Child Adverse Childhood Experiences, Child Behavioral Health Needs, and the Presence of a Firearm in the Home of Parents in Chicago

Megan M. Attridge, MD
Marie E. Heffernan, PhD
Anne Bendelow, MPH
Carly G. Menker, MS
Matthew M. Davis, MD, MAPP
Karen Sheehan, MD, MPH

Firearm violence is a leading cause of pediatric morbidity and mortality in the United States. The presence of a firearm in the home poses an immense risk to children with significantly increased rates of suicide and unintentional injury by firearm. Furthermore, recent studies suggest children exposed to adverse childhood experiences (ACEs) and children with behavioral health disorders are at increased risk of experiencing firearm violence. Several studies have explored family demographic predictors of firearm ownership but have not explored the association of child ACEs and child behavioral health needs with the presence of a firearm in the home. The objective of this study was to explore an association between these factors, other family demographics, and the presence of a firearm in the home.

We collected data through the Voices of Child Health in Chicago Parent Panel Survey wave 2 (November 2020-February 2021), a longitudinal survey administered tri-annually in English and Spanish via web and phone to parents from all 77 neighborhoods in Chicago. Parents responded to questions about their child’s exposure to ACEs and behavioral health service utilization, parent health, their families’ experience with firearm violence, and their families’ demographics (including child age, parent age, race and ethnicity, gender, and level of education, and household income).

Overall, 382 of 1,436 (weighted to 22.0%) responding parents reported the presence of a firearm in the home. In the adjusted model, the odds ratio of firearm presence increased incrementally with increasing exposure to ACEs. Compared to a child in the household exposed to no ACEs, a child in the household exposed to two or more ACEs was associated with a 5.16 times higher odds ratio of firearm presence in the home (95% confidence interval (CI) 2.92-9.10). Similarly, compared to a child in the household who has not used behavioral health services, a child in the household who had was associated with a 2.10 times higher odds ratio of firearm presence in the home (95% CI 1.35-3.26). Presence of firearm in the home was also associated with higher household income, younger parent age (under 35 years), and male parent gender.

Chicago parents have higher odds of reporting the presence of a firearm in the home when living in a household with a child exposed to ACEs and with behavioral health needs. These findings are particularly important in the context of injury prevention, considering children experiencing ACEs and with behavioral health disorders may be at increased risk of experiencing firearm violence. These findings could inform future public health interventions and targeted safe storage messaging to prevent pediatric firearm injury.

Firearm presence in the household is associated with:
1) Children in the household with adverse childhood experiences
2) Children in the household with behavioral health services
3) Other family demographics including higher household income, younger parent age (under 35 years), and male parent gender.