Caregiver-Perceived Appropriateness of Discussing Firearm Storage in the Healthcare Setting

Firearms are the leading cause of death for children in the US - secure storage decreases morbidity and mortality. Though effective at improving storage, healthcare providers (HCPs) seldom discuss secure storage, partly due to concern that it will damage the caregiver-provider relationship. We sought to1) Describe caregiver-perceived appropriateness of HCP firearm storage counseling, and 2) Identify variables associated with perceived appropriateness.

This cross-sectional study used data from the 2025 Colorado Firearm Injury Prevention Survey (COFIPS), administered online in English and Spanish by Ipsos (June-July 2025). Adults with children <18 years old living, visiting, or staying in their home were eligible (herein caregivers). The primary outcome, perceived appropriateness of HCP discussing firearm storage, was dichotomized as "at least sometimes" versus "never" appropriate; responses of "unsure" were excluded. Weighted logistic regression models examined associations between perceived appropriateness and prior HCP firearm counseling, firearm access, storage practices, and beliefs. Poststratification weights were applied to produce state-representative estimates.

Of 627 caregivers, 586 were included in the analysis. Overall, 82.7% (95% CI: 79.3-85.6%) reported discussions were at least sometimes appropriate. Prior firearm counseling during a healthcare visit was strongly associated with perceived appropriateness (OR 7.34, 95% CI: 2.73-19.74). Among caregivers reporting an unlocked and loaded firearm in the home (least secure storage), 72.5% found these discussions appropriate.

Most caregivers were receptive to HCP firearm storage counseling. Prior counseling was associated with increased receptivity, highlighting the benefit of repeated messaging. HCPs should consider capitalizing on clinical visits to discuss firearm safety.