Assessment of Rural-Urban and Geospatial Differences in Perceived Handgun Access and Reported Suicidality Among Youth in Colorado

Abstract

IMPORTANCE Suicide is the second leading cause of death in adolescents, with firearms the most common method, especially in rural communities. Identifying where to target lethal means safety interventions could better leverage limited resources. OBJECTIVESTo understand the associations of rurality, school-level prevalence of easy handgun access, and suicidality measures in Colorado youth, to explore spatial distribution of school-level measures, and to identify communities with high prevalence of both easy handgun access and suicidality. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study used data from the 2019 Healthy Kids Colorado Survey, an anonymous cross-sectional school-based survey conducted at 256 participating Colorado high schools. Participants included students from schools recruited for statewide population-based estimates and additional schools opting in. Data were analyzed from November 9, 2020, to March 13, 2021.EXPOSURES Urban-centric locale according to a 7-level continuum. Geocoded location of schools was used for spatial analysis. MAIN OUTCOMES AND MEASURESThe main outcomes were weighted prevalence for easy handgun access and 4 measures of mental health and suicidality in the previous year (ie, feeling sad for 2 weeks and considering suicide, planning suicide attempt, or attempting suicide in the past year).RESULTS A total of 59 556 students (49.7% [95% CI, 49.3%-50.1%] male and 50.3% [95% CI, 49.9%-50.7%] female; 53.9% [95% CI, 53.5%-54.3%] in 9th and 10th grade; 36.4% [95% CI, 36.0%-36.8%] Hispanic and 50.8% [95% CI, 50.4%-51.2%] non-Hispanic White) from 256 schools participated. Most schools were rural or in small towns (56.8% [95% CI, 50.7%-62.9%]), while more students participated from urban and suburban schools (57.8% [95% CI, 57.6%-58.0%]). Prevalence of perceived easy access to handguns increased with increasing rurality, with 36.2% (95% CI, 35.2%-37.1%) of students in rural (remote) schools reporting easy access, compared with 18.2% (95% CI, 17.3%-19.1%) for city (large) schools. The spatial distribution of easy handgun access and suicidality measures had minimal overlap, but there was correlation at school-level between easy handgun access and considering suicide (ρ = 0.203 [95% CI, 0.0748-0.331]), planning suicide (ρ = 0.300 [95% CI, 0.173-0.427]), and attempting suicide (ρ = 0.218 [95% CI, 0.0869-0.350) in the previous year. The highest quartile for prevalence of both perceived easy access to handguns and planning suicide in the previous year included 21 schools (81.0% [95% CI, 64.0%-97.9%] rural [remote] or rural [distant]).

Rural-Urban Variation in the Association of Adolescent Violence and Handgun Carrying in the United States, 2002-2019

“… 50 , 51 , 52 , 53 , 54 In rural settings, social, cultural, and economic factors may increase perceived acceptability of adolescent handgun carrying and adolescents’ household handgun access, firearm training, and recreational and work-related handgun use. 13 , 18 , 21 , 22 These factors could result in a higher overall prevalence of adolescent handgun carrying in rural areas and, in turn, make violence less likely to be a risk marker for handgun carrying.…”

“…Rural-Urban Variation in the Association of Adolescent Violence and Handgun Carrying in the United States Despite the high and increasing prevalence of adolescent handgun carrying in rural areas, researchers have, until recently, 18,22,[34][35][36] almost exclusively studied handgun carrying among adolescents in urban areas. 30 In these settings, antisocial and aggressive behavior (eg, fighting) are associated with handgun carrying.…”

Our Limited Knowledge of Youth Suicide Risk and Firearm Access

“…How do we protect youth from dying by suicide? As the study by Spark et al 3 shows, our knowledge of where youth have access to firearms is extremely limited. Other studies have shown increased risk of firearm suicide and homicide in areas with high poverty concentration, but models are no substitute for real, focused geospatial data.…”

Social Determinants of Health and Suicidal Behaviors among Children: U.S. Longitudinal Adolescent Brain Cognitive Development (ABCD) Study

“…Social determinants of health (SDoH) have an increasingly recognized influence on the disparities in child mental health and suicidal ideation and suicide attempts (SI/SAs). [1][2][3][4][5][6][7] Previous research has shown that county-level socioeconomic characteristics, such as poverty, unemployment, divorce rates, and social isolation, are associated with poorer mental health, greater rates of substance use, and higher suicide rates. 3,4,[8][9][10] In particular, higher county-level poverty was associated with greater suicide rates in children aged 5 to 19 years old, compared with counties with lower poverty rates.…”

“…6 Rural areas had more firearm access and fewer mental health facilities and antidepressant medication prescriptions, which may contribute to rural-urban disparities in youth suicide. 5,7 Understanding the associations between socioeconomic and structural factors and child mental health outcomes is critical to improving precision in designing social policies and programs.…”