Skip to main content

Perspectives from firearm stakeholders on firearm safety promotion in pediatric primary care as a suicide prevention strategy: a qualitative study

Journal of Behavioral Medicine volume 42, pages 691–701 (2019)Cite this article

Abstract

The primary objective of the current study was to examine the perspective of firearm stakeholders, including firearm safety course instructors, members of law enforcement, and firearm retailers, with regard to the implementation of an evidence-based approach to firearm safety promotion, the Firearm Safety Check, as a universal suicide prevention strategy in pediatric primary care. Twelve firearm stakeholders participated in semi-structured interviews. Using an integrated analytic approach, several themes emerged from the interviews. With regard to acceptability of the intervention, participants generally found counseling caregivers to store firearms safely and the provision of firearm locking mechanisms to be acceptable, but expressed concern about screening for firearm ownership in health systems. Participants identified distinct roles of responsibility for firearm advocacy groups, firearm owners, healthcare clinicians, and caregivers with regard to the promotion and execution of safe firearm storage. Participants called for partnerships between healthcare systems and firearm stakeholders, and also identified potential threats to these partnerships, including lack of trust firearm owners may have in health systems and the government. Finally, participants suggested strategies for preventing firearm-related suicides. Findings support a growing body of literature suggesting the value in researchers, health systems, and firearm stakeholders partnering around a shared agenda of firearm safety promotion as a strategy to prevent suicide.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  • American Foundation of Suicide Prevention. (2016, August 10). American Foundation for Suicide Prevention and the National Shooting Sports Foundation partner to help prevent suicide. Retrieved from https://afsp.org/american-foundation-suicide-prevention-national-shooting-sports-foundation-partner-help-prevent-suicide/.

  • Barber, C., Frank, E., & Demicco, R. (2017). Reducing suicides through partnerships between health professionals and gun owner groups—Beyond docs vs glocks. JAMA Internal Medicine, 177, 5–6.

    Article  PubMed  Google Scholar 

  • Barber, C., & Miller, M. (2014). Reducing a suicidal person’s access to lethal means of suicide: A research agenda. American Journal of Preventive Medicine, 47, S264–S272.

    Article  PubMed  Google Scholar 

  • Barkin, S. L., Finch, S. A., Ip, E. H., Scheindlin, B., Craig, J. A., Steffes, J., et al. (2008). Is office-based counseling about media use, timeouts, and firearm storage effective? Results from a cluster-randomized, controlled trial. Pediatrics, 12, e15–e25.

    Article  Google Scholar 

  • Beidas, R. S., Jager-Hyman, S., Becker-Haimes, E., Wolk, C. B., Ahmedani, B. K., Zeber, J. E., et al. (2018). Acceptability and use of evidence-based practices for firearm storage in pediatric primary care. Academic Pediatrics. https://doi.org/10.1016/j.acap.2018.11.007

    Article  PubMed  Google Scholar 

  • Betz, M. E., Knoepke, C. E., Siry, B., Clement, A., Azrael, D., Ernestus, S., et al. (2018). ‘Lock to Live’: Development of a firearm storage decision aid to enhance lethal means counseling and prevent suicide. Injury Prevention. https://doi.org/10.1136/injuryprev-2018-042944

    Article  PubMed  Google Scholar 

  • Betz, M. E., & Wintemute, G. J. (2015). Physician counseling on firearm safety: A new kind of cultural competence. JAMA, 314, 449–450.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bradley, E. H., Curry, L. A., & Devers, K. J. (2007). Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Services Research, 42, 1758–1772.

    Article  PubMed  PubMed Central  Google Scholar 

  • Butkus, R., Doherty, R., Bornstein, S. S., & Health and Public Policy Committee of the American College of Physicians. (2018). Reducing firearm injuries and deaths in the United States: A position paper from the American College of Physicians. Annals of Internal Medicine, 169, 704–707.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2005). Web-based injury statistics query and reporting system (WISQARS). [cited 2018 Oct 30]. www.cdc.gov/injury/wisqars.

  • Chambers, D., & Azrin, S. (2013). Research and services partnerships: A fundamental component of dissemination and implementation research. Psychiatric Services, 64, 509–511.

    Article  PubMed  Google Scholar 

  • Chapman, S., Alpers, P., & Jones, M. (2016). Association between gun law reforms and intentional firearm deaths in Australia, 1979–2013. JAMA, 316, 291–299.

    Article  PubMed  Google Scholar 

  • Cummings, P., Koepsell, T. D., Grossman, D. C., Savarino, J., & Thompson, R. S. (1997). The association between the purchase of a handgun and homicide or suicide. American Journal of Public Health, 87, 974–978.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cunningham, R. M., Walter, M. A., & Carter, P. M. (2018). The major causes of death in children and adolescents in the Unites States. New England Journal of Medicine, 379, 2468–2475.

    Article  PubMed  Google Scholar 

  • Dowd, D. M., & Sege, R. D. (2012). Council on injury, violence, and poison prevention executive committee. Firearm-related injuries affecting the pediatric population. Pediatrics, 130, e1416–e1423.

    Article  PubMed  Google Scholar 

  • Fowler, K. A., Dahlberg, L. L., Haileyesus, T., Gutierrez, C., & Bacon S. (2017). Childhood firearm injuries in the United States. Pediatrics, 140, e20163486.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gordon, E. (2018, May 24). To better counsel patients, doctors try handling firearms themselves. The Pulse. Retrieved from https://whyy.org/segments/to-better-counsel-patients-doctors-try-handling-firearms-themselves/.

  • Grossman, D. C., Mueller, B. A., Riedy, C., Dowd, D., Villaveces, A., Prodzinski, J., et al. (2005). Gun storage practices and risk of youth suicide and unintentional firearm injuries. JAMA, 293, 707–714.

    Article  CAS  PubMed  Google Scholar 

  • Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18, 59–82.

    Article  Google Scholar 

  • Hepburn, L., Miller, M., Azrael, D., & Hemenway, D. (2007). The US gun stock: Results from the 2004 national firearms survey. Injury Prevention, 13, 15–19.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kaufman, E. J., Morrison, C. N., Branas, C. C., & Wiebe, D. J. (2018). State firearm laws and interstate firearm deaths from homicide and suicide in the United States: A cross-sectional analysis of data by county. JAMA Internal Medicine, 178, 692–700.

    Article  PubMed  PubMed Central  Google Scholar 

  • Luoma, J. B., Martin, C. E., & Pearson, J. L. (2002). Contact with mental health and primary care providers before suicide: A review of the evidence. American Journal of Psychiatry, 159, 909–916.

    Article  PubMed  PubMed Central  Google Scholar 

  • Marino, E., Wolsko, C., Keys, S., & Wilcox, H. (2018). Addressing the cultural challenges of firearm restriction in suicide prevention: A test of public health messaging to protect those at risk. Archives of Suicide Research, 22, 394–404.

    Article  PubMed  Google Scholar 

  • Miller, M., Azrael, D., & Hemenway, D. (2004). The epidemiology of case fatality rates for suicide in the Northeast. Annals of Emergency Medicine, 43, 723–730.

    Article  PubMed  Google Scholar 

  • Miller, M., Azrael, D., & Barber, C. (2012). Suicide mortality in the United States: The importance of attending to method in understanding population-level disparities in the burden of suicide. Annual Review of Public Health, 33, 393–408.

    Article  PubMed  Google Scholar 

  • National Rifle Association Institute for Legislative Action. (2018, November 2). Surprise: Physician group rehashes same tired gun control policies. Retrieved from https://www.nraila.org/articles/20181102/surprise-physician-group-rehashes-same-tired-gun-control-policies.

  • Olson, L. M., Christoffel, K. K., & O’Connor, K. G. (2007). Pediatricians’ involvement in gun injury prevention. Injury Prevention, 13, 99–104.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Pellecchia, M., Mandell, D. S., Nuske, H. J., Azad, G., Wolk, C. B., Maddox, B. B., et al. (2018). Community academic partnerships in implementation research. Journal of Community Psychology, 45, 941–952.

    Article  Google Scholar 

  • Pew Research Center. (2017). American’s complex relationship with guns: An in-depth look at the attitudes and experiences of U.S. adults. Washington, DC: Pew Research Center.

    Google Scholar 

  • Pirelli, G., & Witt, P. (2017). Firearms and cultural competence: Considerations for mental health professionals. Journal of Aggression, Conflict and Peace Research, 10, 61–70.

    Article  Google Scholar 

  • Rowhani-Rahbar, A., Simonetti, J. A., & Rivara, F. P. (2016). Effectiveness of interventions to promote safe firearm storage. Epidemiologic Reviews, 38, 111–124.

    PubMed  Google Scholar 

  • Talley, C. L., Campbell, B. T., Jenkins, D. H., Barnes, S. L., Sidwell, R. A., Timmerman, G., et al. (2019). Recommendations from the American College of Surgeons Committee on Trauma’s Firearm Strategy Team (FAST) Workgroup: Chicago Consensus I. Journal of the American College of Surgeons, 322, 198–206.

    Article  Google Scholar 

  • Tong, A., Sainsbury, P., & Craig, J. (2017). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19, 349–357.

    Article  Google Scholar 

  • Vriniotis, M., Barber, C., Frank, E., Demicco, R., & the New Hampshire Firearm Safety Coalition. (2014). A suicide prevention campaign for firearm dealers in New Hampshire. Suicide and Life Threatening Behavior, 45, 157–163.

    Article  PubMed  Google Scholar 

  • Wallerstein, N., Duran, B., Oetzel, J., & Minkler, M. (2018). Community-based participatory research for health: Advancing social and health equity (3rd ed.). San Francisco, CA: Jossey-Bass.

    Google Scholar 

  • Wintemute, G. J., Parham, A., Beaumont, J. J., Wright, M., & Drake, C. (1999). Mortality among recent purchasers of handguns. New England Journal of Medicine, 341, 1583–1589.

    Article  CAS  PubMed  Google Scholar 

  • Wolk, C. B., Jager-Hyman, S., Marcus, S. C., Ahmedani, B. K., Zeber, J. E., Fein, J. A., et al. (2017). Developing implementation strategies for firearm safety promotion in paediatric primary care for suicide prevention in two large US health systems: A study protocol for a mixed-methods implementation study. British Medical Journal Open, 7, e014407.

    Google Scholar 

  • Wolk, C. B., van Pelt, A., Jager-Hyman, S., Ahmedani, B. K., Zeber, J. E., Fein, J. A., et al. (2018). Stakeholder perspectives on implementing a firearm safety intervention in pediatric primary care as a universal suicide prevention strategy: A qualitative study. JAMA Network Open, 1, e185309.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank Steven C. Marcus, PhD, Research Associate Professor at the School of Social Policy and Practice, University of Pennsylvania, for his methodological contributions as a co-investigator. We are grateful for the support and cooperation the Mental Health Research Network has provided for this project, particularly Gregory Simon, MD, MPH, and the MHRN Suicide Prevention SIG. We would like to thank the following experts who provided their time and input on this project: Collen Barry, PhD, Shari Barkin, MD, MSHS, Maria Fernandez, PhD, Carol Runyan, MPH, PhD, Garen Wintemute, MD, MPH, Marian Betz, MD, MPH, and Megan Ranney, MD, MPH. We are also grateful for the help provided by Danielle Adams, AM; Kelly Zentgraf, BA; Shiv Nadkarni; and Peter Simonsson, MSW.

Funding

This project was supported by the following grants from NIMH: R21 MH109878 (PI: Beidas) and U19 MH092201 (PI: Simon).

Author information

Affiliations

  1. Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA

    Shari Jager-Hyman, Courtney Benjamin Wolk, Gregory K. Brown, Y. Vivian Byeon, Hannah Listerud, Courtney A. Gregor, Adina Lieberman & Rinad S. Beidas

  2. Henry Ford Health System, Center for Health Policy and Health Services Research and Behavioral Health Services, One Ford Place, Suite 3A, Detroit, MI, 48202, USA

    Brian K. Ahmedani

  3. School of Public Health, University of Massachusetts at Amherst, 317 Arnold House, Amherst, MA, 01003, USA

    John E. Zeber

  4. Department of Research, Central Texas Veterans Health Care System, 1901 1st Street, Temple, TX, 76502, USA

    John E. Zeber

  5. Division of Emergency Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, The Perelman School of Medicine at The University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Joel A. Fein

  6. Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Rinad S. Beidas

  7. Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, 19104, USA

    Rinad S. Beidas

Authors
  1. Shari Jager-Hyman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Courtney Benjamin Wolk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brian K. Ahmedani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John E. Zeber
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joel A. Fein
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gregory K. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Y. Vivian Byeon
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hannah Listerud
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Courtney A. Gregor
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Adina Lieberman
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Rinad S. Beidas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rinad S. Beidas.

Ethics declarations

Conflict of interest

Shari Jager-Hyman, Courtney Benjamin Wolk, Brian K. Ahmedani, John E. Zeber, Joel A. Fein, Gregory K. Brown, Y. Vivian Byeon, Hannah Listerud, Courtney A. Gregor, Adina Lieberman, and Rinad S. Beidas declare that they have no conflict of interest.

Human and animal rights and informed consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jager-Hyman, S., Benjamin Wolk, C., Ahmedani, B.K. et al. Perspectives from firearm stakeholders on firearm safety promotion in pediatric primary care as a suicide prevention strategy: a qualitative study. J Behav Med 42, 691–701 (2019). https://doi.org/10.1007/s10865-019-00074-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-019-00074-9

Keywords

  • Firearm safety
  • Primary care
  • Suicide prevention
  • Evidence-based practice