Guns and Children: What Is Responsible Ownership?

This transcript has been edited for clarity. 
Welcome to Impact Factor, your weekly dose of commentary on a new medical study. I’m Dr F. Perry Wilson of the Yale School of Medicine.
We’ve got to talk about kids’ access to guns. I know this is a charged issue. In this space, I often editorialize; I give my thoughts and impressions of a medical study with an understanding that reasonable discourse is still possible, at least when it comes to healthcare. 
But guns are different. Some of you may think an associate professor of medicine and public health is a great person to discuss the gun issue, as it is firmly a medicine and public health problem. Some of you may think guns have absolutely nothing to do with either of my specialties and that I should stay in my lane.
But I don’t want to avoid this. We don’t know all the details surrounding the most recent school shooting, in Georgia, but we do know that the weapon used by the 14-year-old shooter had been in his home. Some reports suggest that it was actually his gun, given to him as a gift from his father. And this week, we have some hard data on how gun owners with kids think about the relationship between kids and guns. Let’s try to figure this out.
I think the best thing I can do with this subject is stick to the facts as much as possible and flag carefully where I am drawing inference. So let’s get started.
Fact #1: Firearm-associated injuries are the leading cause of death in children and adolescents in the United States, outpacing motor vehicle accidents since 2020. A bit more than half of these are deaths from suicide. 
Fact #2: Children with guns in the home are more likely to die from suicide. This meta-analysis from the Annals of Internal Medicine estimated that the risk for completed suicide is 3.2 times higher when a gun is in the home, and the risk for homicide is two times higher. 
Fact #3: Studies show that four storage practices are associated with a lower risk of a child being harmed by a gun in a home: Guns should be locked safely, stored unloaded, and stored in a different location than ammunition, which should also be locked. Each of these factors was associated with a 50%-70% reduction in the risk of a child being harmed by a firearm.
Looking at these data, it makes me think of the concept of “responsible gun ownership.” Just to be clear, I’m moving out of facts and into inference now. None of these reductions are 100%. Given the risk associated with owning a gun in a house with children, is there a way to do it safely? Truly safely? Or is that a pipe dream? Is it akin to talking about “responsible tiger ownership” or something?
One thing I have heard from gun owners — and yes, while I do not personally own a gun, I am friends with quite a few people who do — is that when there are kids in the home, responsible gun ownership is not just about locking guns away safely. It’s about teaching kids what responsible gun use looks like and providing clear guidance on when and how gun use is acceptable.
And that sounds pretty good to me; a little education is never a bad thing.
Unless that education gives parents a false sense of security. And that’s what has me worried after reading this paper, “Parental Engagement With Children Around Firearms and Unsecure Storage,” from JAMA Pediatrics, which came across my desk this week.
This is a rather simple survey study, a representative sample of gun-owning adults with children in their home, from nine states, which I’ve shown here.
The survey was fairly detailed, going into the type of firearm, the characteristics of the parents and the family, as well as the storage of the guns.
Overall, you can see that a majority of parents reported discussing firearm safety with their kids. Half had demonstrated proper firearm handling. A third had taught their kids how to shoot a firearm. 
This is all fine — until you look at the association between teaching your kids about guns and safe gun storage. What the authors found was striking: Parents who said they taught their kids about proper firearm handling, or taught their children to shoot a firearm, were up to twice as likely to have at least one gun unlocked and loaded in the house. 
That’s the data. The inference is that these parents feel safer having educated their children about guns, and thus feel more comfortable leaving a loaded gun unlocked.
This scares me a bit because the data linking safe storage of firearms with safe kids are so strong. But the data we don’t have is the relative impact of unsafe storage among gun-educated vs -uneducated children. There’s an argument to be made that maybe these kids are fine, that they know enough about the gun to respect the gun. 
But we’d do well to remember that kids make mistakes. Kids are impulsive and irrational. Kids can develop depression, schizophrenia, and psychosis without their parents being fully aware. And a kid who knows how to use a gun, and who has free access to a gun, may in fact be particularly dangerous in the right circumstance. 
That’s an inference, of course.
But the facts remain clear. There are millions of kids living in houses with guns. These kids are at higher risk of dying from a gun. Safe storage mitigates that risk. Whether education mitigates the risk of unsafe storage remains an open question. 
We can always say wait for more data, but the precautionary principal is pretty clear on this one. If you own a firearm and you have a child in the house, no matter how well you’ve taught that child to respect the weapon, how knowledgeable they are about it, how safe they have demonstrated they can be with it, please lock it up — unloaded — and lock ammo up elsewhere. Keep the tiger in the cage.
F. Perry Wilson, MD, MSCE, is an associate professor of medicine and public health and director of Yale’s Clinical and Translational Research Accelerator. His science communication work can be found in the Huffington Post, on NPR, and here on Medscape. He tweets @fperrywilsonand his book, How Medicine Works and When It Doesn’t, is available now.
 
Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.