Firearm Possession Among Adolescents and Emerging Adults Seeking Urban ED Treatment

Introduction: Firearms are the 2^nd leading cause of death among adolescents and emerging adults (A/EAs), largely due to interpersonal violence. Little is known about firearm possession, typology, and motivation for possession, and few studies have identified risk/protective factors for firearm possession among this population. Emergency departments (EDs) offer an opportunity to intervene with high-risk A/EAs that may not be reached by school- or community-based prevention efforts. The purpose of this analysis was to assess rates of firearm possession among A/EAs, identify firearm typology, acquisition sources, and motivations for possession, and examine differences in risk/protective factors among A/EAs reporting firearm possession compared to those without firearms.

Methods: 1,312 A/EAs (M_age=22.20, SD=3.75; 29.6% male; 50.5% Black) treated at an urban ED for any reason (7/10/2017-6/25/2018) completed a screening survey. Measures included demographics, firearm-related behaviors/attitudes, substance use, mental health, violent/delinquent behaviors, social influences, neighborhood characteristics, and community involvement.

Results: About 17% of A/EAs endorsed firearm possession (³1 firearm) within the past three months, with 782 firearms possessed collectively. Of these A/EAs, 74% reported possessing a revolver/handgun, 23% a regular or sawed-off shotgun, and 19% a highly lethal military-style rifle or automatic handgun. About 72% of firearm-possessing A/EAs reported having a firearm for protection and 26% for hunting/sporting activities. Notably, only 33% reported obtaining their firearms through legal channels.

Logistic regression results showed that compared to those who do not possess a firearm, A/EAs who possess firearms are less likely to report anxiety symptoms (OR=.63, p<.05), and more likely to be male (OR=2.10, p<.001), binge drink (OR= 1.42, p<.05), endorse firearm retaliatory attitudes (OR=1.27, p<.001), have been violently victimized (OR=1.11, p<.05), have friends who own/carry a firearm (OR=9.74, p<.001), and experience greater community violence (OR=1.03, p<.01). Community involvement and having a positive mentor were not significant correlates of firearm possession.

Conclusions: Our findings suggest that firearm possession may be strongly influenced by peers given that youth who possess firearms are almost 10 times more likely to have friends who own/carry a firearm compared to youth without firearms. Prevention efforts should focus on addressing risky firearm behaviors and social norms within peer groups, reducing exposure to community violence and problematic patterns of substance use, and promoting positive conflict-resolution skills. Additionally, efforts should focus on addressing the widespread availability of illegal firearms.