Frequency of Black and American Indian/Alaskan Native US Residents Screened for Firearm Access

Journal of Racial and Ethnic Health Disparities https://doi.org/10.1007/s40615-025-02334-8 Frequency of Black and American Indian/Alaskan Native US Residents Screened for Firearm Access Allison E. Bond1,2 · Taylor R. Rodriguez1,2 · Gretchen Goldman3 · Jayna Moceri‑Brooks4 · Daniel C. Semenza1,5,6 · Michael D. Anestis1,5 Received: 12 July 2024 / Revised: 30 October 2024 / Accepted: 18 February 2025 © The Author(s) 2025 Abstract Objective This study evaluates Black and AIAN individuals’ self-reported history of being screened for firearm access by healthcare providers, and identifies factors that influence screening. Methods A cross-sectional, nationally representative survey of included 3015 Black and 527 AIAN adults in the US. Participants were recruited via probability-based sampling. Results Among Black participants, 13.1% and among AIAN participants, 18.4% reported being screened for firearm access. Of the participants who reported being screened, most have been by mental healthcare providers or primary care physicians. Factors associated with higher screening odds in Black adults included history of suicidal ideation or mental health treatment, current firearm access, younger age, and having children at home. For AIAN participants, a lifetime history of mental health treatment or identifying as female increased screening odds. Conclusion Black adults report infrequently being screened for firearm access by healthcare providers. Identifying screening barriers and fostering discussions on firearm safety in healthcare settings are important next steps for firearm injury prevention efforts. Keywords Firearms · Suicide prevention · Healthcare providers · Screening for access · Firearm safety Introduction Suicides account for 60% of all firearm deaths within the United States (US), and firearms are used in over 50% of suicide deaths [1]. Firearms are the most lethal method for suicide, with an 85–95% fatality rate [1]. This means that * Allison E. Bond 1 The New Jersey Gun Violence Research Center, Rutgers University, 683 Hoes Ln, Piscataway, NJ 08854, USA 2 Department of Psychology, Rutgers University, 683 Hoes Ln, Piscataway, NJ 08854, USA 3 School of Nursing, Duquesne University, Pittsburgh, PA, USA 4 Rory Meyers College of Nursing, New York University, New York, NY, USA 5 Department of Urban‑Global Public Health, Rutgers University, 683 Hoes Ln, Piscataway, NJ 08854, USA 6 Department of Sociology, Anthropology, and Criminal Justice, Rutgers–Camden, Camden, USA when someone attempts suicide with a firearm, they rarely survive. Research on method substitution in suicide (e.g., utilizing a method other than the one planned due to inability) is ambiguous [2]. Given this, research has sought to determine ways to reduce firearm suicides within the US. One approach for accomplishing this goal is the promotion of secure firearm storage—storing a firearm unloaded, locked, and separate from ammunition—associated with reduced risk for suicide [2]. Although there is an association between secure storage and suicide risk, most firearm owners do not engage in secure storage [3]. Engaging in secure firearm storage before a suicidal crisis emerges is essential, given that those who attempt suicide think about suicide for as little as 10 min before they act [4]. One way to promote secure firearm storage is through lethal means counseling. Lethal means counseling refers to practices that include identifying risk factors for suicide, speaking with patients to identify access to lethal means (e.g., firearms, medications), safety planning for suicide, discussing firearm safety, secure firearm storage, ways to limit access to firearms and other methods, and providing locking devices [5]. In suicide Vol.:(0123456789) Journal of Racial and Ethnic Health Disparities prevention broadly, lethal means counseling shows promise for reducing risk and is often embraced by clinicians. In firearm suicide prevention specifically, lethal means counseling has been found to increase secure firearm storage habits [6]. An understanding of who owns firearms, their attitudes and behaviors to secure firearm storage, and barriers towards firearm screening and lethal means counseling is needed to effectively administer lethal means counseling interventions. Healthcare providers are well conduct lethal means counseling, specifically engaging in conversations on secure firearm storage with those at risk for suicide. Previous research has demonstrated that 83% of those who die by suicide interact with healthcare in the year prior to their death [7]. The National Strategy for Suicide Prevention specifically states that limiting access to lethal means as a key priority for reducing suicide risk. Additionally, professional organizations recognize the role providers have in screening for firearm access; the American Academy of Pediatrics has put forth recommendations for pediatricians to conduct routine firearm screening with parents during well-child visits [8]. Although these recommendations are in place, many providers do not screen for firearm access. The lack of screening may be due to a variety of reasons including lack of guidelines [9], lack of time [10], and belief that patients would not be receptive [11]. Previous research indicates that, even among groups at high risk for suicide, screening for firearm access rarely occurs. Specifically, only 9.2% of Veterans using Veterans Health Administration services report being screened for firearm access by a clinician [12] and only 18% of adults who present to the emergency department (ED) for suicide risk have been screened for firearm access [13]. A study conducted among a nationally representative sample found that only 7.5% of adults who live firearm owning households have discussed firearm safety with a healthcare provider [14]. A recent study expanded upon previous work and found that among a representative sample from five states 17.1% report having been screened for firearm access [15]. Additionally, several factors were associated with increased odds of being screened. Specifically, lifetime suicidal ideation, firearm ownership, mental health treatment, having children under the age of 18 in the home, being male, and identifying as White were associated with significantly increased odds of being screened for firearm access. Concerningly, these findings suggest that racial and ethnic minorities may be less likely to be screened for firearm access by healthcare providers, and in turn less likely to receive resources for secure firearm storage. The potential decreased rates of screening among racial and ethnic minorities are especially concerning when considering that Black and American Indian/Alaskan Native (AIAN) individuals are disproportionately impacted by firearm injury and death. Specifically, Black men have the highest age adjusted rate of firearm violence (51.98 deaths per 100,000; compared to 4.75 per 100,000 among White men) [1 (...truncated)