OBJECTIVES: Access to firearms among youth can increase the risk of suicide or other injury. In this study, we sought to estimate the population prevalence of adolescent perception of firearm access by demographic, geographic, and other individual health characteristics. METHODS:The 2019 Healthy Kids Colorado Survey was an anonymous survey administered to a representative sample of high school students in Colorado. The survey was used to assess health behaviors and risk and protective factors. Analysis was conducted with weights to the state population of public high school students.RESULTS: In total, 46 537 high school students responded (71% student response rate; 83% school response rate). One in 5 students said it was "sort of easy" (11.1%) or "very easy" (8.8%) to access a handgun, with higher prevalence among male and older-aged youth and differences in racial and/or ethnicity groups. There were geographic differences such that students in schools in more rural areas were more likely to report perceived easy access. Students who had felt sad or hopeless, attempted suicide, or been in a fight were more likely to say they had access to a handgun. CONCLUSIONS:A relatively high proportion of youth have easy access to a firearm, with differences across age, sex, race and/or ethnicity, and geography. This highlights the need for efforts to address ways to reduce firearm access for youth, including secure storage at home, for the prevention of youth firearm suicide and other firearm injuries.WHAT'S KNOWN ON THIS SUBJECT: Suicide is a leading cause of death among adolescents, and firearms are implicated in a majority of those deaths. Safe storage of firearms can prevent adolescent suicide, homicide, and unintentional firearm injuries and deaths.WHAT THIS STUDY ADDS: In a representative sample of high school students in Colorado, 20% reported easy access to a handgun. Students with mental health concerns or who had been in a fight were more likely to say they could access a handgun.

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Suicide is a critical public health problem, resulting in more than 40,000 deaths a year in the United States (U.S.) and 800,000 globally. Provision of mental health services is a key component of a comprehensive population-based approach to prevention. State licensing boards in some U.S. states require mental health practitioners to be trained in suicide risk assessment and management, but such requirements are not uniform. Our case study examined mental health practitioner preparedness to engage in suicide prevention and intervention in Colorado, a state with a high suicide rate, using a survey designed to understand training experiences and perceptions of the acceptability of mandated training. Our findings support efforts to require mental health practitioners be trained to prevent suicide.