Firearm safety counseling in primary care pediatrics: A randomized, controlled trial

Context. Physicians have been encouraged to counsel families about risks as sociated with gun ownership, but the effectiveness of physician counseling regarding gun safety is unknown. Objective. To determine the effectiveness of gun safety counseling during w ell-child care visits. Design. Group randomized, controlled trial. Physicians, nurse practitioners , and physician assistants were randomized to either the intervention group or a control group. Setting. Group Health Cooperative, a staff-model health maintenance organiz ation. Patients. Consecutive sample of families (n = 1295) seen for a scheduled ap pointment for well-child care for a child <18 years of age. Of the families originally scheduled for a visit, 80.3% were seen and completed the outcom es surveys. Intervention. Each family in the intervention group was given a 60-second m essage by their practitioner that depended on the presence of guns in the h ome. Families without guns were informed of the health risks associated wit h gun ownership and given a standard information pamphlet. Families with gu ns were given the same information about risks and were told that if they c hose to keep a gun, they should store it locked and unloaded. They were giv en instructions on storage and a folder with material, including the same p amphlet, a letter from the police department, written storage guidelines, a nd discount coupons for gun storage devices. Main Outcome Measure. Changes in the following self-reported events: 1) acq uisition of a safe storage device; 2) removal of firearms from the home; an d 3) acquisition of firearms. Results. There were no important differences between intervention and contr ol groups in the rate of acquisition of new guns (intervention: 1.3% vs con trol: .9%) after the intervention. Among households with guns at baseline, there were also no differences between groups in the removal of guns (inter vention: 6.7% vs control: 5.7%), but there was a fairly large nonsignifican t difference in the proportion who purchased trigger locks (intervention: 8 .0% vs control: 2.5%). Conclusions. A single firearm safety-counseling session during well-child c are, combined with economic incentives to purchase safe storage devices, di d not lead to changes in household gun ownership and did not lead to statis tically significant overall changes in storage patterns.