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Charles Jennissen, MD
Victor Soupene, PhD, MS
Marc Doobay, DMSc, PA-C, DFAAPA
Nicholas Stange, MD, MPH
Pam Hoogerwerf, BA
Cassidy Branch, MA

Firearm suicides rates are higher in rural US areas compared to urban US areas. However, less is known regarding how rural, farm parents address suicide risk and how this affects firearm safe storage practices. We sought to answer the following questions regarding rural, farming parents: 1) How do they understand their responsibility as gatekeepers in regulating firearm access to youth? 2) What strategies do they use to manage home firearm access? 3) How do parents see firearm access affecting rural suicide risk? and 4) How do they view safe storage laws in relation to preventing suicide?

Focus group sessions (in-person and online) were conducted. Participants were recruited through emails to Iowa FFA club advisors who informed member parents and a mass email distributed to University of Iowa faculty/staff. Participants had to : (1) live on and actively farm/ranch in Iowa, (2) have at least one child 10-19 years old, and (3) have at least one firearm in the home. Thematic analysis was conducted through inductive, consensus coding of focus group transcripts involving four research team members.

Thirty-two parents participated. Few participants reported positive remarks toward being considered a “gatekeeper” of firearms in the home, but many provided negative comments-- particularly surrounding this terminology. They considered their role more of monitoring firearm use rather than of being a gatekeeper. In fact, most parents described keeping firearms readily available within the household with most youth in the home having as much access as anyone else. Several parents described firearm accessibility as consistent with how they themselves were raised and believed children simply needed education. Although many participants expected their children to ask for permission to access and, for some, anticipated firearms would be operated under their supervision only, firearms were still readily available to all. Many felt safe storage practices were primarily relevant for young children and that once youth started using firearms, reducing access was considered impractical. Many participants expressed skepticism about statistics indicating higher suicide rates in rural communities. Others were not surprised given the social isolation of rural living and the high firearm availability. Additional explanations included exposure to social media with bullying as a contributor. Several noted they rarely heard about suicide in public discourse. Most participants believed suicide was influenced more by mental health problems than by firearm access and some explicitly rejected the idea that reducing firearm access would meaningfully reduce suicide risk. They had negative views toward safe storage laws as a suicide prevention strategy and perceived such laws would be ineffective due to noncompliance and were concerned about law enforcement in private homes.

Farm parents in the study had not embraced the role of being the gatekeepers of firearms in the home and had not considered how that might contribute to increased suicide risk of rural youth. Addressing rural community attitudes toward firearm storage and the factors contributing to firearm suicide may lead to improvements in secure firearm storage.

Attendees will be able to:
1. Examine the unique perspectives of farm parents regarding their role as gatekeepers of firearms in the home.
2. Identify key factors discussed by farm parents suicides in rural communities.
3. Analyze the range of opinions expressed by farm parents about suicide prevention through safe storage practices and safe storage laws.

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Ann Marie Thomas, MD
Stephanie M. McCarthy, PhD
Alix Radke, BA
Bridget Wild, MD

Firearm (FA) ownership patterns shifted during the COVID era, including growth across racial and ethnic groups. Pediatric settings address FA safety, yet newborn nursery screening remains understudied. Understanding patterns of FA ownership in newborn nurseries will help tailor anticipatory guidance and safety advice for families in these early stages.

We conducted retrospective chart reviews of all newborns born at three hospitals from 01/01/22-12/31/25. The Newborn Safety Screener, which asks whether FAs are in the home and if so, whether they are securely stored (locked with firearm and ammunition stored separately), is incorporated into the electronic medical record and administered to all caregivers of infants as part of the standard newborn admission process. Responses to the Newborn Safety Screener were collected, along with demographic variables including birth year, race, ethnicity, insurance, and hospital. Level III NICU admissions, maternal age <18, or neonatal death were excluded from analysis.

Among 12,005 newborns, 9,425 (78.5%) were screened over four years. Firearms were reported in 1020 screened households (10.8%), while 8,405 (89.2%) reported no firearms in the home. Among all FA owners, 910 (89.2%) practiced safe storage, 72 (7.1%) admitted to unsafe storage, and 38 (3.7%) had no storage documentation. FA ownership varied by hospital, with the highest prevalence at the suburban hospital (Hospital B, 12.9%) and lowest at the urban hospital (Hospital C, 5.5%). Firearm ownership was significantly associated with race/ethnicity and insurance type (all p<0.001) (Table 1). Families reporting firearm ownership were more likely to identify as White (63.3% vs 47.8%) and have private insurance (77.8% vs 55.8%) compared with non-firearm-owning families. Hispanic/Latino families were less likely to report firearm ownership overall (22.1% vs 28.6%, p<0.001).

FA ownership among screened families remained stable between 2022-2025, despite a greater than 300% increase in screening rates over this time. Increased screening was likely driven by physician education initiatives and modifications to the infant documentation templates. Ownership varied across hospitals and across racial and ethnic groups and insurance categories, with differences seen between overall groups and amongst owners between hospitals. Although most FA owners reported secure storage, self-reported behaviors may differ from real practice. Newborn caregivers may underreport firearm ownership or overreport safe storage because of stress, social desirability bias, or concerns related to caring for a new baby. These findings highlight the importance of consistent, unbiased FA screening in newborn care settings to better identify families who may benefit from tailored safety counseling. Future work will examine demographic predictors of unsafe storage and explore whether firearm ownership correlates with other newborn health decisions such as consent to newborn vaccinations, erythromycin and Vitamin K.

• Reported firearm ownership varies greatly between hospital environments, racial and ethnic groups, and between private and public insurance holders
• Approximately 7% of our reported firearm owners admitted to unsafe storage practice, underscoring the need for targeted education and awareness efforts.
• Firearm ownership proportions have remained stable in the population at our three participating hospitals

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Elizabeth Hendrickson, MD
Jennifer Schanzle, DO
Tabitha Kearns, MD
Tamera Coyne-Beasley, MD, MPH

In the United States, firearms are the leading cause of death in children and adolescents with especially high burden for Black/African Americans, urban youth, and those in the Deep South. Behavioral programs that encourage youth to stay away from firearms have not reduced rates of firearm violence. There is paucity of data that focuses on youth experiences of firearm exposure and their perspectives on firearm counseling.

Patients were recruited for this mixed-methods study from Adolescent Health of a tertiary care hospital in the Deep South. All adolescents 14-19 years old who were able to give informed consent were considered eligible; those who were considered “in crisis” by their provider or unable to read English were excluded. Participants were de-identified and asked to answer a survey and participate in an interview. The survey combined custom and validated questions from the Youth Risk Behavior Surveillance System. Interviews were recorded, transcribed, and coded via thematic inductive analysis by three study team members. Participants were monetarily compensated.

Forty-eight adolescents met inclusion criteria and agreed to participate in the survey alone, most were non-Hispanic (91.3%), black or African American (68.9%), and female (68.1%). Majority were in twelfth grade (35.9%) or college (23.1%). Over half reported having a gun in the home; of these, the majority disclosed they would be able to access the firearm in less than five minutes (Table 1). Fortunately, most have not been threatened by a firearm at school (Table 1).

Of the survey participants, twenty-four interviews were completed before reaching thematic saturation. Several themes emerged: reliance on social media for news and education, experience of serious and life-threatening exposure to firearm violence, early exposure to personal gun use, fear of firearms yet belief they are necessary for personal safety, experience of inadequate firearm safety education at school, and confusion about physicians’ roles in firearm violence prevention counseling with preference to receive education from perceived firearm experts (Table 2).

Interviews concluded with adolescents sharing ideas for firearm safety education. There was a clear preference for interactive media platforms and small in-person group sessions. They expressed direct interest in receiving information on how to properly use a firearm and how to provide first aid safety measures during a shooting.

Our results present a challenge to pre-existing strategies for firearm injury prevention counseling. By centering adolescent voices in the Deep South, the population at greatest risk of firearm-related injury and death, we have identified many gaps in current counseling goals and their realistic efficacy. Further steps are necessary to review and revise counseling practices that currently center around safe storage and youth firearm abstinence to better address the true needs of the at-risk populations we serve.

1. Recognize disparities in firearm exposure and risk among adolescents in the Deep South including racial and urban differences.

2. Describe adolescents’ experiences, perceptions, and preferred methods for firearm safety education.

3. Apply adolescent-informed insights to improve firearm injury prevention counseling and strategies.

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Christina Delgado, MN, DNP
Tihetna Felege, MPH
Gloria Vidal, MPH
Isabell Sakamoto, MS

Firearm injuries are a leading cause of death among children and adolescents in the United States, with unintentional shootings and firearm-related suicide representing significant and preventable contributors to this burden. Secure firearm storage is an evidence-based strategy to reduce access to firearms by individuals in crisis, including pediatrics. A well-established secure firearm storage program by a children’s hospital with a strong foundation of community trust, partnerships, and evidence-based practice in firearm injury prevention developed a new program component in 2023 with funding from a state agency. The goal was to expand reach and equip diverse partner organizations with tailorable resources to independently implement culturally relevant models in their own communities.

Multi-sector partner organizations within the hospital’s state were recruited including education, public health, healthcare, community-based organizations, tribal nations, and organizations serving service members, veterans and their families (SMVF). Organizations received at least one of three toolkits — a community organization, event or healthcare provider toolkit — along with a 60-90 minute in-person, virtual or hybrid training, a demo kit, complimentary firearm locking devices and ongoing technical assistance. Afterwards, participants were expected to implement their own secure storage efforts in community or clinical settings reaching parents, teens and families. Program reach was tracked by county, organization type, and number of devices distributed.

To date, this program component has distributed over 11,000 firearm locking devices to partner organizations across more than 27 counties. Collaborative reach demonstrates the program’s broad replicability beyond a single institution. Program evaluation and quality improvement efforts are ongoing and include an immediate post-training survey measuring training utility and readiness for implementation and a six-month follow-up survey and interview assessing training and toolkit suitability, barriers to implementation and adaptations made for specific populations. To date, most participants report that the training is very useful, and more than half feel ready to implement their own program following the training. The most common barrier to implementing and sustaining their own program is lack of funding, and participants suggest adapting materials to account for differing gun cultures and policies across regions.

A toolkit-based, multi-sector model for secure firearm storage education and device distribution can achieve substantial community reach across diverse populations, including those that have been historically underserved by traditional injury prevention programming. Equipping partner organizations with training, resources, and devices rather than relying on institution-led events represents a scalable and replicable approach to reducing firearm injury risk among children, adolescents and families. These findings have implications for injury prevention practitioners seeking to expand community-level impact with limited institutional resources.

1. Describe the components of a secure firearm storage program toolkit designed for independent implementation by diverse partner organizations.
2. Identify strategies for meaningfully engaging cross-sector partners in firearm injury prevention efforts.
3. Apply lessons from this program’s dissemination model to expand secure firearm storage initiatives within their own communities or organizations.

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Tara Copper, MD
Lindsay Clukies, MD
Susan Wiltrakis, MD
David Liss, MD
Emily Wynia, MD
Donna Hunt O'Brien, MA
Lindsey Shah, MSW
Nancy Ayala, BA Psych
Abby Edwards, MPH
Allison Kemner, MPH

Firearm injuries are the leading cause of death among U.S. children, while unintentional pediatric cannabis exposures continue to rise amid an evolving legal landscape. Knowledge gaps persist among caregivers regarding injury risks associated with firearm and cannabis exposure. Parents as Teachers (PAT), an international parenting support organization, offers a unique opportunity to disseminate child safety education through trusted educator-family relationships. We sought to develop, disseminate, and evaluate educational tools on cannabis and firearm safety through an academic-community partnership with Parents as Teachers National Center.

Evidence-informed educational content focused on age-specific safety needs was developed by experts in Pediatric Emergency Medicine, Medical Toxicology, and Injury Prevention at a tertiary care academic medical center. Five PAT educator resources and nine caregiver resources were created for distribution to an estimated 170,000 families and 205,000 children, through approximately 1.6 million home visits. Content was translated into 10 languages to reflect the diverse population served by Parents as Teachers. Educator tools were integrated into core curriculum beginning June 2024. Between January and June 2025, we surveyed PAT educators and a cohort of families in St. Louis, who are participants in the Show Me Strong Families service arm of PAT National Center. Surveys conducted during routine home visits assessed changes in knowledge, confidence, and intended cannabis and firearm safety behaviors using Likert-scale responses.

Eighty-nine parents and 24 parent educators completed surveys. Over 90% of parents and all educators reported learning new information about cannabis safety, including product types, the effects on children, and secure storage. Most (90%) parents reported increased confidence in safely storing cannabis and intent to discuss safety with caregivers. Parent educators found the curriculum relevant, easy to use, and helpful for counseling and motivating families. Regarding firearm safety, 92% of parents and all educators reported learning that firearm injuries are the leading cause of death among U.S. children. A majority of parents found the topic relevant, and that the resources enhanced education from their parent educator. All parent educators reported increased confidence discussing secure firearm storage and addressing barriers to secure storage. After education, all parent educators and 84% of parents correctly identified best practices for secure firearm storage. Ninety-three percent of parents expressed intent to discuss firearm safety with others.

Partnership with Parents as Teachers led to the successful development and dissemination of cannabis and firearm safety education for families and parent educators. These resources improved knowledge, confidence, and intended secure storage behavior, demonstrating the potential of trusted community-based organizations to deliver scalable injury prevention education.

1. Understand how community partnerships can support large-scale injury prevention education.
2. Recognize that families are receptive to firearm and cannabis safety education from trusted parent educators.
3. Describe how education improved confidence and intention to promote safe firearm and cannabis storage practices.