New Data: WA State Firearm Ownership and Storage …...> Missing Not at Random –Refusal to answer...
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New Data: WA State Firearm Ownership and Storage Practices November 13 th , 2018 WA Firearm Tragedy Prevention Network Meeting
Transcript of New Data: WA State Firearm Ownership and Storage …...> Missing Not at Random –Refusal to answer...
New Data:
WA State Firearm Ownership and
Storage Practices
November 13th, 2018
WA Firearm Tragedy Prevention Network Meeting
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.
What is Surveillance
> Started in 1984
> Nationwide in 1993
> Surveys representative sample
> Largest telephone survey in the world
Brief History of BRFSS
> Computer Assisted Telephone Interview (CATI)
> Surveys on various health behaviors
> All data is completely anonymous
> Sampling
> Raking/weighting and analysis
BRFSS Methodology
Surveillance
Surveillance
Proportion of
Adults 65+ Not
Receiving
Influenza Vaccine
(2011–2015)
https://www.kingcounty.gov/depts/health/data/community-health-indicators.aspx
Background
> Suicide is tenth leading cause of death in US1
> Ecologic studies show relationship between state-level firearm ownership
and suicide rate2-4
> Individual level studies found strong association between household
firearm ownership and suicide risk5,6
> Firearm regulation proposed (e.g. safe storage laws, communication
between clinicians and patients, etc.)
> Some postulate that firearm owners are inherently more suicidal
Background
Firearm Ownership Suicide
Mental Health
?
Background
> Are We Missing Something Pertinent?
> Bias analysis results7:
– Risk factor with 10-fold increase in suicide
– Over 400 times more common among residents of firearm-
owning households
> Does this discrepancy in risk factors exist?
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
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
Methods – Data Collection
> 2013, 2015, & 2016 Washington BRFSS Surveys
> Total Survey Responses: 41,537
> Completed the Firearm Module: 34,884
Methods - Analysis
> Poisson Regression
> Survey Weighting
> Covariates Included:
– Age
– Race
– Sex
– Income
– Education
– Employment
– Marital Status
– Urbanicity
Results
> Statewide:
> 34% Live in Firearm Owning Homes
> 46% Store unlocked
> King County
> 21% Live in Firearm Owning Home
> 43% Store unlocked
Results – Firearm Ownership
Prevalence Ratio
Depression Diagnosis
Felt Worthless
Felt Everything Was an Effort
Serious Mental Illness
Frequent Mental Distress
Binge Alcohol Use
Chronic Alcohol Use
Chronic Pain
Results – Firearm Storage
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
Intermediate
High Risk
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
Implications
> Accessible to thieves
> $4.2 million worth of firearms stolen Statewide (2017)
> 730 incidents in King County
> 4300 incidents statewide
> Accessible to kids
> 130 on-campus incidents 2015-2016
> 11% of 8th graders and 23% of 12th graders would not be
caught if they carried a handgun without permission
> 4% of 10th and 12th graders carried a gun at least once during
the past month
Implications
Implications
> Disparity in Suicide
> Clinicians Initiating Discussions
Implications
> Lethal Means Interventions
– Suicide Prevention Training
– King County Lock-It-Up
– Children’s Hospital Campaign
– Safer Homes Task Force
> Importance of Surveillance Tools
Acknowledgements
Questions?
References
1. Drapeau CW, McIntosh JL. U.S.A. Suicide: 2015 Official Final Data. Washington D.C.; 2016. doi:10.1111/sltb.12093.
2. Miller M, Lippmann SJ, Azrael D, Hemenway D. Household Firearm Ownership and Rates of Suicide Across the 50 United States.
2004;62(4). doi:10.1097/01.ta.0000198214.24056.40.
3. 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. 2002:313-317.
4. 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. 2012. doi:10.1146/annurev-publhealth-031811-124636.
5. 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):101-110. doi:10.7326/M13-1301.
6. Kellermann A, Rivara F, Somes G, et al. Suicide in the home in relation to gun ownership. N Engl J Med. 1992;327(7):467-472.
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):62-69. doi:10.1093/epirev/mxv011.
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
2013 991 998
2015 1845 1845
2016 1941 1971
Theoretical Framework for Storage
Suicidal
Ideation
Suicide
Attempt
Suicide Death
End of Crisis Means Substitution
