A new study published this month by researchers at the University of Washington reveals patterns of handgun use among adolescents and young adults living in rural communities. More than 2,000 youth in seven states, including Oregon, were surveyed about carrying handguns over a 15-year period, from the age of 12 to 26. The researchers found that some of the study participants reported carrying a handgun as young as 12 years-old. They also found that 20% of those surveyed reported carrying a handgun 40 or more times a year by age 26, which suggests that handgun use may increase with age in rural communities. Joining us is the lead author of the study, Ali Rowhani-Rahbar, a professor of epidemiology at the University of Washington School of Public Health.


The following transcript was created by a computer and edited by a volunteer:

Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. Over the course of 15 years, researchers at the University of Washington asked young people in rural communities in seven different states a whole series of questions to figure out ways to reduce drug use and other public health problems at the community level. Some of the questions they asked have provided insight into handgun use. Some study participants reported carrying a handgun at the age of 12 years old. Twenty percent of those surveyed reported carrying a handgun 40 or more times a year by the age of 26. Ali Rowhani is a professor of epidemiology at the University of Washington School of Public Health and the lead author of two handgun studies. He joins us with more details. Welcome to Think Out Loud.

Ali Rowhani-Rahbar: Thank you for having me.

Miller: Why did you want to focus on rural areas in particular in terms of handgun use?

Rowhani-Rahbar: That’s a great question, and the fundamental question here is that the reason is rural areas typically are underserved and under researched. The lack of inclusion of rural areas and rural populations in research really has perpetuated their invisibility, in a sense. We did a scoping review of the literature on handgun carrying a couple of years ago and actually found only one study – two or three years ago this scoping review was done – only one study that had focused on rural populations and handgun carrying. So we felt there is a really great need to improve knowledge on this. Especially because the burden of firearm related injury in rural areas, and some people may not know this, is actually greater than burden of firearm related injury in urban settings, especially the rates of suicide are notably greater in rural populations than in urban populations.

Miller: What you were looking at specifically was based on responses to questions about carrying a handgun. And you asked these questions over the course of 15 years starting with, I think it was, sixth graders. What qualifies as carrying a handgun?

Rowhani-Rahbar: As part of this project, which is funded by the Centers for Disease Control, we are trying to dig deep into that very question. What does carrying a handgun mean to youth and young adults, and what are the circumstances and the context in which carrying occurs? On the survey that generated this paper, the question was simply, ‘Did you carry a handgun in the past 12 months or past year?’ It did not go into details of the context of whether it was for hunting, for sports, for employment – what was it for? So our goal as other parts of this larger project is to really understand, while respecting the culture of rural areas, really understand what are the circumstances that lead to exposure to handguns and particularly carrying a handgun. Because, as you know, federal law bans possession of a handgun by anybody who is younger than 18, with exceptions such as those that are supervised by an adult or a caregiver, or it’s a particular context such as hunting or sports. Understanding that context is our next step after we have quantified, as you rightly mentioned at the outset, the frequency of this behavior in rural populations, which is greater than some may think it is.

Miller: Maybe this is my ignorance about firearms, but people use handguns for hunting?

Rowhani-Rahbar: They do. Handguns can be used for hunting, for sports, as part of employment. So it could be. One of the important things about this particular survey, [the] Community Youth Development Survey that we are using here, is that it kept asking this question about handgun carrying. But once people age, and they turn age 21 and above, the question does specifically ask, ‘Outside the context such as hunting or sports or as part of employment, did you carry a handgun?’ So I think, in terms of the legal landscape, that’s an important change that we need to be aware of.

Miller: Your more recent study, that was just published recently, describes six different patterns of handgun carrying among the young people who’ve been surveyed over a decade and a half. What most stands out to you in those patterns?

Rowhani-Rahbar: The patterns that we found – there are six different patterns – are really helpful in terms of informing prevention programs in the future. What stood out to me was a couple of different things. One was that many of these youth in rural areas carried handguns very episodically. Among those who reported carrying a handgun between ages of 12 and 26, about half of them reported carrying it just for one wave or one phase of this study – because we asked them this question 10 times, over 10 phases or waves of this study – so it’s an intermittent behavior, if you will. For some of them it was more persistent. We had a group out of these six who persistently carried a handgun over this period of time in their life, and some of them carried it quite a bit – 40 times or more over the course of a past year. We also found a couple of new patterns of handgun carrying, such as steadily increasing: a pattern that started in adolescence but kept going up, it increased and increased as they transitioned into young adulthood. This is a pattern that prior research in urban areas had actually not found. So we essentially found some new patterns of handgun carrying that were more unique to rural areas, if you will.

Miller: At this point. How much do you know about why young people in rural communities are carrying handguns?

Rowhani-Rahbar: Based on this particular research, we really don’t know the reasons because the question really stopped at asking, ‘did you carry a handgun and how many times did you carry a handgun?’ But we are in the process right now of conducting more focus groups and interviews and conversations with youth and young adults to really understand better the context in which this behavior occurs, the reason, the why and their perceptions within their own culture of handgun carrying and their relationship with firearms.

Miller: What’s your ultimate goal in terms of this data you’re collecting and the future questions you’re asking? What do you want this research to be used for?


Rowhani-Rahbar: Ultimately for reducing the burden of firearm related injury. As I mentioned at the outset, the rural communities in terms of burden of firearm related injury, especially self harm, have a really high burden of this in our country. This type of research hopefully will be foundational in terms of increasing our understanding of the frequency of this behavior and then in the later phase, the context of this behavior, why, and really promoting safety and firearm injury prevention programs. There are some programs out there, but many of them are geared towards urban settings. We should respect the unique culture of rural settings and develop and tailor firearm injury prevention programs for rural settings, so hopefully reduce the burden of this a public health and public safety concern.

Miller: Just to be very specific here, if say, a 22 year old in a rural town is regularly carrying a handgun, do you want to figure out ways to convince that person to stop?

Rowhani-Rahbar: I think it depends on the context. One of the most important things that we wanted to highlight as part of this research is that this research really didn’t look into legal versus illegal access to a handgun or carrying a handgun. That we cannot distinguish with this data. So I think it highly depends on the context in which that handgun carrying is occurring. Yes, overall, safety promotion for reducing firearm related injury of any intent, whether it’s an accident or unintentional or negligence or self harm or in a situation where it’s being used in interpersonal violence where there is an escalation, that is the goal: to reduce that firearm injury burden.

Miller: Is the next point there the idea that the fewer guns that there are on the street, the less likely it is that guns will go off?

Rowhani-Rahbar: Typically, yes. That has been shown a lot in urban settings. But as I mentioned, in rural settings it’s a different context and different culture and different … different context. It really depends on why it’s being used, how it’s being used. But something doesn’t change: for firearm injury, obviously, to occur of any intent, the presence of firearms is a necessary cause. It needs to be there. So the question would be what kind of approaches we could take to reduce the likelihood of that injury and death and violence that may occur in the presence of firearms. This type of research, that focuses on those specific patterns as you mentioned, is important because it really highlights [that] maybe the focus should be on when and how to intervene because there are inflection points throughout somebody’s life in the course of development where you need to intervene to prevent the risk of harm. When people show different patterns of certain behavior, it shows that one particular approach may not fit all and needs to be tailored towards specific people. It could be that co-occurrence of handgun carrying with, let’s say, alcohol use or substance use or other risk factors for injury and violence. That’s something we need to focus and think about in terms of injury prevention.

Miller: Is the basic idea, for example, that you want to figure out ways to have it be that young people could still hunt, for example, but you need more research to figure out how to get young people to not hurt themselves or others?

Rowhani-Rahbar: It could be one of them. For example, if it’s in the context of unintentional firearm injuries or accidental firearm injuries, [we] call them sometimes negligent, yes. That could be one example in which access to firearms and exposure to firearms is something that needs to be really – the safety promotion and training needs to be there to reduce the risk of that.

But also you could think about another intent, which is self harm or suicide, which has a really high burden in rural areas, as we talked about. What are ways to reduce the risk of suicide? Well, one of the most important thing is for parents and adults and caregivers to be aware of exposure of youth and their children to firearm and the potential use of firearm for suicide. This is not necessarily in the context of carrying; it could be just a firearm that is stored at home. So then that opens up all these conversations about issues around storage at home and the different context in which exposure to handguns happens among, let’s say, teens and awareness about the likelihood of firearm-related suicide and factors that go into preventing that. It really is a package of awareness about preventing firearm injury of all types, whether it’s interpersonal assault, whether it’s suicide or whether it’s accidental shootings.

Miller: For decades, until pretty recently, you couldn’t get federal grants to study gun violence. What were the effects of that prohibition?

Rowhani-Rahbar: Essentially, what’s called the Dickey Amendment, unfortunately was interpreted as a ban on research on firearms. So for a couple of decades at least there has been this drought of research on firearms, which I believe it probably is very hard to quantify its impact in terms of how it may have affected lives. But [it] really, really hindered research in this area such that we don’t have some even basic information about the ABCs, or foundations, of this type of work. You can’t even compare it with how much we know about cancer, AIDS, cardiovascular disease, Alzheimer’s.

Only in the last few years, as you are aware, there has been much more funding available to study this. Without really this data, we can’t move the needle in terms of preventing firearm injuries. There just was one article I believe came out today in [The] New England Journal of Medicine that shows that firearm injury is now the leading cause of death among youth, age 1-19… surpassed car crashes. Those are powerful and sobering numbers and the goal should be really approaches to reduce the risk of firearm injury among all ages – but particularly to our conversation, youth and young adults – in all communities, not just urban settings, but also in rural settings and across different socio-economic status, race, gender and other identities.

Miller: You started your career as an epidemiologist studying vaccine effectiveness. And then the terrible mass shooting at Sandy Hook happened, and it seems like that was a cataclysmic event for you. You changed your academic and research focus. But that was 10 years ago now. When you made that switch, how big of a change did you think you would see in 10 years in terms of the effects of gun violence in the US?

Rowhani-Rahbar: That’s a really great question and a personal one for me, as you mentioned. This is not very typical in academia to have such drastic change. I was a vaccine epidemiologist and after Sandy Hook it really– I felt as a public health person, a risk scholar and a researcher, I should probably spend some time on this, and the rest of it really is history. But when I started, the landscape was grim in that there were not lots of funding opportunities to really do this type of work, which is needed. This type of research is really, in terms of funding, is really needed for lifting and elevating the voices of those who have been harmed, the voices of gun owners, the voices of people who actually might be at risk of firearm injury – to have conversations with them, have partnership with them. The landscape has changed slightly since then in terms of funding, as I mentioned to you, but the reality is that the solution is not just the research.

We can conduct research and not change anything. The research is just one component of it. It really needs to be coupled with action: conversations with community partners, different organizations, policymakers to really devise evidence-based policies and programs that, while respecting the robust gun culture that we have in this country, while respecting that, also reducing the harm – almost a harm reduction strategy, if you will. We have many, many guns in this country – over 300 million guns in this country – and that’s part of American life. The question would be how we could reduce the risk of firearm injury, to really be able to say that we have achieved some success. We have achieved success in other areas of public safety and public health and medicine through sociological approaches, psychological approaches, public health approaches. Collision casualties have gone down – traditionally speaking, there has been some uptick recently, but there has been a trend that’s been going down – and in many other diseases and conditions. Unfortunately for firearm injuries, we have not been able to succeed. To move the needle, to really reduce the risk of some of these tragedies, such as suicides that we see quite common in rural communities for example. We all need to talk to each other and act. Research is just one component of it.

Miller: Ali Rowhani, thanks very much.

Rowhani-Rahbar: Thank you for having me.

Miller: Ali Rowhani is a professor of epidemiology at the University of Washington School of Public Health and the lead author of two recent studies looking into handgun use among young people in rural communities, including in Oregon and Washington.

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