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Rural Health Information Hub

Unintentional Firearm Injury Prevention Models

Firearms can cause serious and fatal injury when safe handling and storage practices are not followed. Unintentional firearm injuries cause approximately 27,000 emergency department visits and 500 deaths every year in the United States, according to the Johns Hopkins Center for Gun Violence Solutions. In cases where the unintentional shooting was fatal, most instances occurred when someone was playing with a gun, handling a gun they believed was unloaded, or hunting. Unintentional firearm injury or death may also occur from improperly handling a gun, handling a gun while under the influence of alcohol or drugs, or accidentally firing a gun while cleaning it.

Children are more likely to be unintentionally injured by someone else, most often by someone playing with a gun, whereas adults are more likely to unintentionally injure themselves. Despite the risks of unintentional injury from a firearm, the majority of gun owners do not secure their guns and millions of children live in homes with unsecured guns.

Firearm safety practices can help prevent unintentional firearm injury. Firearm safety is especially important in rural communities, where people are more likely to own guns and to be affected by unintentional shootings compared to people living in urban areas. This toolkit focuses on strategies for preventing unintentional firearm injuries. It does not specifically address prevention strategies for violent and intentional firearm injuries. The Centers for Disease Control and Prevention provides resources and information related to stopping firearm violence. For more information on rural suicide prevention programs, see the Rural Suicide Prevention Toolkit.

Firearm Safety Education and Safe Gun Storage

Unsecured guns pose a risk to people of all ages, with children especially at risk of injuring themselves or others if they can access unsecured guns. Eight children and adolescents are unintentionally injured or die every day in the U.S. due to an unlocked gun in the home. Most unintentional firearm shootings that involve children occur in the home of the victim, their friend, or their relative.

Many experts recommend storing firearms outside of the home, when possible, especially when children and adolescents are present. The safest way of storing guns within the home is to:

  1. Unload the firearm by removing all ammunition, including any rounds in the chamber of the gun.
  2. Lock the firearm with a gun lock that prevents the gun from firing. Gun locks are not substitutes for secure storage devices and should be used in combination with secure storage devices.
  3. Separate the firearm from the ammunition.
  4. Secure the firearm and ammunition in separate storage devices that can each be locked.
  5. Keep keys or combinations to the gun locks and storage devices with you or in a separate, secured location that is inaccessible to children.

There are several types of firearm safety storage and locking devices available including:

  • Lock boxes, which are small portable safes that can securely hold a single handgun or ammunition. These safes can be locked using a push-button, combination, digital keypad, or key.
  • Console or vehicle gun safes, which are small safes that can securely store guns within a vehicle.
  • Gun vaults or safes, which are larger safes that can securely hold multiple long guns or handguns. Gun vaults or safes can be locked using a push-button, combination, digital keypad, or key.
  • Cable locks, which are cable devices that attach to the firearm to prevent the firearm from firing. These devices can be locked with a combination or a key.
  • Trigger locks, which are devices that attach to the firearm to prevent the trigger from being pulled. These devices can be locked with a push-button keypad, combination, or key.
  • Personalized locks, which come in various forms, such as magnetic or electronic locks or fingerprint recognition.

Firearm storage and locking devices can be found at many online and in-store retailers, including gun stores, sporting goods stores, firing ranges, and discount stores. Some community programs also partner with local law enforcement agencies or public health departments to provide community members with free or low-cost locking devices.

Adult Firearm Safety Education Programs

Most firearm safety educational efforts are designed for adults and parents. There is evidence that people are more likely to store firearms safely in the home when the intervention includes counseling about firearm safety in combination with free distribution of a safe storage device (most commonly cable gun locks).

Some educational interventions may be led by pediatric clinicians, police officers, public health officials, and other trusted community members. Clinicians can be a valuable resource for families to provide advice about safe storage options and how to talk to children about firearm safety.

Firearm safety education may include digital, print, or audiovisual resources with information about:

  • Data and statistics on firearm injuries
  • Types of firearm storage and steps to store firearms safely
  • How to talk to other parents and children about firearms in the home
  • Precautions to take if engaging in recreational activities that involve a firearm (for example, hunting)

Educational materials and free storage devices may be distributed at community events and settings, such as:

  • Sporting goods stores that sell firearms
  • Schools (for example, Parent Teacher Association meetings)
  • Farmers markets
  • Community or recreational centers
  • Public libraries
  • Religious organizations
  • Police departments
  • Public health departments
  • Health centers or clinics

Legislation and Regulation of Firearms

Firearm safety legislation and regulation efforts to prevent unintentional injuries and deaths may focus on child-access prevention (CAP) laws and comprehensive background checks. CAP laws can encourage families to store guns safely in the home. There is promising evidence that CAP laws, which hold gun-owning adult caregivers and parents accountable if youth access a gun, regardless of the reason, can reduce unintentional firearm injuries in children and adolescents. CAP laws differ by state, and many states do not have CAP laws in place. CAP laws that hold gun owners accountable for negligence and not properly storing guns in the home may be the most effective.

Universal background checks that prevent the purchase of firearms for a person with a criminal record have been shown to reduce unintentional injuries. As with CAP laws and other firearm legislation, laws that require background checks differ by state. Research shows that states with universal background checks in place for over five years have had a decrease in child deaths from firearm injuries. Background checks have also been shown to reduce youth possession of guns. The American Academy of Pediatrics, American Public Health Association, American College of Emergency Physicians, and many other organizations support extending background checks to cover all gun purchases in the U.S.

Firearm Safety Education and Safe Storage Program Examples

  • The University of Iowa Injury Prevention Research Center and UI Stead Family Children's Hospital Safety Store distribute free gun safety locks during National Injury Prevention Days.
  • Project ChildSafe is a firearm safety education program developed by the National Shooting Sports Foundation that promotes safe firearm handling and secure storage. The program provides educational resources such as infographics, videos, handouts, and other digital content for parents, children, law enforcement, and educators. Through partnerships with law enforcement, the program helps deliver firearm safety kits to gun owners, including gun-locking devices and educational handouts.
  • Be SMART is a safety campaign focusing on secure firearm storage and how adults can limit children's access to firearms. The campaign includes resources such as educational handouts, videos, and social media messages. The campaign also offers safety trainings and informational sessions at community events across the country.
  • ASK (Asking Saves Kids) is an educational campaign that began as a collaborative effort between Brady, a national gun violence prevention group, and the American Academy of Pediatrics. ASK is part of a broader campaign called End Family Fire. The message to parents and guardians of children is that before their child visits any home, the adults are encouraged to ask whether there are any unlocked guns being kept in the home. Over the years, the campaign has partnered with local organizations and helped millions of households ask the question about safe gun storage before allowing children to visit other homes.
  • Store Safely is a four-step online program developed collaboratively between the University of Michigan and other public health, education, law enforcement, and local business partners in Marquette County, Michigan. The program was specifically adapted with messages for rural families and with specific resources to prevent unintentional firearm injuries in local children and adolescents.
  • The Family Safety Net initiative combines research and programmatic efforts to improve firearm safety and secure storage in rural and remote parts of Northwest Alaska. The research component includes surveys and interviews with community members to understand their beliefs and practices related to firearms, firearm storage, culture, and education. These community responses help to inform program activities, which include providing ammo boxes, gun safes, and locks for adults. This research and programmatic effort is led by the Maniilaq Association and University of Michigan Institute for Firearm Injury Prevention.
  • Bullet Proof Kids - Utah Chapter is a public awareness campaign led by the Utah Chapter of the American Academy of Pediatrics and the Utah Parents Against Gun Violence to promote safe gun storage. The campaign provides educational resources and blog posts on local and national firearm topics. This campaign partners with local organizations to reach various community audiences, including parents, healthcare providers, and shooting ranges.

Implementation Considerations

Rural programs for firearm safety and safe storage should consider existing laws and policies, which may help shape program activities. Firearm laws differ by state, which can affect access to firearms and storage behaviors. Several states have safe storage laws requiring firearms have a locking device or trigger lock and safe storage to prevent access by children and adolescents. However, many states in the U.S. do not have any safe storage requirements in place. Some states require participation in firearm safety training before purchasing a gun, but many states allow people to purchase a gun without any prior training or certification.

Programs interested in distributing locking and storage devices may need to consider offering a variety of devices to accommodate various needs. Different types of firearms may require different storage considerations. For example, long guns may require different storage and locking devices than handguns. The different types of storage devices also have varying prices, and larger storage devices are often more expensive.

Many rural communities have higher gun ownership than suburban and urban communities. People living in rural areas are more likely to grow up in a home with a gun, and views about gun ownership, storage, and the sense of freedom may differ among different households. Individual perspectives about gun ownership and cultural views are important to account for when developing messaging about injury prevention policies and legislation.

Rural residents, including children, are more likely to participate in recreational activities that involve firearms, such as hunting and target shooting. It can be helpful to understand community knowledge, beliefs, and attitudes towards firearms to help inform program activities. Programs can gather information about the community through surveys, focus groups, interviews, or public forums. Programs may consider tailoring educational materials, outreach, and other program activities to fit the interests and culture of the community. Programs may also consider how to integrate program activities into popular community activities and events, including local events that are highly attended by gun owners.

Resources to Learn More

Appalachian Caregiver Perspectives on Childhood Gun Safety in the Home
Reports on a qualitative study detailing the perspectives of ten caregivers living in Appalachia about gun ownership and childhood safety when guns are present in the home.
Author(s): Boatman, D.
Citation: Journal of Appalachian Health, 3(1), 29-42
Date: 2021

Guide to Secure Gun Storage Devices
Provides images, descriptions, and pricing of different types of firearm storage and locking devices.
Organization(s): Everytown for Gun Safety

Integrating Firearm Injury Prevention into Health Care: Proceedings of a Joint Workshop of the National Academies of Sciences, Engineering, and Medicine; Northwell Health; and PEACE Initiative
Discusses how health systems can implement firearm injury prevention interventions into routine patient visits to improve health and well-being in communities, including rural-specific considerations.
Organization(s): National Academies of Sciences, Engineering, and Medicine, Northwell Health, PEACE Initiative
Date: 2022

Personal Firearms: Programs that Promote Safe Storage and Research on Their Effectiveness
Identifies national and local level public and nonprofit programs that promote safe storage of firearms and the degree to which these programs have been studied.
Organization(s): United States Government Accountability Office
Date: 9/2017

Personal Firearm Storage in the United States
Defines safe firearm storage and provides estimates on gun owner's storage practices from U.S. and state surveys. Discusses clinical, community, and policy-level interventions to promote safe firearm storage.
Author(s): Ramchand, R.
Organization(s): RAND
Date: 7/2022

The Science of Gun Policy: A Critical Synthesis of Research Evidence on the Effects of Gun Policies in the United States
Describes the scientific evidence for different firearm laws and policies, and explores what steps can be taken to improve the evidence-base.
Author(s): Morral, A.R., Ramchand, R., Smart, R., et al.
Organization(s): RAND
Date: 2018