Prevalence and Correlates of Firearm Access Among Post-9/11 US Women Veterans Using Reproductive Healthcare: a Cross-Sectional Survey

Abstract

Background Suicide rates have increased among women Veterans, with increased use of firearms as the method. Addressing suicide risk in this population requires understanding the prevalence and correlates of firearm access in healthcare settings frequented by women Veterans. Objectives Characterize the prevalence and correlates of firearm ownership and storage practices among women Veterans using Department of Veterans Affairs (VA) reproductive healthcare (RHC) services. Design Cross-sectional national survey conducted in 2018–2019 (17.9% response rate). Participants Post-9/11 women Veterans using RHC (n=350). Main Measures VA Military Sexual Trauma Screen, PTSD Checklist for DSM-5, Hurt/Insult/Threaten/Scream, Columbia-Suicide Severity Rating Scale screener, self-reported firearm access. Key Results 38.0% (95% confidence interval [95% CI]: 32.9, 43.3) of participants reported personally owning firearms, and 38.9% (95% CI: 33.7, 44.2) reported other household members owned firearms. Among those with firearms in or around their homes, 17.8% (95% CI: 12.3, 24.4) and 21.9% (95% CI: 15.9, 28.9) reported all were unsafely stored (loaded or unlocked, respectively). Women who experienced recent intimate partner violence were less likely to report personally owning firearms (adjusted prevalence ratio [APR]=0.75; 95% CI: 0.57, 0.996). Those who experienced military sexual harassment (APR=1.46; 95% CI=1.09, 1.96), were married (APR=1.74; 95% CI: 1.33, 2.27), or lived with other adult(s) (APR=6.26; 95% CI: 2.87, 13.63) were more likely to report having household firearms owned by someone else. Storing firearms loaded was more prevalent among women with lifetime (APR=1.47; 95% CI=1.03, 2.08) or past-month (APR=1.69; 95% CI=1.15, 2.48) suicidal ideation and less likely among those with other adult(s) in the home (unadjusted PR=0.62; 95% CI=0.43, 0.91). Those with parenting responsibilities (APR=0.61; 95% CI=0.38, 0.97) were less likely to store firearms unlocked. Conclusions Firearm access is prevalent among post-9/11 women Veterans using VA RHC. Interpersonal factors may be important determinants of firearm access in this population. Safe firearm storage initiatives are needed among women Veterans using RHC, particularly for those with suicidal ideation.

“Feel the need to prepare for Armageddon even though I do not believe it will happen”: Women Veterans’ Firearm Beliefs and Behaviors during the COVID-19 Pandemic, Associations with Military Sexual Assault and Posttraumatic Stress Disorder Symptoms

“…As such guidance was not mandated at the time of data collection, it is possible that women Veterans' firearm access and beliefs have changed since then, particularly for those who have used VHA services (data indicate, however, that only 14% of those using VHA services recall ever having a conversation with a provider about firearms [67]). Additionally, considering the prevalence of military sexual trauma in this sample, as well as in other studies of women Veterans with firearm access [51], a trauma-informed approach to firearm discussions with women Veterans may be particularly important [53,56]. This may entail carefully attending to power differentials in the context of such discussions, clearly communicating the rationale for firearm questions and recommendations, and approaching firearm-related conversations collaboratively [68].…”

“…However, in research conducted with women Veterans prior to the pandemic, sexual assault during military service appeared to precipitate women Veterans' firearm acquisition and firearm storage (e.g., keeping firearms easily accessible) following their military service [50]. Military sexual harassment has also been associated with increased prevalence of household firearm access among women Veterans [51]. The present findings add to this knowledge base by suggesting that post-9/11 women Veterans who experience military sexual trauma (specifically, sexual assault) have a higher prevalence of changed beliefs regarding firearms and a higher prevalence of engagement in firearm behaviors during the COVID-19 pandemic, relative to women Veterans who have not experienced military sexual harassment or assault.…”

Women Veterans’ experiences discussing household firearms with their intimate partners: collaborative, devalued, and deferential relational types

“…Cleveland and colleagues found that Veteran women were less likely than Veteran men to personally own firearms (24.4% vs. 47.2%, respectively), but more likely to report living in households with firearms that they did not personally own (14.4% vs. 2.2%) (Cleveland et al 2017 ). Subsequent surveys with post-9/11 women Veterans also reported a high prevalence of personal and household firearm ownership among women Veterans (Monteith et al 2022b , Monteith et al 2023 ). Further, a qualitative study highlighted the prominent role of spouses and partners of women Veterans in household firearm access (Monteith et al 2020 )—findings which converge with survey-based findings in which married women Veterans reported a higher prevalence of living in a household with firearms owned by someone else (Monteith et al 2022b ).…”

Violent Experiences and Patterns of Firearm Ownership From Childhood to Young Adulthood

“…17,18 Recently, firearm marketing campaigns have targeted women in this vein, with slogans like "God Created Man and Woman, But Samuel Colt Made Them Equal." 21 At the individual level, though, evidence regarding associations between personal experiences of violence and gun ownership or gun carrying is mixed, [22][23][24][25][26] with positive associations found between experiencing violence and firearm carrying behavior among youths. 22,23,[27][28][29][30] An understanding of how lasting the effects of violent experiences are on gun access has been hindered by a lack of longitudinal, individual-level data on firearms.…”

“…The proportion of gun owners who cite personal protection as a primary motivation for ownership has grown from 48% to 76% over the past 2 decades, signaling a growing public acceptance of firearms as an appropriate and empowering strategy to address fear of external violence. 17 , 18 Recently, firearm marketing campaigns have targeted women in this vein, with slogans like “God Created Man and Woman, But Samuel Colt Made Them Equal.” 21 At the individual level, though, evidence regarding associations between personal experiences of violence and gun ownership or gun carrying is mixed, 22 , 23 , 24 , 25 , 26 with positive associations found between experiencing violence and firearm carrying behavior among youths. 22 , 23 , 27 , 28 , 29 , 30 An understanding of how lasting the effects of violent experiences are on gun access has been hindered by a lack of longitudinal, individual-level data on firearms.…”