Studied Interventions With Positive Findings (ie, Improved Gun Safety)
| First Author, Year | Study Design | Study Setting | Study Population | Intervention Group | Results | Limitations | Key Conclusions |
|---|---|---|---|---|---|---|---|
| Kruesi, 199923 | Quasiexperimental | Midwest rural ED, Illinois | Parents of 6- to 19-y-old patients seen in the ED for a mental health assessment | Means restriction verbal counseling to limit access to lethal weapons targeting parents of youth at risk for suicide(n = 41) | Increased likelihood of locking up or disposing of firearms in those who had guns in the home | Not randomized, small sample size, self-reported data | Means restriction counseling delivered to parents of children seen for mental health assessment in an ED may increase likelihood of decreasing access to firearms. |
| 0 of 7 control, 5 of 8 intervention (P < .05) | |||||||
| Albright, 200331 | Quasiexperimental (3-arm) | Family practice clinic, urban community-based, university affiliated teaching clinic, Texas | Adult patients or families of children attending clinic visits (mostly female and Hispanic); restricted to gun owners | Group 1: survey and verbal counseling (n = 36) | Made safe changes: 31% control, 64% group 1, 58% group 2 (P = .02) | Not randomized, small sample size | Office-based verbal counseling with or without written materials improved safe firearm storage habits. |
| Group 2: survey, verbal counseling, and written counseling (n = 52) | |||||||
| Made an unsafe change: 31% control, 22% group 1, 31% group 2 (P = .09) | |||||||
| Carbone, 200529 | Quasiexperimental | Pediatric clinic, urban community health center, Arizona | Families at clinic visits (mostly Hispanic); restricted to gun owners | Physician-delivered 1- to 2-min verbal counseling, gun safety brochure, and free gun lock (n = 73 families) | Improvement in gun safety practices: 27% control, 62% intervention (P < .001) | Time series design, small sample size, self-reported data, social desirability bias | Office-based safe storage counseling with written materials and a free gun lock led to significant improvements in safe gun storage behaviors (but not removal of firearms from home). |
| Improvement in gun safe storage: 12% control, 51% intervention (P < .001) | |||||||
| Barkin, 200821 | Randomized controlled trial | Pediatric clinics in 41 US states, Canada, and Puerto Rico participating in practice-based research network of the AAP | Families of children 2–11 y old for well child visit | Physician-delivered counseling using motivational interviewing with provision of free cable locks (n = 68 practices, 470 families) | Using firearm cable locks at 1 mo: 59% control, 64% intervention (P = .006) | Self-reported data | Office-based counseling with provision of free cable firearm locks significantly increased safe firearm storage in firearm-owning families. |
| Safe firearm outcomes only analyzed by gun owners | |||||||
| Using firearm cable locks at 6 mo: 54% control, 68% intervention (P < .001) | |||||||
| Grossman, 201230 | Randomized controlled trial | 6 villages in 2 regions, Alaska | Gun-owning households with no operational gun safe for storage | Stepped wedge design in 2 phases (early vs late), installation of a free metal gun cabinet with verbal and written instructions on use, and safety message about safe storage of guns and ammunition (early n = 129, late = 126) | Report both gun and ammunition unlocked at 12 and 18 mo: 23% control, 78% intervention (P < .001) | Lack of generalizability of the intervention and results to other settings and populations | Community-based intervention to install gun cabinets along with verbal and written safety messages increased safe firearm storage practices. |
| Zatzick, 201432 | Randomized controlled trial | Inpatient setting in a level 1 trauma center, Washington | Inpatient adolescents (12–18 y old) hospitalized for both intentional and unintentional injuries | Stepped collaborative care intervention including motivational interviewing targeting risk behavior and substance abuse, and cognitive–behavioral therapy targeting PTSD and depression (n = 59) | Collaborative care intervention: Patients had reduced weapon carrying at 1 y | Primary outcome was not specific to carrying weapons, but the study did include weapon carrying at 1 y as a secondary outcome; small sample. | Stepped collaborative care intervention for assault-injured teens reduced likelihood of carrying a weapon at 1 y. |
| 21% control, 7% intervention, odds ratio = 0.31 (95% confidence interval, 0.11–0.9) |
Table adapted from Rowhani-Rahbar et al28 and Roszko et al.61 AAP, American Academy of Pediatrics; PTSD, posttraumatic stress disorder.