Perceptions of Firearm Safety and Youth Suicide Among Adults With a Child in Their Home

In the United States, 4.6 million households with youth contain loaded and unlocked firearms.1 Firearms in the home, particularly unsecured household firearms, are associated with an increased risk of youth suicide.2,3 This study examined perceptions of firearm safety and suicide among adults with children in the home, with and without household firearms. This is critical to providing effective, patient-centered anticipatory care for children and the adults they live with.4The cross-sectional Colorado Firearm Injury Prevention Survey was administered by the Ipsos survey firm online in English and Spanish from April through May 2023. The sample comprised 627 participants from the Ipsos KnowledgePanel (70.3% response rate of 924 fielded) and 893 opt-in (nonrandom) participants.5 The opt-in sample used calibrated weights of known geodemographic and behavior measures to ensure the blended sample was representative of the Colorado population. Of these 1520 participants, we included 512 reporting children aged <18 years “living, visiting, or staying in [their] home” regardless of their relationship to the child. Survey questions assessed firearm storage, perceptions of firearm-related risks, and concerns about youth suicide in the community and at home. Likert scales facilitated participants identifying with a response option but were dichotomized to improve interpretability. Neutral responses were categorized as negative. We estimated weighted prevalences and 95% confidence intervals (CI) and compared differences between households with and without firearms using weighted χ2 tests using R version 4.3.2. Poststratification weights were applied to account for differential nonresponse such that findings are representative of the statewide population of Colorado adults. The study was approved by the Colorado Multiple Institutional Review Board and followed STROBE reporting guidelines.Most Colorado adults with children in the home were female (56.4%), aged 25–54 (77.4%), White (87.8%), non-Hispanic (74.9%), and had a child ≤12 years at home (79.3%) (Table 1). Nearly half (45.5%) reported having a firearm in the home. Among all adults with children in the home, 23.7% correctly identified suicide as the leading cause of firearm death in Colorado, with no significant difference between those with versus without household firearms. Compared with adults with children in the home without firearms, those in households with firearms were less likely to believe that a firearm in the home made the home more dangerous (6.7 vs 28.9%, P < .001), that suicide can be prevented (47.8 vs 68.9%, P < .001), or that temporary removal in times of crisis decreases risk of firearm injury or death (59.6 vs 77.7%, P < .001), but more likely to believe that secure storage reduced the risk of firearm injury or death (92.9 vs 85.9%, P = .012).Nearly two thirds of adults with children in the home were concerned about youth suicide in their community (63.7%), with no significant difference groups. Adults with children in the home with household firearms were less frequently concerned about suicide among youth within their own family compared with those without household firearms (28.1 vs 38.5%, P = .013) (Table 2).Among Colorado adults with children in the home living in households with firearms, most do not believe that having a firearm in the home makes it more dangerous or that suicide is preventable. All adults with children in the home expressed more concern for youth suicide in the community than in their own family. The belief among firearm owners that an individual in their household is less likely to suffer a firearm injury than the general public, or optimism bias, has been well described in firearm research.6 In this sample, the risk may be compounded by a belief among firearm-owning households that suicide is not preventable and that strategies to mitigate the risk of suicide, such as temporarily and voluntarily removing firearms from the home, are not effective.Our finding that most firearm owners believe that secure firearm storage is protective against firearm injury is a promising messaging strategy. It presents a preventive education opportunity for adults living with children who have with mental health concerns, who may benefit most from secure in-home storage and/or temporary and voluntary storage of firearms away from home.7 Future research should explore the effectiveness of preventive messaging in improving perceptions around household firearms and youth suicide risk.This study has several limitations. Results may not be generalizable to other US states. As in all survey studies, responses may have been impacted by nonresponse or social desirability bias. Finally, perceptions of firearms and safety did not include context that may affect violence risk, such as prevalence of neighborhood crime, socioeconomic status, and history of violence victimization.