Understanding caregiver preferences for firearm locking devices in a pediatric emergency department

Around 40% of US households with children have a firearm kept in the home. This study sought to describe firearm storage practices and locking device preferences among caregivers of children presenting to a pediatric emergency department (ED).

We conducted a cross-sectional survey of caregivers of children presenting to a pediatric ED who endorsed having a firearm in the home from August 2023 to May 2024. A self-administered electronic survey inquired about current firearm storage practices and locking device preferences. Caregivers who endorsed any unsafe firearm storage practice (i.e., firearm stored unlocked, loaded, and/or with ammunition) were offered, based on their preference, a free cable gun lock, lock box, or gun safe along with safe firearm storage education materials. Caregivers given a device were surveyed 30 days later to reevaluate firearm storage behavior. McNemar's test was used to evaluate differences in reported baseline locking device use. Wilcoxon signed rank test was used to evaluate changes in storage behaviors (locked, unloaded, and stored separate from ammunition) from baseline to 30-day follow-up.

Of 139 caregivers with a firearm in the home, 91% (n = 126) reported having a handgun and 41% (n = 57) reported storing firearms with triple safe storage. Safes/vaults were more frequently used (40%, n = 56) than cable gun locks (20%, n = 28) (p = 0.003). Factors involved in caregiver preference for firearm locking devices were: speed of access to firearms (47%, n = 66), strength of the device (45%, n = 63), and cost of device (42%, n = 58). Seventeen caregivers were provided a free device based on preference: 15 gun safes, 2 lock boxes, and 0 cable gun locks. At 30-day follow up, 70.6% (n = 12) of eligible caregivers responded, and the proportion of respondents who reported storing all firearms locked increased significantly from baseline (from 67 to 100%, p = 0.036).

Caregivers in a pediatric ED reported using safes most frequently and, when offered a device, preferred safes over other locking devices. After being provided a free device of their preference, all caregivers who completed follow-up surveys reported all firearms were locked. Healthcare and community organizations should align resources with caregiver preferences.