Injuries/Violence
Neighborhood gun violence, psychosocial risks and perceived firearm access among youth in an emergency department setting Jungwon Min* Jungwon Min Vicky Tam Stephanie Mayne Polina Krass Joel Fein
Background: Youth firearm access is linked to psychosocial behaviors, violence and injury. Some youth without firearms at home perceive they could obtain one, indicating higher risk than those with securely stored firearms. We examined youth and neighborhood factors associated with perceived firearm access.
Methods: This cross-sectional study analyzed 23,334 Emergency Department (ED) visits by 14-18-year-olds completing Behavioral Health Screening (2013-2024) for firearm access and psychosocial risks. Neighborhood gun violence (shooting incidence rate per 1,000 residents) and Child Opportunity Index (COI) scores were linked to patients’ census tracts. Patient and neighborhood characteristics were compared across groups: no firearm access, at-home access, and perceived access. Mixed-effects models and mediation analyses further examined the associations.
Results: Among 16,174 patients (63% non-Hispanic-Black, 65% Medicaid insured, 75% in very low COI neighborhoods with higher gun violence), perceived firearm access was associated with racial/ethnic minority status, reported fighting, retaliation, at-risk substance use, school bullying, intimate partner violence, lower COI and higher neighborhood gun violence. At-home firearm access was linked to non-Hispanic White status, non-Medicaid insurance, ED visits for mental health, higher COI, and lower gun violence (all p < 0.001). Among those without firearms at home, fighting (OR=3.6 [3.1-4.3]) and high neighborhood gun violence (OR=1.8 [1.5-2.3]) were positively associated with perceived access after adjusting for age and gender. Fighting behaviors mediated 32% of the total effect of neighborhood gun violence on perceived firearm access.
Conclusions: Youth fighting and high neighborhood gun violence were linked to perceived firearm access, highlighting the connection between violence exposure and firearm perceptions. ED-based screening for perceived firearm access may help intervene youth gun carriage and future violence.