New Data: WA State Firearm Ownership and Storage Practices. November 13 th, 2018 WA Firearm Tragedy Prevention Network Meeting

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Allan Booth
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1 New Data: WA State Firearm Ownership and Storage Practices November 13 th, 2018 WA Firearm Tragedy Prevention Network Meeting

2 What is Surveillance Public health surveillance is the continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice.

3 Brief History of BRFSS > Started in 1984 > Nationwide in 1993 > Surveys representative sample > Largest telephone survey in the world

4 BRFSS Methodology > Computer Assisted Telephone Interview (CATI) > Surveys on various health behaviors > All data is completely anonymous > Sampling > Raking/weighting and analysis

5 Surveillance

Surveillance Proportion of Adults 65+ Not Receiving Influenza Vaccine (2011

6 Surveillance Proportion of Adults 65+ Not Receiving Influenza Vaccine ( )

7 Background > Suicide is tenth leading cause of death in US 1 > Ecologic studies show relationship between state-level firearm ownership and suicide rate 2-4 > Individual level studies found strong association between household firearm ownership and suicide risk 5,6 > Firearm regulation proposed (e.g. safe storage laws, communication between clinicians and patients, etc.) > Some postulate that firearm owners are inherently more suicidal

8 Background Mental Health? Firearm Ownership Suicide

9 Background > Are We Missing Something Pertinent? > Bias analysis results 7 : Risk factor with 10-fold increase in suicide Over 400 times more common among residents of firearmowning households > Does this discrepancy in risk factors exist?

10 Methods - Exposure > Residing in a Firearm Owning Household > Storage of Household Firearm Safe Storage: > Locked & Unloaded Intermediate Storage: > Locked & Loaded > Unlocked & Unloaded Least Safe Storage: > Unlocked & Loaded

11 Methods - Outcomes > Depression Diagnosis > Felt Worthless > Felt Everything Was an Effort > Serious Mental Illness > Frequent Mental Distress > Chronic Alcohol Use > Binge Alcohol Use > Chronic Pain

12 Methods Data Collection > 2013, 2015, & 2016 Washington BRFSS Surveys > Total Survey Responses: 41,537 > Completed the Firearm Module: 34,884

13 Methods - Analysis > Poisson Regression > Survey Weighting > Covariates Included: Age Race Sex Income Education Employment Marital Status Urbanicity

14 Results > Statewide: > 34% Live in Firearm Owning Homes > 46% Store unlocked > King County > 21% Live in Firearm Owning Home > 43% Store unlocked

15 Results Firearm Ownership Depression Diagnosis Felt Worthless Felt Everything Was an Effort Serious Mental Illness Frequent Mental Distress Binge Alcohol Use Chronic Alcohol Use Chronic Pain Prevalence Ratio

16 Results Firearm Storage Depression Diagnosis Intermediate High Risk Felt Worthless Felt Everything Was an Effort Serious Mental Illness Frequent Mental Distress Binge Alcohol Use Chronic Alcohol Use Chronic Pain Prevalence Ratio

17 Results Summary > Firearm Owning vs Non-owning No differences in mental health Increased alcohol misuse > Storage Practices Both Unsafe Storage Practices > Binge Alcohol Use Least Safe Storage > Chronic Alcohol Use > Frequent Mental Distress

18 Implications > Accessible to thieves > $4.2 million worth of firearms stolen Statewide (2017) > 730 incidents in King County > 4300 incidents statewide

19 Implications > Accessible to kids > 130 on-campus incidents > 11% of 8th graders and 23% of 12 th graders would not be caught if they carried a handgun without permission > 4% of 10 th and 12 th graders carried a gun at least once during the past month

20 Implications > Disparity in Suicide > Clinicians Initiating Discussions

21 Implications > Lethal Means Interventions Suicide Prevention Training King County Lock-It-Up Children s Hospital Campaign Safer Homes Task Force > Importance of Surveillance Tools

22 Acknowledgements

23 Questions?

24 References 1. Drapeau CW, McIntosh JL. U.S.A. Suicide: 2015 Official Final Data. Washington D.C.; doi: /sltb Miller M, Lippmann SJ, Azrael D, Hemenway D. Household Firearm Ownership and Rates of Suicide Across the 50 United States. 2004;62(4). doi: /01.ta Hemenway D, Miller M. Association of rates of household handgun ownership, lifetime major depression, and serious suicidal thoughts with rates of suicide across US census regions. 2002: Miller M, Azrael D, Barber C. Suicide Mortality in the United States : The Importance of Attending to Method in Understanding Population-Level Disparities in the Burden of Suicide doi: /annurev-publhealth Anglemyer A, Horvath T, Rutherford G. The Accessibility of Firearms and Risk for Suicide and Homicide Victimization Among Household Members. Ann Intern Med. 2014;(160): doi: /m Kellermann A, Rivara F, Somes G, et al. Suicide in the home in relation to gun ownership. N Engl J Med. 1992;327(7): Miller M, Swanson SA, Azrael D. Are We Missing Something Pertinent? A Bias Analysis of Unmeasured Confounding in the Firearm- Suicide Literature. Epidemiol Rev. 2016;38(1): doi: /epirev/mxv011.

25 Methods - Missingness > Missing Not at Random Refusal to answer sensitive questions > Mostly Missing at Random Survey Fatigue Year No. Missing Previous Module No. Missing Firearms Module

26 Theoretical Framework for Storage Suicidal Ideation Suicide Attempt Suicide Death End of Crisis Means Substitution

WA Firearm Tragedy Prevention Network Kick-Off Meeting. Welcome!

WA Firearm Tragedy Prevention Network Kick-Off Meeting Welcome! Seattle May 24, 2016 Agenda 9 to 9:20 a.m. - Welcome & Introduction to the Firearm Tragedy Prevention Network 9:20 to 9:50 a.m. - Roundtable