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Abstract
Background The Gun Shop Project aims to reduce firearm suicide and is widely implemented in the USA, yet little is known about the core firearm business practices and behaviours that might contribute to preventing firearm suicide.
Methods Owners or managers of all firearm businesses identified as participants in Colorado’s Gun Shop Project were invited to respond to a questionnaire. Data collection occurred from March to May 2021. Analyses included unweighted descriptive statistics with CIs and Pearson χ2 tests for categorical associations.
Results 54 firearm businesses participated (response rate: 28%). Under half reported practices that are Gun Shop Project core aspects (range: 14%–45%). 22% of businesses frequently engaged customers on the importance of safe firearm storage in suicide prevention while 26% had denied a firearm sale and 14% had assisted with temporary secure storage in the past year with customers perceived to be in suicidal crisis. However, high proportions reported willingness to engage in these behaviours if a customer was in crisis: 74% were willing to refuse a sale of a firearm or ammunition, 70% were willing to discuss temporary secure storage options and 70% were willing to direct customers to mental health services.
Conclusions This study suggests that efforts to continue educating and involving firearm businesses may have an impact on the adoption of organisational suicide prevention practices and behaviours. Ongoing efforts are needed to understand core components of Gun Shop Project to inform standardised recommendations for effective firearm business practices that prevent firearm suicide.
- public health
- firearm
- suicide/self?harm
- cross sectional study
- community
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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WHAT IS ALREADY KNOWN ON THIS TOPIC
Using trusted messengers to deliver firearm suicide prevention education to the firearms community is a promising pathway to deliver firearm suicide prevention education to a high-risk population with access to firearms. The Gun Shop Project establishes firearm businesses as the trusted messenger to provide this education and services to the firearms community.
WHAT THIS STUDY ADDS
Little is known on the core components of the Gun Shop Project and how businesses are adopting and implementing them. This study advances our understanding of the core aspects of implementation of the Gun Shop Project in Colorado and which are associated with organisational practices that may prevent firearm suicides.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
The Gun Shop Project has been widely implemented in US states; implementing agencies and firearm businesses would benefit from guidance on core aspects that are associated with adoption of practices that may prevent suicide. These findings suggest that businesses implementing the Gun Shop project would be better supported with consistent visits and technical assistance to build their understanding of their role in promoting secure firearm storage to prevent firearm suicide and services they could offer to their customers and community.
Introduction
Suicide is a leading cause of death in the USA; in 2021, there were 48 183 suicide deaths and 55% of these involved firearms.1 Firearm access is a key risk factor for suicide,2–6 largely due to the high lethality (85%–90%) of suicide attempts with firearms.7 Reducing access to lethal means—particularly firearms—is an evidence-based strategy to prevent suicide.8 9 Securely storing firearms in-home or out-of-home is practising lethal means safety with firearms. The Gun Shop Project (GSP) builds collaborative partnerships between the firearms and public health communities to educate firearm owners on the importance of secure firearm storage for suicide prevention and to encourage temporary, voluntary reduction of access to firearms during times of crisis.10
GSP began in 2009; the efforts rely on trusted messengers in the firearms community: firearm retailers, shooting ranges and other establishments that provide firearm-related services (eg, safety instruction, hunting licenses, ammunition sales, gunsmithing).10–12 GSP efforts have since expanded to 21 other states,13 varying in scale and complexity. They generally have core components, including educational messaging (eg, displaying or distributing suicide prevention materials or engaging customers in discussions about firearm access and suicide risk) and staff training (eg, to recognise individuals at risk for suicide and ways in which the business might intervene).14 However, there are few studies on GSP core components and how these practices may drive organisational education or intervention efforts. A qualitative study with leaders of state and national GSP partnerships confirmed critical core components of providing educational materials to customers and creating trainings on suicide prevention for staff.14 A study of the New Hampshire GSP assessed ongoing engagement in suicide prevention efforts, finding that almost half of firearm retailers remained engaged in GSP 6 months after being invited to participate.12
Based on the promise of this initiative and a call for expanding efforts like these by the surgeon general in 2012,15 Colorado’s GSP began in 2015; by 2020, partnerships were in place between public health and firearms communities in 34 of 64 (53%) Colorado counties. The present study used a cross-sectional survey to understand GSP participation in Colorado, the core GSP practices used by firearm businesses to engage in suicide prevention, and how these practices were associated with business behaviours that had the potential to prevent suicide among the firearms community.
Methods
Study population
Eligible survey participants were owners and/or managers of firearm businesses who had participated in the Colorado GSP between 2015 and 2020. Firearm businesses were identified via the Colorado Department of Public Health and Environment administrative files that included the county and name of businesses visited as part of GSP outreach between 2015 and 2020; 355 visits were recorded over this 5-year period and included outreach to businesses in 53% of Colorado counties. To refine the list of eligible firearm businesses, we removed duplicates and coded businesses as having participated in GSP if they had at least one documented visit indicating interest in GSP messaging or materials. To identify whether the business was still in operation in 2021 and to find the physical address, we compared our list with the publicly available Federal Firearms License (FFL) list maintained by the US Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF).16 We confirmed the business was still open and had a brick-and-mortar location using Google. These steps resulted in a final list of 196 active firearm businesses that had participated in the Colorado GSP between 2015 and 2020.
Patient and public involvement
The research design and survey instrument were informed by firearms community experts, including firearm advocates who recruited firearm businesses to participate in GSP, firearm instructors and representatives of firearm organisations.
Survey instrument
The survey instrument included questions on business characteristics, respondents’ individual demographic characteristics and their knowledge, beliefs, self-efficacy and motivation for participation in the GSP (behavioural antecedents). We also collected information on GSP participation and suicide prevention practices and behaviours that could be implemented by businesses (see online supplemental appendix for survey instrument questions).
Supplemental material
Supplemental material
Supplemental material
Data collection
From March to May of 2021, we emailed (when publicly available) or mailed a letter to eligible firearm businesses explaining the purpose of the study and support for the study from multiple reputable firearm industry partners. The initial communication asked that a business owner or manager (or employee familiar with organisational policies and practices) respond to the online survey. We sent three separate communications to non-respondents with a letter with a link to the survey; the third included the paper survey with a postage-paid envelope to return. All offered a US$50 incentive for completing the survey. We made one final phone call to contact non-respondents call to explain the study purpose and to ensure they had received the letters or offered to email the link directly to them. Study data were collected and managed using Research Electronic Data Capture, a secure, web-based software platform designed to support data capture for research studies.17 18
Data analysis
Bias analyses confirmed the sample of businesses was equally representative of urban and rural gun shops. We used SPSS Statistics V.29 to produce unweighted descriptive statistics and we included 95% CIs around the estimates. To understand potential core components of GSP that may shape organisational behaviours that could result in preventing suicide, we assessed how factors were associated with the behaviours of engaging customers on suicide prevention, denying sales to customers and assisting customers with temporary secure storage. To determine whether factors were present for respondents, we dichotomised all survey question responses where applicable. Behavioural antecedent scales were constructed from dichotomised item responses (see online supplemental appendix for analysis procedures). We used Pearson χ2 tests for categorical associations.
Results
A total of 54 firearm businesses completed the survey (28% response rate). While the majority were firearm retailers (61%), businesses also included training centres or safety instructors (22%), gunsmiths (20%), pawn shops (13%), ranges (11%) and other products or services or frequently interacted with firearm owners (table 1). Almost all (91%) of the responding businesses had been in operation for over 5 years and 42% were in rural areas. 69% of respondents were owners of the business; most were non-Hispanic (92%), white (85%), men (84%), over the age of 45 (64%) (table 1).
Business and individual characteristics of study participants: participating GSP firearm businesses in Colorado, 2021
Participation in GSP
The eligible participant list was developed based on administrative records indicating that the firearm businesses indicated interest in GSP messaging or materials at least one point in time between 2015 and 2020. These records did not include any information about the nature of the engagement or what educational materials or technical assistance were provided at that time, nor did the records have information about how often businesses were visited which may have helped to understand how long GSP was implemented in the businesses. At the time of data collection in 2021, only 20% (11 of 54) reported they were involved in the Colorado GSP. Survey participants self-defined whether they were involved in GSP, which may have included displaying or distributing suicide prevention materials, providing employees with suicide prevention training or firearm safety training that included suicide prevention information to customers or providing temporary secure storage of firearms to customers. All those who reported involvement in GSP indicated their motivation for participation was to make a positive contribution to their community and all but one indicated it was because they wanted to help prevent suicide. While only 44% (24 of 54) were aware of the Colorado GSP by name, of those who reported they were not involved with GSP, 62% (26 of 42) reported they had been visited by someone who provided information and/or resources on secure storage and suicide prevention.
Suicide prevention practices and behaviours
While not all businesses reported GSP recognition or current involvement, all were included in the analyses since administrative records showed they had participated in GSP at some time between 2015 and 2020. We presented the respondents with a series of organisational practices that are typical GSP components to understand whether these practices were adopted (table 2). While 44% (24 of 54) made suicide prevention materials available for customers or put materials on display, only 14% (7 of 50) included suicide prevention materials during a sale or when interacting with customers regularly. 17% (9 of 54) reported their employees received suicide prevention training. Of the 29 businesses that provided firearm safety courses or training to customers, 45% included suicide prevention information in the instruction. Finally, 41% (22 of 54) reported providing temporary secure storage for firearms.
Percentage of participating GSP firearm businesses engaging in practices and behaviours to prevent suicide: Colorado, 2021
We also asked respondents about organisational behaviours they employ that engage customers in suicide prevention (table 2). Only 22% (11 of 50) engaged customers regularly in conversation about the role secure storage can play in suicide prevention. In more direct opportunities for intervention with customers that were in crisis or displaying warning signs of suicide, 14% (7 of 51) had assisted a customer with temporary secure storage in the last year. Of businesses that sold firearms, 26% (10 of 38) had denied a sale to a customer perceived to be in suicidal crisis in the last year. Finally, high proportions of respondents reported willingness to engage in behaviours that could prevent suicide if customers were in crisis: 74% (40 of 54) were willing to refuse a sale of a firearm or ammunition, and 70% (38 of 54) were willing to discuss temporary secure storage options or direct customers to mental health services. Businesses were also willing to notify law enforcement (46%), ask customers directly if they were considering suicide (43%) and notify other firearm businesses of their concerns about customers (35%).
Factors associated with suicide prevention behaviours
Table 3 presents factors associated with engaging customers in the role of secure storage in suicide prevention regularly, compared with those who only did this sometimes or never. Businesses were more likely to report frequently engaging customers if they reported including suicide prevention materials during a sale or regularly when interacting with customers (36% vs 8%, p=0.02) or if they provided firearm safety instruction to customers that included suicide prevention information (83% vs 38%, p=0.050). They were also more likely to frequently engage customers if the respondent had high motivation for firearm businesses being involved in suicide prevention efforts (73% vs 36%, p=0.03).
Relationships between engaging customers on importance of secure storage in suicide prevention and suicide prevention practices, business characteristics and behavioural antecedents: participating GSP businesses in Colorado, 2021
Table 4 presents factors associated with denying a sale of a firearm to a customer in the past year if they believed a customer was in crisis or displaying warning signs of suicide compared with businesses that did not deny a sale in the past year. There were no significant associations between denying a sale and suicide prevention practices typical of GSP. Those who reported denying a sale were more likely to report having been impacted by suicide in some way than businesses that had not denied a sale (71% vs 24%, p=0.02). Moreover, those who had reported denying a sale (compared with those who had not) had significantly higher knowledge about firearms and suicide prevention (80% vs 43%, p=0.04), self-efficacy to take steps to prevent suicide (90% vs 46%, p=0.02) and were motivated for firearm businesses to be involved in suicide prevention efforts (90% vs 39%, p=0.01).
Relationships between denying sales in past year to customers in crisis or displaying warning signs of suicide and suicide prevention practices, business characteristics and behavioural antecedents: participating GSP Businesses in Colorado, 2021
There were no significant associations with assisting a customer with temporary secure storage in the last year if a customer was in suicidal crisis (online supplemental appendix table A).
Discussion
This is the first study to examine state-wide GSP participation and assess which suicide prevention practices typical to GSP, business characteristics or behavioural antecedents may be associated with suicide prevention behaviours in firearm businesses. Our findings suggest that firearm businesses are willing to engage and are engaging in direct behaviours that would intervene and support a customer in suicidal crisis or displaying warning signs. 74% reported willingness to refuse the sale or rental of a firearm or ammunition and 26% had denied the sale of a firearm to a customer in crisis in the past year.
While providing temporary and voluntary out-of-home storage is an effective practice to reduce access to firearms for someone in suicidal crisis, only 14% reported they had assisted a customer with temporary secure storage in the past year; however, 70% said they were willing to provide this service when there was a concern about mental stability of a firearm owner or person in their home. This is consistent with a previous study assessing gun retailers’ willingness to provide temporary firearm storage in the Mountain West.19 We are aware that many firearm businesses with FFLs closely adhere to guidance from ATF and acknowledge there are established guidelines of the legality of denying the sale of a firearm if there are mental health or substance abuse concerns. The lower reports of assisting with temporary storage may be due to a lack of guidance from ATF on this practice (which became available in 2023,20 following this study timeline) and concerns for liability in storing firearms of individuals and when returning them if a person might still be in crisis.21 22
Moreover, our study found only 22% of firearm businesses were engaging customers regularly in conversations about the importance of secure storage for suicide prevention. A study in Washington state found that 62% of firearm retailers were willing to engage in these conversations,23 demonstrating a gap between willingness and routine action to engage customers in these educational opportunities.
A qualitative study of GSP in nine states reported the most common GSP efforts included distribution of educational materials and employee training.14 However, only 44% of businesses in our study reported providing or displaying suicide prevention materials to customers, 45% of businesses that provided firearm safety instructions reported providing information on suicide prevention, and 41% reported offering temporary secure storage. Even fewer businesses provided suicide prevention materials during a sale or when interacting with customers (14%) or ensured their employees received suicide prevention training (17%). Our study assessed firearm business participation in GSP at any point since Colorado began its efforts in 2015, which meant businesses had participated anywhere from 3 months to 6 years prior to receiving our survey. Given this, these findings suggest there is an opportunity to support firearm businesses in maintaining core GSP efforts over time.
Our study had interesting findings on how suicide prevention practices typical to GSP, business characteristics and behavioural antecedents were related to organisational behaviours that could be implemented to prevent suicide. It is important to understand and identify the most effective components of GSP to provide standardised recommendations for what practices and behaviours GSP should target to achieve the stated goals of reducing firearm suicide. Our study shows the educational practices of providing suicide prevention materials during a sale or when interacting with customers and presenting suicide prevention information in firearm safety instruction are more common practices among firearm businesses that report frequently engaging customers on the importance of secure storage in preventing suicide. This might be because there is an easy opportunity to facilitate this conversation through classroom instruction or as a pamphlet is handed to a person during a sale. Moreover, we demonstrate that individuals having strong knowledge and self-efficacy about how firearm access is associated with suicide risk and suicide prevention are highly associated with having denied a sale to a customer suspected to be in a suicidal crisis. A study assessing mechanisms for behaviour change among Washington firearm retailers found that knowledge and beliefs were predictors of willingness to engage in suicide prevention efforts.23 Our study found that businesses reporting higher motivation for being involved in firearm suicide prevention were more likely to report denying a sale or engaging customers in suicide prevention. Together, these findings suggest that efforts to continue educating and involving firearm businesses through GSP—and not only leadership but all employees—may have an impact on the adoption of organisational practices and behaviours that could prevent suicide.
Finally, it was notable that few businesses reported being currently involved in GSP (20%) or recognising it by name (44%). This may be explained by the extensive time frame of potential involvement in GSP (began at any time between 2015 and 2020 and may not have been consistently involved during this time) and possible turnover of business staff and leadership. It is also limited due to the study team’s use of administrative records to define ‘participation’ as an indication of interest in GSP materials or messaging, which does not mean they ever engaged after the visit. Moreover, public health agencies were given the ability to locally brand and train firearm advocates which might mean GSP was called something different and firearm advocates were trained inconsistently. These findings demonstrate the importance of implementation agencies including robust tracking of programmatic data across multiple visits to each business, including the nature of engagement between the firearm advocate and the business employee, what prevention activities businesses were implementing and what resources and technical assistance were provided to businesses. One study that assessed GSP involvement found that over half of the firearm retailers in New Hampshire were still engaged, but this was only 6 months after the retailer agreed to participate.12 This study’s findings demonstrate there is a need for repeated and consistent contact between firearm advocates and firearm businesses engaging in GSP. This would result in ongoing support for these firearm businesses to implement practices that may serve as core components of GSP and have the potential to enhance critical education on suicide prevention to the firearms community.
Limitations
This is an innovative study that examines the implementation of GSP to understand which components of GSP may be associated with organisational behaviours that can prevent firearm suicide among the firearms community. An important limitation of our study is the limited definition of exposure to or involvement in GSP; we only had administrative records that allowed us to define GSP involvement as a single point in time between 2015 and 2019. Given the focus on only firearm businesses in Colorado who had participated in GSP, the size of the study sample was small, limiting our analysis to detect only large effects; smaller effects may be possible to detect in future studies with larger samples. Because the study was limited to one high-risk state and one way of administering GSP, findings may not be generalisable to other states or other GSP efforts. Additionally, these data reflect the self-reported responses largely of owners or managers. Depending on organisational structure and practices, these respondents may or may not be fully aware of their business’ day-to-day practices or behaviours which may result in under-reports or over-reports of these measures. Moreover, self-reported data may also have been less reliable than actual observations of what practices were implemented within businesses. Our response rate of 28% was low and non-respondents may have different behaviours than respondents, thus limiting the representativeness of these findings. However, our response rate was slightly higher than other studies administering surveys (also using email, phone and mail methods) to firearm businesses with response rates of 25% to an eight-state region19 and 22% in Washington State.23 Future data collection efforts should consider collecting these data through in-person visits in order to build trust and rapport between researchers and firearm businesses. Future research efforts should consider including programmatic data that better measure exposure of GSP involvement within each business and using data collection methods that include participant observation of what is occurring at businesses to triangulate findings from self-reported data. Future studies could also increase sample sizes across multiple states and GSP implementations to detect smaller effects, use longitudinal methods and assess GSP impact on customer firearm safety behaviours in addition to organisational behaviours assessed in this study.
Conclusion
GSP is being implemented at varying scales in 21 states and has promise as a firearm business-led suicide prevention effort among the firearms community, where they are a trusted messenger. While our study was limited, it suggests that GSP-involved firearm businesses may benefit from consistent visits and relationship-building to build their understanding of the importance of secure firearm storage and their role in suicide prevention. They would also benefit from technical assistance on services they could offer to educate and prevent firearm suicide among their customers and best practices in offering these services to their community.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Ethics statements
Patient consent for publication
Ethics approval
This study was approved by the University of Colorado Boulder Institutional Review Board (20-0558). Participants were provided information about the study and gave informed consent when completing the confidential survey.
Acknowledgments
We are grateful for the support in aligning evaluation with Gun Shop Project implementation efforts from the Colorado Department of Public Health and Environment staff: Matthew Wetenkamp, Felice Seigneur, Sarah Brummett, Eric Jones, Lena Heilmann; the guidance from our firearm community advisory board: Jacquelyn Clark, Sabra Lin O’Crotty, Nate Rudolf, and Jason Russ; the work of Stesha Peacock in finalising the population sample; and the work of Andrew MacFarland, Julia Simoes and Susanne Argamaso Maher in developing and programming the survey instrument. We also acknowledge the support from the firearm advocates in reviewing the survey and the study participants throughout Colorado who gave us their time in responding to the survey.
References
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Correction notice This article has been corrected since it was first published due to a small error in calculations of businesses reporting their employees had received suicide prevention training and aligning data reported in the narrative with those in tables. These corrections did not affect previously reported discussion or conclusions.
Contributors EW-K, JTB-A and SA-M conceptualised the study. KL and JSL led the analysis. EW-K drafted the manuscript. All authors contributed critical revisions to the article. SA-M accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
Funding This project was supported by a grant from the Centers for Disease Control and Prevention (RO1 CE003289-01-00). We also used REDCap for data collection and management, which was supported by NIH/NCRR Colorado CTSI grant number RR025780.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.