0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Are Household Firearms Stored Less Safely in Homes With Adolescents?  Analysis of a National Random Sample of Parents FREE

Renee M. Johnson, PhD; Matthew Miller, MD, ScD; Mary Vriniotis, MS; Deborah Azrael, PhD; David Hemenway, PhD
[+] Author Affiliations

Author Affiliations: Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Mass.


Arch Pediatr Adolesc Med. 2006;160(8):788-792. doi:10.1001/archpedi.160.8.788.
Text Size: A A A
Published online

Objective  To examine whether firearms are more frequently stored loaded, unlocked, or both in households with adolescents only (aged 13-17 years) compared with households with younger children only (aged 0-12 years).

Design  Random-digit-dial survey on firearms (n = 2770). We computed bivariate associations between the presence of adolescents and firearm storage practices. Statistical significance was assessed using prevalence ratios with 95% confidence intervals.

Setting  United States.

Participants  Survey respondents with children (aged <18 years) who reported the presence of a household firearm.

Main Outcome Measures  Prevalence of firearms in the home stored loaded and/or unlocked.

Results  Of the 392 respondents, 22% had a loaded firearm, 32% had an unlocked firearm, and 8% had a firearm stored loaded and unlocked. Compared with households with younger children, households with adolescents only were somewhat more likely to store a firearm unlocked (42% vs 29%; prevalence ratio, 1.48; 95% confidence interval, 1.04-2.02), loaded (26% vs 20%; prevalence ratio, 1.25; 95% confidence interval, 0.82-1.91), or both (10% vs 8%; prevalence ratio, 1.43; 95% confidence interval, 0.64-3.19).

Conclusions  Parents of adolescents appear to be more likely to keep household firearms stored unsafely, especially with regard to keeping firearms unlocked. This is of concern because most youth firearm injuries happen to adolescents. Firearm injury prevention programs should directly target parents of adolescents to promote safe firearm storage.

Figures in this Article

Firearms are present in about one third of US households with children and youth.14 Therefore, safe firearm storage practices—including keeping firearms stored unloaded and locked up—represent important safety behaviors. Research suggests that safe storage may confer a degree of protection in the risks for suicide and unintentional injury.58 In keeping with these findings, professional organizations, including the American Academy of Pediatrics9 and the Society for Adolescent Medicine,10 recommend that parents keep firearms stored unloaded and locked up.

In the United States, 14% to 30% of households with guns and young or adolescent children (aged <18 years) have at least 1 loaded firearm, and about 43% contain an unlocked firearm.1,3,4,11,12 A recent study13 estimated that nearly 2 million US children live in homes with loaded, unlocked firearms. The home is the primary place from which young people obtain firearms that are used in unintentional and violent injuries, as well as a primary setting in which pediatric firearm injuries, especially suicides, take place.7,8,1416

Keeping children and youth safe represents a strong motivation for parents to not have firearms in the home or to store them locked up and unloaded.24,17,18 However, parents' perceptions of how likely their children are to get hurt with a firearm may vary based on characteristics of the child. Qualitative research shows that parents' expectations that their children will not play with or touch guns are based on beliefs about their children having the wherewithal to act responsibly.18 When asked whether their children would handle firearms, parents who disagreed said things such as “My child knows better” or “has common sense.”18 In the same vein, parents are more apt to believe that older children are old enough to act responsibly and use good judgment when there are firearms in the home1820; parents may therefore be less likely to use safe firearm storage practices when the only young people in the home are adolescents.3,4,1820

A few studies have explored how firearm storage practices vary by the age of the children in the home; their results suggest that parents of adolescents have less safe firearm storage practices than parents of younger children.3,4,18 In 1 national random-digit-dial study, authors found that, among gun owners with children (n = 252), those with children younger than 13 years were less likely than those with adolescent children to store at least 1 gun loaded and unlocked (6% vs 17%; P<.01).3 Similarly, a separate national study showed that parents whose youngest children were aged 13 to 17 years were significantly more likely to report the presence of a firearm that was stored loaded and unlocked than parents who had children younger than 13 years.4 Unfortunately, neither study examined these 2 firearm storage practices individually. A third study, which was based on a sample of parents of children aged 5 to 15 years in northeastern Ohio, showed that parents with at least 1 child aged 5 to 9 years were significantly less likely than those whose children were all aged 10 to 15 years to have a firearm stored loaded and unlocked (12% vs 30%; P = .046).18

Additional research is needed to confirm how parents' firearm storage practices vary on the basis of the ages of children in the home. The purpose of this study was to examine the prevalence of having a firearm in the home that is loaded, unlocked, or both among a national sample of parents with children 17 years or younger. On the basis of findings from previous studies, we expected that parents of adolescents (aged 13-17 years) would be more likely to have a loaded and/or unlocked firearm in the home than those with younger children (aged 0-12 years).

Data for this investigation come from the National Firearms Study 2004, a telephone survey in which adults (aged ≥18 years) in the United States were randomly selected for participation from a list-assisted sampling frame.21 Those who were unable to complete an interview in English were excluded. Data collection was performed by Fact Finders Inc, a social science research firm in Albany, NY. The number of interviews designated for each state was determined by that state's population relative to the total population of the United States. In multiadult households, 1 adult was randomly selected to take part in the study.

Of the 31 302 telephone numbers called for the study, 91.1% did not result in an interview. Of these, 41.4% were ineligible numbers (eg, nonresidential, line out of service, quota reached for the particular state). For an additional 39.2%, an interview did not take place after the maximum number of calls (ie, 10) had been made for 1 of the following reasons: only an answering machine picked up, the line was always busy, the line was never answered, or the potential respondent was never available. Only 19.0%5,21 of the numbers called that did not result in an interview were refusals. The total National Firearms Study 2004 sample included 2770 adults.

The instrument included some 100 items and was designed to be completed in approximately 15 minutes. A verbal informed consent procedure was conducted before beginning the interview. Items inquired about included attitudes and beliefs regarding firearms, firearm ownership and storage practices, and demographic characteristics of the respondent and members of the household. To inquire about firearm ownership, we asked the following question: “Do you have any guns in your home or motor vehicle?” We then asked about how those firearms were stored (eg, “How many of those guns are currently loaded?”). Data were collected in the spring of 2004 using computer-assisted telephone interviewing technology.2224 The study was approved by the Institutional Review Board at the Harvard School of Public Health, Boston, Mass.

For this investigation, the National Firearms Study 2004 sample was restricted to the 405 respondents who had at least 1 child younger than 18 years living with them and who also indicated that there was a firearm in the home. Thirteen of the 405 eligible respondents were excluded because they had not provided information on the ages of children in their households, leaving a total number of respondents in the analysis sample of 392. Descriptive statistics were generated for demographic characteristics, firearm storage practices (presence of any firearm in the home that was loaded, unlocked, or both), and ages of the children (<5, 5-12, and 13-17 years). We calculated cross-tabulated frequency distributions to examine the relationship between the ages of the children in the home and firearm storage practices. Next, we compared the prevalence of an unsafe firearm storage practice (storing a firearm loaded, unlocked, or both) in homes in which all of the children were aged 13 to 17 years with that in homes in which all of the children were younger than 13 years. We excluded households that contained children in both age groups from this analysis. We tested the statistical significance of the associations by estimating prevalence ratios (PRs) with 95% confidence intervals.25,26 Analyses were conducted using SAS statistical software, version 9.1.2.27

Of the 392 respondents in the analysis sample, 58.7% were male, 78.5% were married, 66.5% were aged 30 to 49 years, and 87.1% were white. By design, all respondents in the study sample had firearms in the home and children younger than 18 years. Ages of children ranged from a few weeks to 17 years. Nearly half (47.7%) had at least 1 teenager in the home. For 110 (28.1%) of the 392 respondents, all of the children in the home were aged 13 to 17 years (Table 1).

Table Graphic Jump LocationTable 1. Demographic Characteristics of the Study Sample

The number of guns respondents had in their homes ranged from 1 to 70; more than three quarters (78.1%) reported having more than 1 gun. Of the respondents, 70.8% indicated that they personally owned at least 1 of the household firearms, and 64.9% reported the presence of a handgun. In terms of storage practices, 21.7% had a loaded gun, 31.5% had an unlocked gun, and 8.3% had a gun that was loaded and unlocked (Table 2).

Table Graphic Jump LocationTable 2. Comparison of Firearm Storage Practices in Homes With Younger Children vs Adolescents*

Respondents whose children were all aged 13 to 17 years had the highest prevalence of unsafe firearm storage practices (Figure). Whereas 28.8% of parents whose children were all 12 years or younger had an unlocked firearm in the home, 41.7% of parents whose children were all aged 13 to 17 years did (PR, 1.48; 95% confidence interval, 1.04-2.02). Although not statistically significant at the .05 level, the PRs suggest that having a teenager as opposed to a younger child is associated with an increased likelihood of having a household firearm stored loaded (PR, 1.25) or loaded and unlocked (PR, 1.43) (Table 2).

Place holder to copy figure label and caption
Figure.

Reported firearm storage practices stratified by the age of the young people living in the home. Age categories are mutually exclusive. Respondents with children in more than 1 age group were excluded from the analyses.

Graphic Jump Location

Previous research suggests that parents with children older than 12 years may be more likely to store firearms unsafely than those with younger children.3,4,18 We tested those findings by investigating whether parents of adolescents were more likely to have firearms stored unsafely. Our results were consistent with those of previous research. We found that parents of adolescents were significantly more likely than parents of children 12 years or younger to have an unlocked firearm in the home (41.7% vs 28.8%; P<.05). Findings were similar, but not statistically significant, for keeping firearms stored loaded and both loaded and unlocked.

An alternative explanation for the associations between children's ages and firearm storage practices is that parents of older children are less likely to have safe storage practices. Because parents whose children were all aged 13 to 17 years were about 10 years older on average than parents whose children were all younger than 13 years, we sought to test this alternative explanation. When we examined storage practices by mean age of respondents, we did not find evidence that older parents had less safe firearm storage practices. When we analyzed all 392 respondents, the mean age of the respondents with unsafe storage practices was not substantially different than the mean age of the respondents without unsafe storage practices (data not shown).

A secondary finding is that children of all ages have access to unsafely stored firearms in their homes. More than one third of the parents in this sample said there was a gun in their home that was stored loaded, unlocked, or both. This represents a threat to the safety of young people.

As with most survey research, these data may be subject to bias because of inaccurate recall, lack of knowledge, or social desirability. An additional limitation is that some respondents chose not to disclose information about how firearms were stored, or about how old their children were. This resulted in missing data, including 14.3% of the respondents with missing data on the presence of a firearm stored unlocked; 10.5% with missing data on the presence of a firearm stored loaded and unlocked; and 4.8% with missing data on the presence of a firearm stored loaded. It is unclear how the results would differ with complete information. Because of this limitation, it is important for future studies examining firearm storage practices to report information on the ages of children to confirm the validity of our findings. Nevertheless, the proportion of respondents with a loaded firearm (21.7%) or an unlocked firearm (31.5%) obtained from this investigation were comparable to estimates from other studies (14%-30% and 43% respectively).1

As young people become adolescents, parents may become less vigilant about keeping firearms stored securely. This assertion is supported by the present research, as well as by studies on parents' attitudes about firearm safety,1820,28 in which authors concluded that parents were more likely to believe that adolescents, compared with younger children, are old enough to exhibit good judgment around firearms. This belief creates a situation in which adolescents have easy access to a lethal means with which to kill themselves or to hurt others. Unfortunately, our study did not inquire about parents' perceptions of their children being injured with a firearm in the home, limiting our ability to assess whether the perception of susceptibility is, in fact, the intervening variable between the age of the children in the home and storage practices.

Safe storage practices have the potential to reduce the risk of death by limiting access to the most lethal means of injury.58 In recent years, public health and medical professionals have worked to educate gun owners, and gun-owning parents in particular, about the importance of safe storage practices through face-to-face counseling, mass media campaigns, and legislation.2937 Anticipatory guidance by pediatricians has been a leading strategy for promoting safe firearm storage.30,33,34,38,39 Although important, most of these promotional efforts focus on preventing unintentional injury (rather than suicide) and may have the greatest influence on parents of children younger than 13 years. As an example, a billboard for 1 media campaign included a child-sized coffin and the slogan: “Buy a box for your gun, not for your kid.”37 In our attempts to keep young children safe, we may be leaving behind adolescents, who are significantly more at risk for gun injuries than younger children. In the future, it may be important for educational efforts to purposefully include messages that are directly targeted to parents of adolescents. A specific recommendation for reaching parents of adolescents is more firearm safety education outside of pediatric clinics because many adolescents do not visit pediatricians or their parents do not accompany them to the physicians' offices.

Correspondence: Renee M. Johnson, PhD, Harvard Injury Control Research Center, Harvard School of Public Health, 677 Huntington Ave, Kresge Building, Room 318, Boston, MA 02115 (rejohnso@hsph.harvard.edu).

Accepted for Publication: February 15, 2006.

Author Contributions:Study concept and design: Johnson, Miller, and Hemenway. Acquisition of data: Miller, Azrael, and Hemenway. Analysis and interpretation of data: Johnson, Miller, Vriniotis, Azrael, and Hemenway. Drafting of the manuscript: Johnson and Miller. Critical revision of the manuscript for important intellectual content: Miller, Vriniotis, Azrael, and Hemenway. Statistical analysis: Johnson, Vriniotis, and Azrael. Obtained funding: Miller, Azrael, and Hemenway. Administrative, technical, and material support: Hemenway. Study supervision: Miller and Hemenway.

Funding/Support: The National Firearms Study 2004 was supported by a grant from the Joyce Foundation to the Harvard Injury Control Research Center (principal investigator, Dr Miller).

Previous Presentations: This study was presented as a poster at the CDC National Injury Prevention and Control Conference; May 9, 2005; Denver, Colo.

Acknowledgment: We thank Jenny Hochstadt, MS, MSW, of the Harvard Injury Control Research Center for assistance with data analysis.

Johnson  RMCoyne-Beasley  TRunyan  CW Firearm ownership and storage practices, US households, 1992-2002: a systematic review Am J Prev Med 2004;27173- 182
PubMed Link to Article
Stennies  GIkeda  RLedbetter  SHouston  BSacks  J Firearm storage practices and children in the home, United States, 1994 Arch Pediatr Adolesc Med 1999;153586- 590
PubMed Link to Article
Azrael  DMiller  MHemenway  D Are household firearms stored safely? it depends on whom you ask Pediatrics 2000;106e31
PubMed Link to Article
Schuster  MAFranke  TBastian  ASor  SHalfon  N Firearm storage patterns in US homes with children Am J Public Health 2000;90588- 594
PubMed Link to Article
Miller  MAzrael  DHemenway  DVriniotis  M Firearm storage practices and rates of unintentional firearm deaths in the United States Accid Anal Prev 2005;37661- 667
PubMed Link to Article
Grossman  DCMueller  BARiedy  C  et al.  Gun storage practices and risk of youth suicide and unintentional firearm injuries JAMA 2005;293707- 714
PubMed Link to Article
Brent  DAPerper  JAAllman  CJMoritz  GMWartella  MEZelenak  JP The presence and accessibility of firearms in the homes of adolescent suicides: a case-control study JAMA 1991;2662989- 2995
PubMed Link to Article
Shah  SHoffman  REWake  LMarine  WM Adolescent suicide and household access to firearms in Colorado: results of a case-control study J Adolesc Health 2000;26157- 163
PubMed Link to Article
American Academy of Pediatrics Committee on Injury and Poison Prevention, Firearm-related injuries affecting the pediatric population Pediatrics 2000;105888- 895
PubMed Link to Article
Duke  NResnick  MDBorowsky  IW Adolescent firearm violence: position paper of the Society for Adolescent Medicine J Adolesc Health 2005;37171- 174
PubMed Link to Article
Hemenway  DSolnick  SJAzrael  DR Firearm training and storage JAMA 1995;27346- 50
PubMed Link to Article
Weil  DSHemenway  D Loaded guns in the home: analysis of a national random survey of gun owners JAMA 1992;2673033- 3037
PubMed Link to Article
Okoro  CANelson  DEMercy  JABalluz  LSCrosby  AEMokdad  AH Prevalence of household firearms and firearm-storage practice in the 50 states and the District of Columbia: findings from the Behavioral Risk Factor Surveillance System, 2002 Pediatrics 2005;116e370- e376
PubMed Link to Article
Centers for Disease Control and Prevention, Source of firearms used by students in school-associated violent deaths: United States, 1992-1999 MMWR Morb Mortal Wkly Rep 2003;52169- 172
PubMed
Grossman  DCReay  DTBaker  SA Self-inflicted and unintentional firearm injuries among children and adolescents: the source of the firearm Arch Pediatr Adolesc Med 1999;153875- 878
PubMed Link to Article
Wintemute  GJTeret  SPKraus  JFWright  MABradfield  G When children shoot children: 88 unintended deaths in California JAMA 1987;2573107- 3109
PubMed Link to Article
Smith  TW 1997-98 National Gun Policy Survey of the National Opinion Research Center: Research Findings.  Chicago, Ill National Opinion Research Center, University of Chicago1998;
Connor  SMWesolowski  KL “They're too smart for that”: predicting what children would do in the presence of guns Pediatrics 2003;111e109- e114
PubMed Link to Article
Farah  MMSimon  HKKellermann  AL Firearms in the home: parental perceptions Pediatrics 1999;1041059- 1063
PubMed Link to Article
Webster  DWWilson  MEHDuggan  AKPakula  LC Parents' beliefs about preventing gun injuries to children Pediatrics 1992;89908- 914
PubMed
Waksberg  J Sampling methods for random digit dialing J Am Stat Assoc 1978;7340- 46
Link to Article
Groves  RMedBiemer  PPedLyberg  LEedMassey  JTedNicholls  WLedWaksberg  Jed Telephone Survey Methodology.  New York, NY John Wiley & Sons2001;
Marcus  ACCrane  LA Telephone surveys in public health research Med Care 1986;2497- 112
PubMed Link to Article
Sainsbury  RDitch  JHutton  S Computer-assisted personal interviewing Soc Res Update 1993;31- 11
Spiegelman  DHertzmark  E Easy SAS calculations for risk or prevalence ratios and differences Am J Epidemiol 2005;162199- 200
PubMed Link to Article
Cummings  PRivara  FP Reporting statistical information in medical journal articles Arch Pediatr Adolesc Med 2003;157321- 324
PubMed Link to Article
SAS Institute Inc, Statistical Applications Software, Version 9.1.2.  Cary, NC SAS Institute Inc2004;
Webster  DWWilson  MEHDuggan  AKPakula  LC Firearm injury prevention counseling: a study of pediatricians' beliefs and practices Pediatrics 1992;89902- 907
PubMed
Coyne-Beasley  TSchoenbach  VJJohnson  RM “Love Our Kids, Lock Your Guns”: a community-based firearm safety counseling and gun lock distribution program Arch Pediatr Adolesc Med 2001;155659- 664
PubMed Link to Article
Grossman  DCCummings  PKoepsell  TD  et al.  Firearm safety counseling in primary care pediatrics: a randomized controlled trial Pediatrics 2000;10622- 26
PubMed Link to Article
Horn  AGrossman  DCJones  WBerger  LR Community based program to improve firearm storage practices in rural Alaska Inj Prev 2003;9231- 234
PubMed Link to Article
Kunz Howard  P An overview of a few well-known national children's gun safety programs and ENA's newly developed program J Emerg Nurs 2001;27485- 488
PubMed Link to Article
McGee  KSCoyne-Beasley  TJohnson  RM Review of evaluations of educational approaches to promote safe storage of firearms Inj Prev 2003;9108- 111
PubMed Link to Article
Oatis  PJBuderer  NMFCummings  PFleitz  R Pediatric practice based evaluation of the Steps to Prevent Firearm Injury program Inj Prev 1999;548- 52
PubMed Link to Article
Wafer  MSCarruth  A “Locks for Life”: a gun lock distribution community health intervention program J Emerg Nurs 2003;29349- 351
PubMed Link to Article
Meyer  GRoberto  AJAtkin  C A radio-based approach to promoting gun safety: process and outcome evaluation implications and insights Health Commun 2003;15299- 318
PubMed Link to Article
Sidman  EAGrossman  DCKoepsell  T  et al.  Evaluation of a community-based handgun safe-storage campaign Pediatrics 2005;115e654- e661
PubMed Link to Article
Coyne-Beasley  TBaccaglini  LJohnson  RMWebster  BWiebe  DJ Do partners with children know about firearms in their home? evidence of a gender gap and implications for practitioners Pediatrics 2005;115e662- e667
PubMed Link to Article
Stevens  MMOlson  ALGaffney  CATosteson  TDMott  LAStarr  P A pediatric, practice-based, randomized trial of drinking and smoking prevention, and bicycle helmet, gun, and seatbelt safety promotion Pediatrics 2002;109490- 497
PubMed Link to Article

Figures

Place holder to copy figure label and caption
Figure.

Reported firearm storage practices stratified by the age of the young people living in the home. Age categories are mutually exclusive. Respondents with children in more than 1 age group were excluded from the analyses.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable 1. Demographic Characteristics of the Study Sample
Table Graphic Jump LocationTable 2. Comparison of Firearm Storage Practices in Homes With Younger Children vs Adolescents*

References

Johnson  RMCoyne-Beasley  TRunyan  CW Firearm ownership and storage practices, US households, 1992-2002: a systematic review Am J Prev Med 2004;27173- 182
PubMed Link to Article
Stennies  GIkeda  RLedbetter  SHouston  BSacks  J Firearm storage practices and children in the home, United States, 1994 Arch Pediatr Adolesc Med 1999;153586- 590
PubMed Link to Article
Azrael  DMiller  MHemenway  D Are household firearms stored safely? it depends on whom you ask Pediatrics 2000;106e31
PubMed Link to Article
Schuster  MAFranke  TBastian  ASor  SHalfon  N Firearm storage patterns in US homes with children Am J Public Health 2000;90588- 594
PubMed Link to Article
Miller  MAzrael  DHemenway  DVriniotis  M Firearm storage practices and rates of unintentional firearm deaths in the United States Accid Anal Prev 2005;37661- 667
PubMed Link to Article
Grossman  DCMueller  BARiedy  C  et al.  Gun storage practices and risk of youth suicide and unintentional firearm injuries JAMA 2005;293707- 714
PubMed Link to Article
Brent  DAPerper  JAAllman  CJMoritz  GMWartella  MEZelenak  JP The presence and accessibility of firearms in the homes of adolescent suicides: a case-control study JAMA 1991;2662989- 2995
PubMed Link to Article
Shah  SHoffman  REWake  LMarine  WM Adolescent suicide and household access to firearms in Colorado: results of a case-control study J Adolesc Health 2000;26157- 163
PubMed Link to Article
American Academy of Pediatrics Committee on Injury and Poison Prevention, Firearm-related injuries affecting the pediatric population Pediatrics 2000;105888- 895
PubMed Link to Article
Duke  NResnick  MDBorowsky  IW Adolescent firearm violence: position paper of the Society for Adolescent Medicine J Adolesc Health 2005;37171- 174
PubMed Link to Article
Hemenway  DSolnick  SJAzrael  DR Firearm training and storage JAMA 1995;27346- 50
PubMed Link to Article
Weil  DSHemenway  D Loaded guns in the home: analysis of a national random survey of gun owners JAMA 1992;2673033- 3037
PubMed Link to Article
Okoro  CANelson  DEMercy  JABalluz  LSCrosby  AEMokdad  AH Prevalence of household firearms and firearm-storage practice in the 50 states and the District of Columbia: findings from the Behavioral Risk Factor Surveillance System, 2002 Pediatrics 2005;116e370- e376
PubMed Link to Article
Centers for Disease Control and Prevention, Source of firearms used by students in school-associated violent deaths: United States, 1992-1999 MMWR Morb Mortal Wkly Rep 2003;52169- 172
PubMed
Grossman  DCReay  DTBaker  SA Self-inflicted and unintentional firearm injuries among children and adolescents: the source of the firearm Arch Pediatr Adolesc Med 1999;153875- 878
PubMed Link to Article
Wintemute  GJTeret  SPKraus  JFWright  MABradfield  G When children shoot children: 88 unintended deaths in California JAMA 1987;2573107- 3109
PubMed Link to Article
Smith  TW 1997-98 National Gun Policy Survey of the National Opinion Research Center: Research Findings.  Chicago, Ill National Opinion Research Center, University of Chicago1998;
Connor  SMWesolowski  KL “They're too smart for that”: predicting what children would do in the presence of guns Pediatrics 2003;111e109- e114
PubMed Link to Article
Farah  MMSimon  HKKellermann  AL Firearms in the home: parental perceptions Pediatrics 1999;1041059- 1063
PubMed Link to Article
Webster  DWWilson  MEHDuggan  AKPakula  LC Parents' beliefs about preventing gun injuries to children Pediatrics 1992;89908- 914
PubMed
Waksberg  J Sampling methods for random digit dialing J Am Stat Assoc 1978;7340- 46
Link to Article
Groves  RMedBiemer  PPedLyberg  LEedMassey  JTedNicholls  WLedWaksberg  Jed Telephone Survey Methodology.  New York, NY John Wiley & Sons2001;
Marcus  ACCrane  LA Telephone surveys in public health research Med Care 1986;2497- 112
PubMed Link to Article
Sainsbury  RDitch  JHutton  S Computer-assisted personal interviewing Soc Res Update 1993;31- 11
Spiegelman  DHertzmark  E Easy SAS calculations for risk or prevalence ratios and differences Am J Epidemiol 2005;162199- 200
PubMed Link to Article
Cummings  PRivara  FP Reporting statistical information in medical journal articles Arch Pediatr Adolesc Med 2003;157321- 324
PubMed Link to Article
SAS Institute Inc, Statistical Applications Software, Version 9.1.2.  Cary, NC SAS Institute Inc2004;
Webster  DWWilson  MEHDuggan  AKPakula  LC Firearm injury prevention counseling: a study of pediatricians' beliefs and practices Pediatrics 1992;89902- 907
PubMed
Coyne-Beasley  TSchoenbach  VJJohnson  RM “Love Our Kids, Lock Your Guns”: a community-based firearm safety counseling and gun lock distribution program Arch Pediatr Adolesc Med 2001;155659- 664
PubMed Link to Article
Grossman  DCCummings  PKoepsell  TD  et al.  Firearm safety counseling in primary care pediatrics: a randomized controlled trial Pediatrics 2000;10622- 26
PubMed Link to Article
Horn  AGrossman  DCJones  WBerger  LR Community based program to improve firearm storage practices in rural Alaska Inj Prev 2003;9231- 234
PubMed Link to Article
Kunz Howard  P An overview of a few well-known national children's gun safety programs and ENA's newly developed program J Emerg Nurs 2001;27485- 488
PubMed Link to Article
McGee  KSCoyne-Beasley  TJohnson  RM Review of evaluations of educational approaches to promote safe storage of firearms Inj Prev 2003;9108- 111
PubMed Link to Article
Oatis  PJBuderer  NMFCummings  PFleitz  R Pediatric practice based evaluation of the Steps to Prevent Firearm Injury program Inj Prev 1999;548- 52
PubMed Link to Article
Wafer  MSCarruth  A “Locks for Life”: a gun lock distribution community health intervention program J Emerg Nurs 2003;29349- 351
PubMed Link to Article
Meyer  GRoberto  AJAtkin  C A radio-based approach to promoting gun safety: process and outcome evaluation implications and insights Health Commun 2003;15299- 318
PubMed Link to Article
Sidman  EAGrossman  DCKoepsell  T  et al.  Evaluation of a community-based handgun safe-storage campaign Pediatrics 2005;115e654- e661
PubMed Link to Article
Coyne-Beasley  TBaccaglini  LJohnson  RMWebster  BWiebe  DJ Do partners with children know about firearms in their home? evidence of a gender gap and implications for practitioners Pediatrics 2005;115e662- e667
PubMed Link to Article
Stevens  MMOlson  ALGaffney  CATosteson  TDMott  LAStarr  P A pediatric, practice-based, randomized trial of drinking and smoking prevention, and bicycle helmet, gun, and seatbelt safety promotion Pediatrics 2002;109490- 497
PubMed Link to Article

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 13

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles