Legislators and gun safety advocates often focus on how guns are purchased, but many lives could be saved, especially among children, if they look more at how they are stored. 

In the last decade, guns killed more than 14,000 American children. A startling number of those deaths, more than a third, were classified as suicides, around 6% is accidents. Many more children were injured.

Nearly everyone agrees that children should not be able to buy guns, and no state lets them do so on there own. When children die by suicide in this way, it's a result of being able to get a hold of a gun that somebody else already obtained, often legally.

How guns are stored matters. A study that was just recently published in JAMA Pediatrics has found that even a modest increase in owners locking up their guns would pay off in an outsize drop in gun deaths. That's the topic of this week's Healthcare Triage.

[Intro]

Storing guns in a way that makes them inaccessible to children can reduce the number who die, especially from suicide. In 2010, researchers examined who owned the firearms used in youth suicides. In cases where this could be determined. three-quarters of the time, the owner was a parent, and for a further 7%, it was some other relative.

In a 2005 study published in JAMA, researchers found that keeping guns locked and unloaded, and keeping ammunition locked and separate from guns, were significantly associated with lower levels of suicides and accidents among adolescents in gun-owning households. This held true for both handguns and long guns.

But, such safety practices aren't common. If a recent New York bill is signed into law, it would make the state one of just a handful with comprehensive gun storage laws to protect children.

Last year, a study based on a national survey in 2015 found that about one in three of all households in the United States owned at least one gun. Of those households with both guns and children at home, more than 20% reported storing them both loaded and unlocked (the least safe way). And additional 50% stored them either loaded or unlocked.

This means that about 7% of all children in the United States lived in a house in which at least one gun was stored in an unsafe manner. This is about twice the number reported in the previous national survey published in 2002.

Other research suggests that many people in gun-owning households, typically not the primary owner of the gun, think they are stored safely when they're not.

Critics of gun storage laws say homeowners need to be able to act quickly if a criminal tries to enter a home. It's not easy to measure how often guns are used in self-defense when someone attempts a break-in, but research suggests it's a rare occurrence.

Suicides are more common than self-defense shootings, and, along with accidents, are more likely in children with parents who abuse alcohol. Studies have also found that children living with an adult who misuses alcohol were more likely to live in a house with a gun stored unsafely, and that heavy alcohol use was most common in those who store guns loaded and unlocked.

Critics also say safe storage laws are hard to enforce, because of privacy concerns. As the recent study from JAMA Pediatrics points out though, even a moderate level of compliance can save many lives.

Last year, in the journal Injury Prevention, researchers reported on the results of two community-based fire arm safety events in Washington, state. They found that presenting people with information and offering to sell them trigger guards or lock-boxes resulted in an increase of about 14% of households that stored all guns locked and 9% more that stored them unloaded. 

In 2017, the Government Accountability Office reviewed 16 public or non-profit programs that aimed to improve the storage of guns. It also reviewed studies of these programs. It found that distributing locks led to more safely stored guns. Few of those evaluations were rigorous, however.

Gun research, as with most things related to guns, is a politically divisive issue, and, for many years, research funding has been very low relative to other major causes of death. 

Policy can make a difference, too. In 2004, a study examined how laws that focus on the sale of guns affected the suicide rates of children, compared with laws mandating safe storage of firearms. They found that between 1976 and 2001, minimum-age purchase laws and possession-age laws had no effect on adolescent suicide rates. Laws preventing children's access to guns, on the other hand, were associated with significant reductions of suicides by guns, even when reductions were not seen in suicides by other methods. 

About two-thirds of gun deaths in the United States are suicides, and given political stalemate over gun rights, that's where it seems policy-makers could be more productive. Safer storage of guns, especially households with children, might make more of a difference than many legislative and advocacy efforts that get much more attention.

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If you liked this episode, you might might enjoy this other episode on why won't the United States study gun deaths.

We'd like to thank all the people who support Healthcare Triage through Patreon.com at Patreon.com/HealthcareTriage. We'd especially like to thank our research associate, Joe Sevits, and, of course, our surgeon admiral, Sam.

And my book, The Bad Food Bible, is now out in paperback. Hope you buy a copy.