Firearm Ownership and Storage Practices Among Families During Birth Hospitalization at Three Hospitals

Ann Marie Thomas, MD
Stephanie M. McCarthy, PhD
Alix Radke, BA
Bridget Wild, MD

Firearm (FA) ownership patterns shifted during the COVID era, including growth across racial and ethnic groups. Pediatric settings address FA safety, yet newborn nursery screening remains understudied. Understanding patterns of FA ownership in newborn nurseries will help tailor anticipatory guidance and safety advice for families in these early stages.

We conducted retrospective chart reviews of all newborns born at three hospitals from 01/01/22-12/31/25. The Newborn Safety Screener, which asks whether FAs are in the home and if so, whether they are securely stored (locked with firearm and ammunition stored separately), is incorporated into the electronic medical record and administered to all caregivers of infants as part of the standard newborn admission process. Responses to the Newborn Safety Screener were collected, along with demographic variables including birth year, race, ethnicity, insurance, and hospital. Level III NICU admissions, maternal age <18, or neonatal death were excluded from analysis.

Among 12,005 newborns, 9,425 (78.5%) were screened over four years. Firearms were reported in 1020 screened households (10.8%), while 8,405 (89.2%) reported no firearms in the home. Among all FA owners, 910 (89.2%) practiced safe storage, 72 (7.1%) admitted to unsafe storage, and 38 (3.7%) had no storage documentation. FA ownership varied by hospital, with the highest prevalence at the suburban hospital (Hospital B, 12.9%) and lowest at the urban hospital (Hospital C, 5.5%). Firearm ownership was significantly associated with race/ethnicity and insurance type (all p<0.001) (Table 1). Families reporting firearm ownership were more likely to identify as White (63.3% vs 47.8%) and have private insurance (77.8% vs 55.8%) compared with non-firearm-owning families. Hispanic/Latino families were less likely to report firearm ownership overall (22.1% vs 28.6%, p<0.001).

FA ownership among screened families remained stable between 2022-2025, despite a greater than 300% increase in screening rates over this time. Increased screening was likely driven by physician education initiatives and modifications to the infant documentation templates. Ownership varied across hospitals and across racial and ethnic groups and insurance categories, with differences seen between overall groups and amongst owners between hospitals. Although most FA owners reported secure storage, self-reported behaviors may differ from real practice. Newborn caregivers may underreport firearm ownership or overreport safe storage because of stress, social desirability bias, or concerns related to caring for a new baby. These findings highlight the importance of consistent, unbiased FA screening in newborn care settings to better identify families who may benefit from tailored safety counseling. Future work will examine demographic predictors of unsafe storage and explore whether firearm ownership correlates with other newborn health decisions such as consent to newborn vaccinations, erythromycin and Vitamin K.

• Reported firearm ownership varies greatly between hospital environments, racial and ethnic groups, and between private and public insurance holders
• Approximately 7% of our reported firearm owners admitted to unsafe storage practice, underscoring the need for targeted education and awareness efforts.
• Firearm ownership proportions have remained stable in the population at our three participating hospitals