Prevalence and correlates of handgun access among adolescents seeking care in an urban emergency department

Objective: To determine prevalence and correlates of handgun access among adolescents seeking care in an urban Emergency Department (ED) in order to inform future injury prevention strategies. Methods: In this observational cross-sectional study performed in the ED of a large urban hospital, 14- to 18-year-old adolescents completed a computerized survey of risk behaviors. Adolescents seeking ED care (for injury or medical complaint) were approached seven days a week over a 22-month period. Validated measures included measures of demographics, sexual activity, substance use, injury, violent behavior, and handgun access. A logistic regression model predicting handgun access was performed. Results: A total of 3050 adolescents completed the survey (44% male, 58.9% African-American), with 417 (12%) refusing to participate. One-third of the sample (n = 1003) reported access to a handgun, and of those 54% were males (n = 542). Logistic regression results indicated that older age (AOR: 1.58; 95% CI: 1.30-1.94), African-American race (AOR: 1.34; 95% CI: 1.11-1.61), male gender (AOR: 1.99; 95% CI: 1.66-2.37), and being employed (AOR: 1.35; 95% CI: 1.11-1.65), as well as seeking ED care for a medical complaint as compared to intentional injury (AOR: 1.69; 95% CI 1.62-2.50) predicted handgun access. Binge drinking (AOR: 1.75; 95% CI: 1.37-2.27), marijuana use (AOR: 1.93; 95% CI: 1.58-2.36), sexual activity (AOR: 1.64; 95% CI: 1.32-2.02), prior injury by a gun (AOR: 1.80; 95% CI: 1.32-2.46), serious physical violence (AOR: 1.37; 95% CI: 1.13-1.66) and group fighting (AOR: 2.07; 95% CI: 1.68-2.56) also predicted access. Conclusions: High rates of handgun access were evident among adolescents presenting in an inner city ED, including those seeking care for non-injury related reasons. Adolescents with access to handguns were more likely to report risk behaviors and past injury, providing clinicians with an opportunity for injury prevention initiatives.