Installing a gun cabinet dramatically reduces unlocked guns and ammunition in the home, according to a study in rural Alaska villages where the residents are primarily Alaska Native people. Group Health Research Institute Senior Investigator David Grossman, MD, MPH, a UW professor of health services, led the research published in the American Journal of Public Health March 8. Grossman is also a pediatrician and medical director for preventive care at Group Health.
Grossman’s research team included representatives from the Alaska Native Tribal Health Consortium, two Native health organizations (Yukon Kuskokwim Health Corporation and Bristol Bay Area Health Corporation), village tribal governments and faculty from UW Medicine’s Harborview Injury Prevention and Research Center. They identified households in six Alaska Native villages in the Bristol Bay and Yukon Kuskokwin Delta area of western Alaska.
The study was a randomized trial with 255 gun-owning households. An $80 locking metal gun cabinet was installed free of charge in the homes, with participants given a brief safety message and instructions on how to use the gun cabinet, including keeping the key in a secure place. The households were divided into two groups, with cabinet installation in the “early” group happening 12 months before installation in the “late” group.
To measure the effect of the gun cabinets, the household member most knowledgeable about the guns in the home took a 13-question survey about how the guns and ammunition were stored. The questions were asked by a researcher visiting the home before, and 12 and 18 months after installation of the gun cabinet.
When the study began,
• 93 percent of participating households reported at least one unlocked gun in the home;
- 89 percent reported unlocked ammunition.
One year after the study began, when early group homes had gun cabinets for 12 months but cabinets were not yet installed in late-group homes,
• 35 percent of households in the early group reported unlocked guns in the home;
• 89 percent of households in the late group, without gun cabinets, reported unlocked guns (declining to 35 percent, six months after receiving a cabinet);
• 35 percent of homes in the early group reported unlocked ammunition;
• 84 percent in the late group reported unlocked ammunition.
Grossman showed in a 2005 JAMA study on U.S. youth that safe firearm storage reduced the risk of unintentional injury and suicide. He conducted this work at UW Medicine’s Harborview Injury Prevention and Research Center, with which he is still affiliated. Alaska Native people have a suicide rate more than three times greater than white Americans. Among Alaska Native men aged 15 to 19, firearm-related suicides were more than 10 times higher than for U.S. white male teenagers in 2000–2006.
“We learned from a small, successful, community-based pilot project that installing gun cabinets in homes in an Alaskan Native village increased safe household firearm storage,” Grossman said. “This current study showed conclusively that it can work in other rural Native villages, and the effects are quite durable over time.”
Further discussing the current study, Grossman added: “This community-supported program to install gun cabinets in homes in rural Alaskan Native villages is feasible and acceptable and clearly reduces exposure of children and teens to unlocked guns and ammunition. If these results are maintained over time, gun-related injuries and deaths could be reduced in this population.”
The Alaska Native Tribal Health Consortium Injury Prevention Program estimates that over 300 gun safes have been placed in rural homes in the past four years. The Alaska Native Tribal Health Consortium provided initial support for the gun safe project in 2008, inviting tribal injury prevention and housing authority staff from regions with an established injury prevention program. From there, regions identified funding and determined how to implement the project locally.
In collaboration with multiple partners, healthy choices are promoted as a means to prevent injury and support community wellness. In addition to suicide prevention and gun safety, the Alaska Native Tribal Health Consortium Injury Prevention Program focuses on water safety, traumatic brain injury prevention and fall prevention. Education, advocacy and coalition-building are ways in which this is achieved.
Grossman is affiliated with UW Medicine’s Harborview Injury Prevention and Research Center and the UW School of Public Health. His co-authors were Helen Andon Stafford, EdM, and Ryan Hill, MPH, who were at the Alaska Native Tribal Health Consortium at the time of this study; Thomas D. Koepsell, MD, MPH, professor emeritus of epidemiology and health services at the UW School of Public Health; Kyla D. Retzer, MPH, formerly of the Yukon Kuskokwim Health Corporation and the Alaska Native Tribal Health Consortium and now at the National Institute for Occupational Safety and Health; and Ward Jones, MA, of the Bristol Bay Area Health Corporation.
The Centers for Disease Control and Prevention and the Indian Health Service each provided funding for the study.
Group Health Research Institute: Group Health Research Institute is the research arm of Seattle-based Group Health Cooperative, a consumer-governed, nonprofit health care system. Founded in 1947, Group Health Cooperative coordinates health care and coverage. Group Health Research Institute changed its name from Group Health Center for Health Studies in 2009. Since 1983, the Institute has conducted nonproprietary public-interest research on preventing, diagnosing, and treating major health problems. Government and private research grants provide its main funding. For more information, see http://www.grouphealthresearch.org
Harborview Injury Prevention and Research Center: UW Medicine’s Harborview Injury Prevention and Research Center is a worldwide leader in researching how people suffer injuries and what can be done to prevent them. Founded in 1985, the Center is one of 12 injury-control centers supported by the Centers for Disease Control and Prevention in the country. The Center is affiliated with the University of Washington and Harborview Medical Center in Seattle. For more information, see http://depts.washington.edu/hiprc/index.html
UW Medicine: The UW Medicine health system includes Harborview Medical Center, Northwest Hospital & Medical Center, Valley Medical Center, UW Medical Center, UW Neighborhood Clinics, UW Physicians, UW School of Medicine, and Airlift Northwest. UW Medicine also shares in the ownership and governance of Children’s University Medical Group and Seattle Cancer Care Alliance, a partnership among UW Medicine, Fred Hutchinson Cancer Research Center, and Seattle Children’s. UW Medicine has major academic and service affiliations with Seattle Children’s, Fred Hutchinson Cancer Research Center, the Veteran’s Affairs Puget Sound Health Care System in Seattle, and the VA Hospital in Boise, Idaho. The UW School of Medicine is the top public institution for biomedical research in funding received from the National Institutes of Health. For more information about UW Medicine, visit http://www.uwmedicine.edu
Alaska Native Tribal Health Consortium: The Alaska Native Tribal Health Consortium (ANTHC) is a not-for-profit tribal health organization managed by Alaska Native tribal governments and their regional health organizations. ANTHC provides statewide services in specialty medical care; construction of water, sanitation and health facilities; community health and research; information technology and professional recruiting. For more information, see http://www.anthc.org
Yukon Kuskokwim Health Corporation: Yukon Kuskokwim Health Corporation (YKHC) administers a comprehensive health care delivery system for 50 rural communities in southwest Alaska. The system includes community clinics, subregional clinics, a regional hospital, dental services, behavioral health services including substance abuse counseling and treatment, health promotion and disease prevention programs, and environmental health services. YKHC is a Tribal Organization authorized by each of the 58 federally recognized Tribal councils in its services area to negotiate with the Federal Indian Health Services to provide health care services under Title V of the Indian Self Determination and Education Assistance Act of 1975. YKHC along with 22 other Tribal Organizations, is a co-signer to the Alaska Tribal Health Compact, a consortium which secures annual funding agreements with the federal government to provide health care services to Alaska Natives and Native Americans throughout the state. For more information, see http://www.ykhc.org
Bristol Bay Area Health Corporation: The Bristol Bay Area Health Corporation was formed by Bristol Bay tribes in 1973 to provide health services to residents of Southwest Alaska. It serves 34 villages and employs over 360 health care professionals. For more information, see http://www.bbahc.org
Rebecca Hughes is senior media consultant for the Group Health Research Institute.