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

Abstract

ImportanceAdolescent handgun carrying is associated with increased risk of firearm-related violence. Most evidence on adolescent handgun carrying is from urban areas, but these findings may not generalize to rural areas.ObjectiveTo examine differences in associations of adolescent interpersonal violence with handgun carrying across the rural-urban continuum.Design, Setting, and ParticipantsThis cross-sectional study used nationally representative data from the US National Survey on Drug Use and Health among adolescents aged 12 to 17 years from 2002 to 2019 to estimate time-varying prevalence ratios (PRs) and prevalence differences (PDs) between interpersonal violence and handgun carrying across the rural-urban continuum. Analyses were conducted in April to July 2022.ExposuresAny past-year serious fighting, group fighting, and attacking with intent to harm.Main Outcomes and MeasuresAny past-year handgun carrying. Associations were estimated within county rural-urban strata using the US Department of Agriculture’s Rural-Urban Continuum Codes.ResultsIn each year, the sample included a weighted count of almost 25 million adolescents, with 50.9% (95% CI, 50.2%-51.6%) males and 24.7% (95% CI, 23.8%-25.6%) Hispanic adolescents, 13.5% (95% CI, 12.8%-14.2%) non-Hispanic Black adolescents, and 51.8% (95% CI, 50.8%-52.8%) non-Hispanic White adolescents in 2019. More rural counties had less racial and ethnic diversity. For example, 81.1% (95% CI, 75.9%-85.4%) of adolescents were non-Hispanic White in the most rural counties vs 43.1% (95% CI, 41.7%-44.6%) of adolescents were non-Hispanic White in the most urban counties in 2019. Adolescent handgun carrying increased over time, with the largest increases in the most rural counties, where the prevalence of adolescent handgun carrying increased from 5.2% (95% CI, 3.8%-7.0%) in 2003 to 12.4% (95% CI, 8.9%-16.9%) in 2019. PRs for the association of violence and handgun carrying were greater in more urban counties. For example, in the most urban counties in 2019, adolescents involved in a group fight had 3.7 (95% CI, 2.9-4.8) times the prevalence of handgun carrying vs those not involved in a group fight; this PR was 3.1 (95% CI, 1.6-5.6) in the most rural counties. PDs were similar and, in some cases, larger in rural areas. For example, in the most urban counties in 2019, handgun carrying prevalence was 7.5% (95% CI, 5.7%-9.5%) higher among adolescents who were involved in a group fight compared with those who were not; this PD was 21.8% (95% CI, 8.2%-37.8%) in the most rural counties, where handgun carrying was more common.Conclusions and RelevanceThis cross-sectional study found that associations of interpersonal violence with handgun carrying were stronger in relative terms in urban areas than in rural areas; however, a higher percentage of rural than urban adolescents carried handguns, resulting in a greater absolute prevalence of handgun carrying associated with violence in rural areas than in urban areas. These findings suggest opportunities for preventing handgun carrying–related harms may differ between rural and urban communities.

The association of alcohol use and heavy drinking with subsequent handgun carrying among youth from rural areas

“…Second, our findings extended the existing literature showing that alcohol use may precede subsequent handgun carrying. Third, we expanded on the existing literature by exploring these associations longitudinally using data from the last two decades, during which youth handgun carrying and firearm‐related harm have increased in rural areas 37,38 . Overall, we found that any alcohol use was associated with higher odds of subsequent handgun carrying and the odds were greater with heavy drinking.…”

Patterns in pro‐gun beliefs and weapon carrying behaviors in rural White adolescent

“…Indeed, rural adolescents may have an increased propensity for increased weapon carrying due to victimization (e.g., attacked, sexually assaulted; Kingery et al, 1996). For instance, the prevalence rates of gun carrying after experiencing violence in a fight was higher in urban than rural areas (Schleimer et al, 2023). However, the prevalence difference of gun carrying between individuals who had a serious fight and those who did not was 12.3% in rural areas and only 5.2% in urban areas (Schleimer et al, 2023).…”

“…For instance, the prevalence rates of gun carrying after experiencing violence in a fight was higher in urban than rural areas (Schleimer et al, 2023). However, the prevalence difference of gun carrying between individuals who had a serious fight and those who did not was 12.3% in rural areas and only 5.2% in urban areas (Schleimer et al, 2023). Additionally, rural individuals who were involved in a group fight versus those who were not had a prevalence difference of 21.8% while urban areas only had a difference of 7.5% (Schleimer et al, 2023).…”

“…However, the prevalence difference of gun carrying between individuals who had a serious fight and those who did not was 12.3% in rural areas and only 5.2% in urban areas (Schleimer et al, 2023). Additionally, rural individuals who were involved in a group fight versus those who were not had a prevalence difference of 21.8% while urban areas only had a difference of 7.5% (Schleimer et al, 2023). Consequently, Schleimer et al (2023) concluded that violence may result in higher prevalence of handgun carrying among rural adolescents who experienced violence than those who did not.…”

“…Additionally, rural individuals who were involved in a group fight versus those who were not had a prevalence difference of 21.8% while urban areas only had a difference of 7.5% (Schleimer et al, 2023). Consequently, Schleimer et al (2023) concluded that violence may result in higher prevalence of handgun carrying among rural adolescents who experienced violence than those who did not. In summary, rural students who have had serious fights may be more susceptible to increased gun carrying than their rural counterparts who have not had serious fights, and this phenomenon appears to occur at a higher rate in rural areas than in urban areas.…”