Impact of a Firearm Safety Device Distribution Intervention on Storage Practices After an Emergent Mental Health Visit



      To determine if providing firearm storage devices with training during clinical care improves safe storage practices in household members of children who present to a pediatric hospital with an emergent mental health complaint.


      Prospective, pre-post study. Enrollment occurred in the emergency department or the inpatient psychiatric unit. Participants in the observation phase received usual care. Participants in the intervention phase were randomized to be offered a firearm storage device at either no or low ($5) cost and trained in its use. We surveyed participants at enrollment, 7, & 30 days post visit. Our primary outcome was triple-safe storage (TSS) - storing firearms unloaded, locked, and with ammunition stored and locked separately.


      About 256 participants enrolled. In the observation phase TSS increased from 21% (95% confidence interval [CI] 14%–30%) at baseline to 31% (95% CI 21%–42%) at 7 and 31% (95% CI 21%–43%) at 30 days. In the intervention phase, TSS increased from 32% (95% CI 25%–39%) at baseline to 56% (95% CI 48%–64%) at 7 and 56% (95% CI 47%–64%) at 30 days. Among those not practicing TSS at baseline, 7-day TSS was higher in the intervention (38%) versus the observation phase (14%, P = .001).


      Distribution and training in the use of firearm storage devices increased TSS in the study population, improves pediatric safety and should be part of the routine care of these high-risk patients.


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      1. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Leading causes of death reports, 1981–2019. Available at: Accessed February 17, 2021.

        • Curtin SC
        • Heron M
        • Miniño AM
        • et al.
        Recent increases in injury mortality among children and adolescents aged 10-19 years in the United States: 1999-2016.
        Natl Vital Stat Rep. 2018; 67: 1-16
        • Miller M
        • Azrael D
        • Hemenway D
        The epidemiology of case fatality rates for suicide in the Northeast.
        Ann Emerg Med. 2004; 43: 723-730
        • Shenassa ED
        • Catlin SN
        • Buka SL
        Lethality of firearms relative to other suicide methods: a population based study.
        J Epidemiol Community Health. 2003; 57: 120-124
        • Brent DA
        • Perper JA
        • Allman CJ
        • et al.
        The presence and accessibility of firearms in the homes of adolescent suicides. A case-control study.
        JAMA. 1991; 266: 2989-2995
        • Brent DA
        • Perper JA
        • Moritz G
        • et al.
        Firearms and adolescent suicide. A community case-control study.
        Am J Dis Child. 1993; 147: 1066-1071
        • Shah S
        • Hoffman RE
        • Wake L
        • et al.
        Adolescent suicide and household access to firearms in Colorado: results of a case-control study.
        J Adolesc Health. 2000; 26: 157-163
        • Grossman DC
        • Mueller BA
        • Riedy C
        • et al.
        Gun storage practices and risk of youth suicide and unintentional firearm injuries.
        JAMA. 2005; 293: 707-714
        • Shenassa ED
        • Rogers ML
        • Spalding KL
        • et al.
        Safer storage of firearms at home and risk of suicide: a study of protective factors in a nationally representative sample.
        J Epidemiol Community Health. 2004; 58: 841-848
        • Kellermann AL
        • Rivara FP
        • Somes G
        • et al.
        Suicide in the home in relation to gun ownership.
        N Engl J Med. 1992; 327: 467-472
        • Simonetti JA
        • Theis MK
        • Rowhani-Rahbar A
        • et al.
        Firearm storage practices in households of adolescents with and without mental illness.
        J Adolesc Health. 2017; 61: 583-590
        • Scott J
        • Azrael D
        • Miller M
        Firearm storage in homes with children with self-harm risk factors.
        Pediatrics. 2018; 141e20172600
        • Simonetti JA
        • Mackelprang JL
        • Rowhani-Rahbar A
        • et al.
        Psychiatric comorbidity, suicidality, and in-home firearm access among a nationally representative sample of adolescents.
        JAMA Psychiatry. 2015; 72: 152-159
        • Runyan CW
        • Becker A
        • Brandspiegel S
        • et al.
        Lethal means counseling for parents of youth seeking emergency care for suicidality.
        West J Emerg Med. 2016; 17: 8-14
        • Kruesi MJ
        • Grossman J
        • Pennington JM
        • et al.
        Suicide and violence prevention: parent education in the emergency department.
        J Am Acad Child Adolesc Psychiatry. 1999; 38: 250-255
        • Rowhani-Rahbar A
        • Simonetti JA
        • Rivara FP
        Effectiveness of interventions to promote safe firearm storage.
        Epidemiol Rev. 2016; 38: 111-124
        • Simonetti J
        • Rowhani-Rahbar A
        • King C
        • et al.
        Evaluation of a community-based safe firearm and ammunition storage intervention.
        Inj Prev. 2018; 24: 218-223
        • Miller M
        • Salhi C
        • Barber C
        • et al.
        Changes in firearm and medication storage practices in homes of youths at risk for suicide: results of the SAFETY study, a clustered, emergency department-based, multisite, stepped-wedge trial.
        Ann Emerg Med. 2020; 76: 194-205
        • Fishbein M
        • Ajzen I
        Predicting and Changing Behavior: The Reasoned Action Approach.
        Taylor & Francis, 2010
        • Harris PA
        • Taylor R
        • Thielke R
        • et al.
        Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Gardner W
        • Paier K
        • Cloutier P
        • et al.
        Health outcomes associated with emergency department visits by adolescents for self-harm: a propensity-matched cohort study.
        CMAJ. 2019; 191: E1207-E1216
        • Hawton K
        • Bergen H
        • Kapur N
        • et al.
        Repetition of self-harm and suicide following self-harm in children and adolescents: findings from the Multicentre Study of Self-harm in England.
        J Child Psychol Psychiatry. 2012; 53: 1212-1219
        • Chung DT
        • Ryan CJ
        • Hadzi-Pavlovic D
        • et al.
        Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis.
        JAMA Psychiatry. 2017; 74: 694-702
        • Fowler KA
        • Dahlberg LL
        • Haileyesus T
        • et al.
        Childhood firearm injuries in the United States.
        Pediatrics. 2017; 140e20163486
        • Deisenhammer EA
        • Ing CM
        • Strauss R
        • et al.
        The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a suicide attempt?.
        J Clin Psychiatry. 2009; 70: 19-24
        • Drum D
        • Brownson C
        • Denmark A
        • et al.
        New data on the nature of suicidal crises in college students: shifting the paradigm.
        Prof Psychol Res Pract. 2009; 40: 213-222
        • Barber CW
        • Miller MJ
        Reducing a suicidal person's access to lethal means of suicide: a research agenda.
        Am J Prev Med. 2014; 47: s264-s272
        • Runyan CW
        • Brandspigel S
        • Barber CW
        • et al.
        Lessons learned in conducting youth suicide prevention research in emergency departments.
        Inj Prev. 2020; 26: 159-163
        • Suicide Prevention Resource Center
        Counseling on access to lethal means.
        2020 (Available at:)
        Date accessed: September 11, 2020
      2. Initiative 1639: frequently asked questions. Washington State Office of the Attorney General website. Available at: Accessed March 2, 2020.