METHODS

Data used for the analyses were collected as part of the National Longitudinal Study of Adolescent Health (Add Health) conducted by the Carolina Population Center at the University of North Carolina at Chapel Hill. Details regarding the survey methodology are described elsewhere.¹³ In brief, this survey used a multistage stratified cluster design resulting in a nationally representative sample of US adolescents selected from 80 high schools and 52 middle schools, both public and private. Incorporating systematic sampling methods and implicit stratification into the Add Health study design ensured that this sample was representative of US schools with respect to region of country, urbanicity, school type, ethnicity, and school size. Following local Institutional Review Board approval of the study and receipt of parental consent, each eligible student was asked to complete an in-school survey. The participation rate was 75.6%. All students at each school were then stratified by grade and gender. Within each stratum investigators randomly selected students to be included in a second and much more detailed interview. The selected students were asked to complete a 90 minute in-home interview. In addition, one of the student’s parents or care givers also completed a separate in-home questionnaire. Eighty per cent of students selected in this second stage completed an interview sometime between April and December 1995 (n=18 924). About 85% of the parents or care givers (most often the biological mother) completed a parent questionnaire during the same time period. The current analysis presents findings based on the in-home interviews and is limited to those adolescents between 12 and 18 years of age (n=18 454).

Measures

The interviews asked all student participants, “Is alcohol easily available to you in your home?” They also asked “Is a gun easily available to you in your home?” Respondents answered “yes” or “no”. Students with access to a gun were asked, “What kind of gun is available?” Respondents could indicate all categories that applied: handgun, shotgun, rifle, or other. We created four mutually exclusive categories of students: those with access to alcohol only, those with access to a gun only, those with access to both alcohol and a gun, and those with access to neither alcohol nor a gun.

Demographic information collected included: gender, age, race/ethnicity, family structure, mother’s education, and the family’s economic situation. Race and ethnicity were combined and coded as follows: (1) Hispanic, (2) non-Hispanic white, (3) non-Hispanic African-American, and (4) non-Hispanic other (Native American, Asian, or Pacific Islander).

Analytic methods

Prevalence estimates were obtained for the availability of alcohol and/or a gun in the home. Crude logistic regression analyses determined the association between each of the demographic characteristics and the availability of either alcohol or a gun. We used the SUDAAN statistical software package for all statistical analyses in order to accommodate the complex sampling design and to provide accurate standard errors for the weighted analyses.¹⁴

RESULTS

Overall, 28.7% of US adolescents reported easy availability of alcohol in the home. Availability of alcohol in the home was associated with age, race/ethnicity, mother’s education, family structure, and welfare status (see table 1).

Nearly one quarter (24.3%) of adolescents reported easy access to a gun in the home. Availability of a gun in the home was associated with gender, race/ethnicity, mother’s education, family structure, and welfare status (see table 1). Among those who reported that a gun was available in their home, most reported availability of a shotgun (63.0%) followed by a rifle (61.3%), handgun (57.3%), and other gun (16.4%).

More than half (57.2%) of the adolescents reported that neither alcohol nor a gun was easily available to them, 18.5% reported availability of alcohol only, 14.1% reported availability of a gun only and 10.2% reported availability of both alcohol and a gun in the home (see table 2).

DISCUSSION

Overall, 28.7% of US adolescents reported easy availability of alcohol in the home, 24.3% reported availability of a gun in the home, and 10.2% reported availability of both alcohol and a gun in the home. Our findings regarding the availability of alcohol or a gun are much lower than estimates from previous studies.^8,9 These differences likely reflect the fact that our findings are limited to availability in the home.

Our study is the first to examine adolescents perceptions of in-home availability to alcohol or guns in a nationally representative sample. Of particular interest are the findings indicating that adolescents who are white, who live with two parents, who are not receiving welfare, and who have mothers that had attained a high school degree or higher, were more likely to report access to alcohol and guns. These findings are not surprising given the demographic characteristics of adults who drink alcohol¹⁵ or have a gun in their home.¹⁶ Accordingly, the demographic characteristics of adolescents who reported access to alcohol or a gun simply reflect those demographic characteristics of adults who are alcohol users or gun owners.

It is also intriguing to note that the prevalence of in-home availability of a gun or alcohol is comparable (24.3% and 28.7%, respectively). This finding is contrary to the perception that it is more common for adolescents to find alcohol, rather than guns, easily available to them in their homes. Moreover, our findings show that one in 10 adolescents (10.2%) report in-home availability of both alcohol and guns. This finding is troubling given the link between alcohol use, guns, and suicides. For example, suicide victims who used a firearm were found to be five times more likely to have been drinking alcohol before their death than were suicide victims who used different methods.⁷

The study involves three limitations. First, the study does not corroborate data from participants’ self reports with any other sources of information. Second, it is unknown how adolescents interpreted the question “Is alcohol (a gun) easily available to you in your home?” The study did not obtain any information about how the alcohol (or gun) was stored or who owned it. Third, we were not able to determine whether the availability of alcohol or a gun in the home is related to their use. However, it is likely that easy access to these items in the home facilitates their misuse.

Results from other studies have linked availability of alcohol or a gun in the home and its use. One study found that 27% of alcohol users in ninth grade reported their homes as the source of the alcohol consumed during their last drinking occasion.¹⁰ Likewise, findings from a retrospective case series of injuries among children and adolescents in King County, Washington, determined that 84% of the guns used in suicides and suicide attempts and 42% of the guns involved in unintentional injuries were stored in the victim’s home.¹²

Our findings highlight three important issues. First, the home is an important and underestimated source of both alcohol and guns among adolescents. Second, prevention efforts that seek to decrease access and misuse of alcohol and guns need to target white middle class families who are traditionally not considered high risk. Third, the relatively large number of adolescents (2.1 million) living in households with access to both alcohol and guns, as well as the combined injury risk when both alcohol and guns are present, justify prevention programs focusing on increasing safe storage practices of alcohol and guns simultaneously rather than either alone.

IMPLICATIONS FOR PREVENTION

Research shows that current prevention and intervention strategies focusing on traditional parent education, even those delivered by physicians, are relatively ineffective at removing guns from homes with children, or at changing the firearm storage practices by parents.^17–19 Similarly, despite laws prohibiting youth under age 21 to purchase alcohol, or for adults over 21 to provide alcohol to minors, adolescents continuously report that alcohol is very easy to obtain.⁸ Therefore, media campaigns may be a productive and innovative way to inform the public of the risks associated with the misuse of alcohol and guns among adolescents while also pointing out that a substantial number of adolescents, one in four, find alcohol or a gun easily available to them in their home.

Prevention programs are already using the media to inform the community, parents, and older siblings regarding the laws prohibiting sales of alcohol to minors, legal enforcement efforts, the potential penalties associated with providing alcohol to minors, and also the negative consequences of alcohol use.²⁰ It is unclear if similar strategies have been used with respect to increasing safe gun storage practices. However, a media campaign may be a particularly productive strategy to improve safe gun storage practices since it could target married women with children who tend to be unaware that guns in their homes may be stored in an unsafe manner.²¹ In addition, a media campaign can highlight that access to alcohol and guns are more common in intact middle class families while emphasizing that the risks associated with the misuse of alcohol and guns not only pertain to an adolescent living in a particular household but also to that of friends, siblings, parents, and others who may visit the home. Raising public awareness of these issues, and making parents discuss them, will be necessary in order to increase safe storage practices of alcohol and guns.