Parental Firearm Storage and Their Teens' Perceived Firearm Access in US Households.

Importance: Firearm access increases fatal and nonfatal firearm injury risk among teens. Identifying parental firearm storage behaviors associated with teen access may inform efforts to prevent teen firearm injuries. Objective: To examine the associations between parent-reported household firearm storage behaviors and teen perceived access to firearms. Design, Setting, and Participants: This cross-sectional study used national survey data of US firearm-owning parents and their teens (aged 14 to 18 years) surveyed between June and July 2020, with a response rate of 31% for parents and 21% for teens. Analyses were conducted January to May 2024. Exposures: The number of firearms stored in the household as (1) unlocked, (2) loaded, (3) unlocked and loaded, and (4) unlocked or loaded. Main Outcomes and Measures: Teen perceived firearm access, overall and stratified by teen gender, parental education, and urbanicity. Survey-weighted logistic regression analyses assessed the associations between the number of firearms parents reported storing in each unsecured state (unlocked and loaded, unlocked, loaded, and unlocked or loaded) and teen perceived firearm access, overall and stratified by teen gender, parental education, and urbanicity (metropolitan vs nonmetropolitan). The areas under the receiver operating characteristic curves (AUROC) were used to identify the firearm storage behaviors with the best ability to estimate teen perceived firearm access. Results: Analyses included 487 parent-teen dyad respondents. The mean (SE) ages of parents and teens were 46.6 (0.80) and 16.0 (0.12) years, respectively. Most parent respondents were male (58.1%; 95% CI, 50.3%-65.8%) and White (73.5%; 95% CI, 66.1%-80.9%), and most teen respondents were female (55.7%; 95% CI, 47.8%-63.6%) and White (69.5%; 95% CI, 61.8%-77.2%). All 4 unsecured firearm storage behaviors were associated with greater teen perceived firearm access (odds ratio [OR], 1.27-1.44; 95% CI, 0.99-2.10), but associations disappeared after restricting to those who stored at least 1 firearm unsecured (OR, 0.99-1.18; 95% CI, 0.67-1.89). The number of firearms stored unlocked performed the best in estimating teen perceived access to firearms in US households (AUROC, 65.7; 95% CI, 61.4-70.1), regardless of teen gender, parental education, and urbanicity. However, sensitivity of this measure was universally low (range, 42%-64%). Additionally, 36.3% (95% CI, 23.6%-49.0%) of teens reported access to a firearm in households where all firearms were stored locked and unloaded. Conclusions and Relevance: This study found that parent-reported firearm storage may be a poor estimator of teen perceived firearm access, regardless of teen gender, parental education, and urbanicity. Strictly focusing safety efforts on locked and unloaded firearm storage may not fully negate teen's perceptions that they can access and load household firearms. Storing additional firearms securely may not prevent teen access if at least 1 household firearm remains unlocked.