Who are the Firearm Owners in Youth Firearm Suicide?

Sofia Chaudhary, MD
Mark Zamani, MS
Christian Pulcini, MD, MEd, MPH
Elizabeth R. Alpern, MD, MSCE
Peter Ehrlich, MD, MSc
Joel Fein, MD, MPH
Monika Goyal MD, MSCE
Matthew Hall, PhD
Stephen Hargarten, MD, MPH
Rachel K. Myers, PhD, MS
Karen Sheehan, MD, MPH
Bonnie Zima, MD, MPH
Jennifer Hoffmann, MD, MS
Eric Fleegler, MD, MPH

Firearms are the most common and lethal means of suicide for youth ages 10-24 years. To inform youth suicide prevention efforts, it is crucial to understand ownership and storage patterns of these firearms. To address this knowledge gap, we describe ownership and storage patterns of firearms used in youth suicide and examine the sociodemographic and clinical characteristics of decedents associated with firearm ownership by the decedent or the parent.

We conducted a retrospective cohort study of firearm suicides by youth aged 10-24 years from 2018-2021 using the CDC National Violent Death Reporting System. We included data from states that report firearm ownership for ?70% of cases (AZ, CT, DE, KS, ME, MT, NH, ND, HI). We described firearm ownership by age group (10-17, 18-24 years) and among decedents with known mental health (MH) problems. We used multivariable logistic regression to estimate the association of age group and firearm ownership by (1) the decedent and (2) the parent, adjusted for sex, race, ethnicity, rural/urban location, and clinical characteristics. Among cases with non-missing firearm storage data, we described whether firearm was locked and/or loaded by age group.

Of 1,021 youth firearm suicide decedents, most were White (82%), non-Hispanic (80%), ages 20-24 years (63%), and male (89%). Firearm ownership was missing for 23% of decedents. Of the remaining cases (n=788/1021 (77%)), firearms were most often owned by the decedent (56%) or a parent (27%). Among 10-17-year-old decedents (n=166/788 (21%)), 5% owned the firearm and 72% used a firearm owned by a parent. Among 18-24-year-olds (n=622/788 (79%)), 69% owned the firearm and 14% used a firearm owned by a parent. Of decedents with known MH problems (n=307/788 (39%)), 60% owned the firearm and 25% used a firearm owned by a parent. There were lower adjusted odds of firearm ownership by the decedent for 10-17-year-olds compared to 18-24-year-olds (aOR 0.03, 95% CI 0.02, 0.07). There were higher adjusted odds of firearm ownership by the parent for 10-17-year-olds compared to 18-24-year-olds (aOR 10.99, 95% CI 7.50, 16.10). Among decedents 10-17 years of age with known locked (n=135) and loaded (n=105) status, 60% were stored unlocked and 70% were stored loaded. Among decedents 18-24 years of age with known locked (n=327) and loaded (n=350) status, 69% were stored unlocked and 81% were stored loaded.

Approximately three-quarters of 10-17-year-old suicide decedents used a parent’s firearm, while two-thirds of 18–24-year-olds used their own. Although storage data are limited, among decedents with known firearm storage practices, most firearms were stored unlocked and loaded, regardless of age group. Suicide prevention strategies should focus on reducing access to firearms owned by youth, in addition to caregivers.

1. Learn ownership patterns of firearms used in youth suicide in the United States.
2. Understand firearm storage patterns for firearms used in youth suicide by age group.
3. Recognize the need for suicide prevention interventions that are directed towards youth in addition to their parents.

Overcoming Barriers to Healthcare-led Firearm Injury Prevention Strategies

Emma Cornell, MPH
Ashley Blanchard, MD
Sofia Chaudhary, MD
Lindsay Clukies, MD
Olivia Frank, MPH

Due to recent increased awareness and advocacy, healthcare led efforts to advance firearm injury prevention have increased in recent years. From lethal means counseling to hospital-based violence intervention programs (HVIPs), pediatric healthcare providers have embraced efforts to reframe firearm injury prevention as a public health issue. Despite this progress, current changes in funding availability and political climate threaten many programs engaged in this important work. This session aims to equip attendees with creative strategies and solutions to navigate current challenges in funding and political climate, to sustain this life-saving work. Attendees will be asked to share common barriers they have experienced in their own practice, and workshop presenters will facilitate a dynamic, solutions-oriented dialogue, drawing on their combined experiences operating HVIPs, lethal means counseling and secure firearm storage programs across the country. Workshop leaders will highlight innovative strategies for program continuity and empower attendees to apply these strategies in their own practice to address various types of firearm injury, including suicide, homicide, and unintentional injury. In this interactive session, participants will first hear from workshop leaders, followed by brief peer-to-peer conversations on individual challenges and solutions. Through these conversations, attendees will network and meet participants at varied levels of institutional engagement in firearm injury prevention efforts offering a broad spectrum of perspectives and possible future collaborations.

1. Describe common barriers among existing clinical programs for firearm injury prevention
2. Identify unique stakeholders to partner with to continue firearm injury prevention initiatives
3. Recognize institutional and community facilitators to strengthen and sustain firearm injury prevention programs