Social Drivers of Health and Firearm Storage Practices.

Importance: Understanding the primary social drivers of unsafe firearm storage practices is essential for preventing firearm-related injuries. Objective: To examine household firearm ownership and storage practices, assess their association with social drivers of health (SDOH), and identify factors associated with unsafe storage practices among adult residents. Design, Setting, and Participants: This cross-sectional analysis used 2022 Behavioral Risk Factor Surveillance System data from adults in 5 US states. Data analysis occurred from April 1 to October 2, 2024. Exposures: Participation in the Behavioral Risk Factor Surveillance System. SDOH include food insecurity, housing insecurity, social isolation, job loss or employment insecurity, feeling stressed, transportation barriers, and financial hardship. Main Outcomes and Measures: Firearm ownership and storage were assessed using structured questions. Storage practices were categorized as safest (all firearms unloaded), intermediate risk (at least 1 loaded and locked), and unsafe (at least 1 loaded and unlocked). Multivariable weighted logistic regression models estimated adjusted odds ratios (aORs) for firearm ownership and storage practices, accounting for demographic, socioeconomic, behavioral and mental health characteristics, and state firearm policies. Results: The unweighted study included 44 736 adults. The weighted population was 52.5% (95% CI, 51.5%-53.5%) female; 1.6% (95% CI, 1.4%-1.9%) American Indian, Alaska Native, and Pacific Islander; 10.0% (95% CI, 9.2%-10.8%) Asian non-Hispanic; 7.7% (95% CI, 7.2%-8.3%) Black non-Hispanic; 25.1% (95% CI, 24.1%-26.1%) Hispanic; 52.5% (95% CI, 51.5%-53.5%) White non-Hispanic; and 3.1% (95% CI, 2.7%-3.6%) multiracial. Firearms were owned in 29.3% of households (17 146 respondents), with 67.9% (11 396 respondents) storing them unloaded, 15.9% (2391 respondents) storing them loaded and locked, and 16.4% (2816 respondents) storing them loaded and unlocked. Unsafe storage was most common among non-Hispanic Black firearm owners (aOR, 2.23; 95% CI, 1.39-3.57). Food insecurity (aOR, 3.09; 95% CI, 1.29-7.40), housing insecurity (aOR, 1.66; 95% CI, 1.01-2.79), transportation barriers (aOR, 2.16; 95% CI, 1.19-3.90), and financial hardship (aOR, 2.22; 95% CI, 1.16-4.28) were significantly associated with unsafe storage practices. Households with children had higher odds of firearm ownership (aOR, 1.22; 95% CI, 1.05-1.43), but lower odds of unsafe storage (aOR, 0.38; 95% CI, 0.26-0.55). Child access prevention laws were associated with lower odds of firearm ownership (aOR, 0.57; 95% CI, 0.51-0.63) and unsafe storage (aOR, 0.52; 95% CI, 0.40-0.68). Behavioral risks like binge alcohol use (aOR, 1.39; 95% CI, 1.01-1.93) and life dissatisfaction (aOR, 1.81; 95% CI, 1.05-3.11) were associated with increased firearm ownership and unsafe storage. Conclusions and Relevance: In this cross-sectional study of US adults, firearm ownership was more prevalent among non-Hispanic White, higher-income, and highly educated households, but unsafe storage was more common among non-Hispanic Black and lower-income households. SDOH and high-risk behaviors, including alcohol misuse and life dissatisfaction, were linked to unsafe storage. Targeted public health initiatives are crucial for improving firearm safety.