles/PMC7052788/?utm_source.com https://jamanetwork.com/journals/jamapediatrics/fullarticle/2822858?utm_source.com Crifasi, Cassandra K., et al. "Storage Practices of US Gun Owners in 2016." American Journal of Public Health, vol. 108, no. 4, 2018, pp. 532-537. Hemenway, David, Deborah Azrael, and Matthew Miller. "Whose Guns Are Stolen? The Epidemiology of Gun Theft Victims." Injury Epidemiology, vol. 4, no. 1, 2017, p. 11. Johnson, Renee M., et al. "Who Are the Owners of Firearms Used in Adolescent Suicide?" Suicide and Life-Threatening Behavior, vol. 40, no. 6, 2010, pp. 609-611. National Threat Assessment Center. Protecting America’s Schools: A U.S. Secret Service Analysis of Targeted School Violence. U.S. Department of Homeland Security, 2019. Kivisto, Anthony J., et al. "Adolescent Suicide, Household Firearm Ownership, and the Effects of Child Access Prevention Laws." Journal of the American Academy of Child & Adolescent Psychiatry, vol. 60, no. 5, 2021, pp. 588-596. Webster, Daniel W., et al. "Association Between Youth-Focused Firearm Laws and Youth Suicides." JAMA, vol. 292, no. 5, 2004, pp. 594-601. Webster, Daniel W., and Marc Starnes. "Reexamining the Association Between Child Access Prevention Gun Laws and Unintentional Shooting Deaths of Children." Pediatrics, vol. 106, no. 6, 2000, pp. 1466-1469. Rowhani-Rahbar, Ali, Joseph A. Simonetti, and Frederick P. Rivara. "Effectiveness of Interventions to Promote Safe Firearm Storage." Epidemiologic Reviews, vol. 38, no. 1, 2016, pp. 111-124.