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Abstract
Despite evidence that firearm access in the home is a strong risk factor for firearm injury, firearms are owned more often for self-protection than for any other reason. In this cross-sectional study, we describe the association between firearm ownership and perceived risk of personal firearm injury using logistic regressions applied to data from the 2018 California Safety and Well-being Survey. Most respondents (57.7%) reported being very/somewhat worried about gun violence happening to them. Compared with non-owners in households without firearms, firearm owners were 60% (adjusted OR (aOR) 0.40, 95% CI: 0.27 to 0.58) less likely to be worried about gun violence happening to them; non-owners living in homes with firearms were 46% (aOR 0.54, 95% CI: 0.33 to 0.88) less likely. This suggests an underestimation of actuarial risk that conflicts with the available evidence, with important implications for public health messaging.
- firearm
- violence
- risk perception
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Introduction
Although firearms may provide a general sense of security, evidence suggests they increase risk of firearm injury and death for owners and those living in homes with firearms, while offering no unique benefits for preventing crime.1 Nevertheless, a large and growing number of Americans own firearms for self-protection.2
The 2015 National Firearms Survey reported that 43% of firearms purchased within the last 5 years (at the time of the survey) were acquired for self-protection, compared with 35% of those purchased more than 5 years ago.2 More recently, firearm sales have surged in the USA amid the COVID-19 pandemic—with an estimated 2.1 million more firearm purchases than expected between March and May 2020.3 News reports have linked the increase to people’s fears about an uncertain future, personal safety and possible civil unrest.4 While the trigger for the current increase in sales is unprecedented in modern history, the reasons underlying the surge are arguably rooted in long-standing perceptions about the risks and benefits associated with firearm ownership.
Indeed, prior work has demonstrated spikes in firearm purchasing associated with societal shocks such as mass shootings and presidential elections.5 These spikes have been associated in turn with increases in firearm violence,3 5 signalling a possible disconnect between perceptions of safety associated with household firearm access and actuarial risk of firearm injury.
Those with access to firearms are more likely to die from firearm violence, including suicide,6 homicide6 and unintentional injury,7 compared with those without access to firearms. Firearm homicide deaths in the home are much more often criminal than self-defensive,8 and risks of firearm homicide victimisation associated with firearm access are greater for women than for men.6 The vast majority of firearm deaths that occur in the home are suicides.8 A recent analysis of 26.3 million California residents found that the purchase of a handgun was associated with 7.82 (95% CI, 7.26 to 8.43) and 35.15 (95% CI, 29.56 to 41.79) times the hazard of firearm suicide for men and women, respectively.9 Further, people who own firearms primarily for protection may be more likely to store their firearms unlocked and/or loaded10—an independent risk factor for firearm injury in households with firearms.11
The risks of firearm access could be exacerbated by COVID-19-related social and economic stressors. Many Americans are experiencing increased anxiety, financial strain and disruptions to daily routines imposed by social distancing measures and stay-home orders, which, in combination with extended periods of access to easily-available firearms, may increase unintentional shootings, completed suicides12 and intimate partner homicides. Better understanding perceptions of risk of firearm injury among firearm owners and those living in homes with firearms can guide strategies for communicating the health risks of firearm access, which may be particularly important during times of crisis or heightened perceived need for safety.
While prior research has examined the relationship between firearm ownership and perceived risk of violence generally,13 this is the first study, to our knowledge, to examine how personal and household firearm ownership, and specific characteristics of owners and ownership, are related to perceptions of personal firearm injury risk. Our findings, which are based on data that pre-date the COVID-19 crisis, nonetheless offer useful context for understanding emerging trends and assessing change over time in firearm purchasing and firearm violence during this unique time.
Methods
Data
We used cross-sectional data from the 2018 California Safety and Well-being Survey (CSaWS) (n=2558), a state-representative survey of adult residents of California which is described in more detail in the online supplementary material and in prior publications.14 CSaWS received institutional review board approval from the University of California, Davis, and respondents received a standard consent page online before starting the survey. Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research.
Supplemental material
Measures
Firearm ownership was measured with two questions: “Do you or does anyone else you live with currently own any type of gun?” and if, yes, “Do you personally own a gun?” Respondents were classified accordingly as personal firearm owners, non-firearm-owners living in homes with firearms and non-firearm-owners living in homes without firearms.
Perceived risk of personal firearm injury was defined according to respondents’ answer to the question: “In general, how worried are you about gun violence happening to you?” To optimise conceptual distinctions and the size of each group, we created two categories: those who felt very or somewhat worried versus not at all or not too worried about gun violence happening to them. Secondary analyses show results for an alternative categorisation (not at all versus any concern).
Available covariates hypothesised to confound the association included characteristics of individuals (age, sex, race/ethnicity), households (children in the home) and the environment (violent crime rate of county of residence). A second model—restricted to firearm owners—examined whether owners’ primary reason for ownership, duration of ownership and storage practices were associated with risk perceptions (Question text in online supplementary file).
Statistical analysis
Data were analysed with multivariable survey-weighted logistic regression models using the SVY suite in Stata, V.15.1 (StataCorp LP, College Station, Texas, USA).
Results
Non-owners in households without firearms accounted for 71.0% of respondents, non-owners living with owners for 10.5% and owners for 14.4% (online supplementary table 1). Most respondents (57.7%) reported being somewhat (35.9%) or very (21.8%) worried about gun violence happening to them.
Compared with non-owners in households without firearms, firearm owners and non-owners living with owners were 60% (adjusted OR (aOR) 0.40, 95% CI: 0.27 to 0.58) and 46% (aOR 0.54, 95% CI: 0.33 to 0.88) less likely to be worried about gun violence happening to them, respectively (table 1). Respondents who were younger, female (vs male), and non-white (vs white) perceived greater risk of personal firearm injury. Results for firearm owners, but not non-owners living with owners, were robust to the alternative outcome categorisation (online supplementary table 2).
Association between firearm ownership status and perceived risk of personal firearm injury among all survey respondents (n=2558), 2018 California Safety and Well-being Survey
Among owners, differences in storage practices, reasons for ownership and duration of ownership were not associated with variation in perceptions of risk of personal firearm injury (table 2).
Association between firearm ownership status and perceived risk of personal firearm injury among firearm owners (n=429), 2018 California Safety and Well-being Survey
Discussion
Individuals living in homes with firearms, including owners and non-owners living with owners, were substantially less likely to be worried about personal firearm injury than were non-owners living in homes without firearms. Our findings highlight a disconnect between the epidemiological literature and individuals’ concern for personal firearm injury. Such a disconnect is consistent with prior work on Americans’ (mis)perceptions about the relative frequency of firearm-involved and non-firearm-involved violent death,15 and it suggests an opportunity for improved public health messaging and shifts in social norms.
Effective communication strategies may involve credible messengers—who have cultural competency and may relate to the various social, economic and cultural factors that contribute to the decision to own firearms—as well as health professionals—who counsel patients about a range of other health-related behaviours, including smoking, seat belt use and diet. For example, in several US states, public health professionals and firearm retailers have partnered to disseminate firearm injury prevention materials to prospective purchasers.16 Clinicians are also uniquely positioned to communicate the risks of firearm ownership and work with their patients to improve safety, for example, through counselling about safer firearm storage and recognition of contributing factors (eg, cognitive impairment).17 Additional research on the reach of firearm safety messages and receptivity to them may identify specific areas of improvement.18
Limitations
Limitations include our relatively small, single-state sample, the potential for social desirability and selection biasses, and the possibility that respondents did not consider all types of firearm violence, specifically suicide.
These cross-sectional data do not allow for assessment of the direction of associations. It is possible that firearm ownership led to lower risk perceptions. It is also plausible that a belief in decreased risk associated with ownership is what motivated some to own firearms. Either way, given the current COVID-19-related surge in firearm purchasing, the association between firearm ownership and lower risk perceptions is likely stronger today than at the time of the survey in 2018. Forthcoming research by our group will explore whether the association between firearm ownership and perceived risk of firearm injury has changed over time and to what extent concern for safety and self-protection motivates first-time purchasers during the coronavirus pandemic. In addition, future research should examine perceived risk of specific types of firearm violence (eg, interpersonal, self-directed) and the development and evaluation of tailored messages and other social norm interventions.
Conclusion
Our findings suggest a disconnect between perceived and actuarial risk of personal firearm injury. Firearm violence prevention interventions should consider culturally-competent strategies to inform firearm owners and people living in households with firearms about the risks associated with having a firearm in the home. This may be particularly important as many Americans purchase firearms—some of whom, it seems, for the first time—for self-protection during the COVID-19 crisis.4 However, firearm ownership, like many health-related choices, must be understood within context and with consideration of the range of factors that influence individual decision-making. Innovative interventions that appropriately address risk perceptions along with cognitive biasses and cultural and economic contexts may be more effective than approaches that address risk perceptions alone.
What is already known on the subject
The health risks of having a firearm in the home have been extensively documented.
Firearms are commonly owned for self-protection.
Firearm sales have surged in the USA amid the COVID-19 pandemic.
What this study adds
Firearm owners and non-owners living in homes with firearms were substantially less likely to be worried about personal firearm injury than were non-owners living in homes without firearms.
There may be a need for culturally-competent strategies to inform firearm owners and people living in households with firearms about the risks associated with having a firearm in the home, particularly during times of crisis or heightened perceived need for safety.
References
Footnotes
Correction notice The article has been corrected since it is published. The citation in the 4th paragraph in the INTRODUCTON section has been updated.
Contributors All authors contributed to the conceptualisation and design of the study. JPS carried out the analyses and drafted the manuscript. GJW and NKW contributed to the interpretation of the findings and critical revision of the manuscript. JPS had full access to the data and takes responsibility for the integrity of the data and accuracy of the analyses.
Funding This research was supported by University of California Firearm Violence Research Center with funds from the State of California (no award number). Additional support came from the California Wellness Foundation (award number 2014–255), the Heising-Simons Foundation (award number 2017–0447) and the University of California, Davis, Violence Prevention Research Program (no award number).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.