Firearm injury risk among primary care patients

Journal of Family Practice, August, 1995 by Bruce W. Goldberg, Eric R. von Borstel, Leslie K. Dennis, Eric Wall

Background. Firearm injuries are the eighth leading cause of death in the United States. Evidence suggests that availability of guns in the home is associated with an increased risk of homicide, suicide, and unintentional injuries and fatalities. Our study examined five demographically diverse primary care practices in Oregon to determine the extent to which patients and members of their households might be at risk for firearm injuries.

Methods. Six hundred and four consecutive English-speaking patients who were at least 18 years old and seeking care at the five different practices were surveyed. Participants were asked about the presence of firearms in the home, methods of storage, history of firearm safety training, and history of firearm counseling by their physicians.

Results. Forty-two percent of respondents reported having at least one firearm in the home. In homes with firearms, 48% contained at least one firearm that was stored unlocked, and 26% contained at least one firearm stored loaded. Twenty percent of homes with children contained at least one unlocked firearm, and 10% contained a loaded firearm. Forty-seven percent of those homes with both children and firearms had at least one gun that was stored unlocked, and 26% contained at least one loaded firearm. Those who reported having had formal firearm safety training were no more likely to store their firearms safely than those without such training. Only 3% of respondents reported that their physician had ever talked with them about gun safety.

Conclusions. Our data indicate that a substantial number of patients cared for by primary care physicians are at risk for firearm injuries.

Key words. Firearms; primary health care; accident prevention; safety. (J Fam Pract 1995; 41:158-162)

In 1992, firearm injury resulted in 37,776 deaths in the United States, making it the eighth leading cause of death.(1) It is estimated that for every firearm fatality, there are 2.6 nonfatal firearm injuries.(2) The economic cost of firearm injuries in 1990 was calculated to be $20.4 billion, and the cost per firearm fatality is higher than that associated with any of the four leading causes of death.(3)

In recent years, violence and firearm-related injury and death have become increasingly recognized as public health problems.(4)(5) Accordingly, reports describing firearm ownership and safety practices have begun to emerge in the medical literature.(6)(7) Although most of these studies have focused on adolescent populations or families with children, firearms present a potential danger to all persons regardless of age.

Evidence suggests that availability of guns in the home is associated with an increased risk of homicide, suicide, and unintentional injuries and fatalities.(8)(9)(10)(11) It is estimated that there are over 200 million firearms in civilian hands and that firearms are present in almost one half of all US homes.(12)(13) A national survey of gun owners revealed that more than one third stored their gunds loaded, and 53% did not store their firearms under lock.(12)

Primary care physicians are expected to routinely counsel their patients about lifestyle issues and health behaviors, but little is known about physicians' attitudes and practices concerning counseling on firearm injury prevention. Many physicians are unaware of which patients in their practices are at risk for firearm injuries. A study of Maryland pediatricians revealed that only 10% reported counseling at least one fourth of the families in their practices about firearm hazards.(14) Many of these physicians believed that their patients were not at risk for fiearm injuries.

The purpose of our study was to examine five demographically diverse primary care practices in Oregon to determine the extent to which patients and members of their households might be at risk for firearm injuries and to assess whether these patients received counseling on firearm injury prevention from their physicians.

Methods

Physicians at five different primary care offices in Oregon were contacted regarding participation in a study of their patients' firearm ownership and safety practices. This was a convenience sample chosen to represent a variety of practice styles and geographic and socioeconomic services areas in Oregon. Each one of the primary care offices contacted agreed to participate. The group included (1) a university-based family practice center in an urban area (referred to as "university"), (2) a multiphysician family practice office in a suburban neighborhood ("suburban"), (3) a county health department primary care clinic in an urban area ("health department"), (4) a solo private practice in a rural area ("rural--solo"), and (5) a multiphysician, rural family practice office 200 miles from the other rural locale ("rural--group").

Six hundred four consecutive English-speaking patients who were at least 18 years old and seeking care at the five practices were surveyed. Each potential subject was approached by the same research assistant, informed that the office was participating in a project on firearm safety, and asked to privately complete an 11-question survey instrument. Potential subjects were informed that disclosed information would be kept confidential and were asked not to record any identifying information on the questionnaire. Participants were asked questions regarding the presence of firearms in the home, methods of storage, history of firearm safety training, history of firearm counseling by their physicians, and basic demographic information.(*)