State-Level Extreme-Risk Protection Order Policies, Mental Health, and Gun Carrying: Demographic and Racial Disparities in U.S. Youth

Gun carrying among U.S. high school students increases risks for violence and injury. Poor mental health is linked to carrying guns, but less is known about how this link varies across demographic and racialized groups. Extreme-risk protection orders (ERPOs) allow temporary removal of firearms from individuals at high risk of harming themselves or others, including during a mental health crisis. Their potential to reduce disparities in youth gun carrying is not well studied. This study assessed whether ERPOs modify the association between poor mental health and gun carrying in high school students overall and subgroups. Data came from the 2023 pooled state Youth Risk Behavior Surveillance System. Gun carrying was the outcome, poor mental health was the predictor, and ERPOs were the moderator, categorized as EROP (less restrictive), Ex parte (moderately restrictive), and Ex parte expanded (more restrictive). Sex, grade, and race were included. Multilevel mixed-effects logistic regression models tested interactions between ERPOs and poor mental health. Demographic and racialized differences in gun carrying were identified. Males had higher odds of carrying guns than females. Poor mental health was associated with higher odds of gun carrying overall and in subgroups, with stronger associations among males, 12th graders, African American students, and Hispanic students. Across the sample and subgroups, ERPOs were linked to reduced gun carrying among students reporting poor mental health. Findings suggest that ERPOs may lower the risk of gun carrying linked to poor mental health and may also reduce demographic and racialized disparities in youth firearm harm.