Growing up in Texas, MPH student ThuyMi Phung was exposed to gun culture from an early age.
“One of my most vivid memories in high school was when one of my classmates interacted with a student who had a gun in their backpack,” she reflected. “When she alerted the police officer about it, they didn’t do a thorough check, they just said, ‘Oh, there’s no gun in there.’”
This sparked a curiosity about the pervasiveness of guns in American life. Phung maintained this focus while studying sociology and business as an undergraduate, and was drawn to the HSPop MPH program, in part, for the opportunities to contribute to the interdisciplinary Firearm Injury Policy Research Program.
Now, Phung has co-authored a mixed-methods article in the Journal of Integrated Social Sciences examining the legitimization of gun use in the home, mixing quantitative and qualitative methods.
The Multilayered Nature of “The Armed Home”
Firearms today are more common than ever before. Between 2015 and 2021, gun ownership rose by 1.5 times, dramatically increasing the number of households with a gun. This trend in gun culture brings worrying public health implications. According to researchers, merely having a gun in the home raises the risk of dying by homicide or suicide. The majority of gun deaths are suicides, and in some states, including Washington, that rate is even higher.
The most commonly cited reason for owning a gun? Self-protection. Sociologists have linked gun ownership to the mythos of “the armed citizen” and crime-fighting “good guys with guns.” Phung discovered a dearth of literature on the subject of gun use in domestic settings, however. Based on prior findings that a fear of gun violence can deter gun ownership, she hypothesized that people who believe a firearm makes a home safer would be less likely to consider gun violence a significant societal ill.
“One of the primary reasons for owning a firearm is for protection,” Phung explained. “I focused on the variable of whether you view a gun as making the home safer or more dangerous, rather than gun ownership, because I wanted to really focus on that protective belief. I also wanted to capture people who may believe a gun is protective, but aren’t necessarily a firearm owner.”
It’s intuitive enough that gun culture could make someone less worried about gun violence, on average. Yet the survey data told a different story. Bucking her expectations, the data showed, “Compared to those who believe having a gun in the home makes it more dangerous, respondents who think having a gun in the home makes it safer are 2.75 – 3.90 times more likely to say that gun violence is a very big problem.”
“My initial reaction was, ‘This [result] is highlighting a bias that I probably had,” Phung recalled.
Clearly, people’s feelings about guns are multilayered, despite the contentiousness of the debate over guns in America. Fear of gun violence can work both ways. On one hand, a cognizance of the risks of gun ownership can dissuade people from owning a firearm. On the other hand, a heightened fear of external threats is a key reason for gun ownership.
“My findings suggest that maybe people view gun violence and the threat of firearms outside of the home to be great, and they counteract that with their own firearm,” Phung explained. “So that was really surprising for me…It highlights the complexity of wanting to be safe, but what does safety entail?”
This counterintuitive result led Phung to develop her own concept of “the armed home.” According to Phung’s article, the armed home concept simultaneously accounts for both “(1) the need to protect the home from external threats, and (2) the need to safeguard against the risks associated with having the gun in the home.”
Making matters even more complicated, our very definitions of gun violence can differ. Study participants who view guns as protective tend to define gun violence as an external threat that originates outside the home. Some participants reframed gun violence as a crime issue perpetrated by “bad guys.”
Politics also plays a key role in encouraging or discouraging gun ownership. For her second hypothesis, Phung chose to focus on voting patterns in the 2016 election because of “unique campaign messaging” around crime. She hypothesized that voting for the Republican candidate in 2016 would be correlated with downplaying the problem of gun violence in society. The survey data readily confirmed this hypothesis. Republican voters, once controlling for other factors, were less likely to view gun violence as a significant societal issue.
Designing Effective Public Health Interventions to Reduce Gun Violence
For public health practitioners and providers, it’s key to understand where firearm-owning patients may be coming from.
“How can we apply these findings to actual work? Specifically, public health work, whether that’s interacting with communities to develop an intervention, or to bring about collective action to reduce firearm injury and death. That’s the public health lens that I bring, because you have to understand people’s worldviews before you try to craft any sort of intervention,” Phung explained.
Public health researchers have studied how to reduce the most common form of gun violence, suicide. The healthcare system has a key role to play in harm reduction, given that in more than 85% of cases of suicide, the person had visited a doctor at least once in the prior year.
Julie Richards, affiliate assistant professor of Health Systems and Population Health and a research associate at Kaiser Permanente Washington Health Research Institute, has extensively studied such interventions. Richards has also helped implement evidence-based interventions, including a program at Kaiser Permanente where pediatricians handed out free firearm locks at appointments.
She is currently running an ongoing study, “Optimizing Firearm Suicide Prevention in Healthcare.” This ambitious study will document stakeholder perspectives on interventions, partner with clinical and quality improvement staff to design intervention strategies, and pilot-test clinical intervention strategies in three healthcare systems to demonstrate feasibility, acceptability, and usability.
Richards has also studied how to facilitate productive conversations around firearms in the doctor’s office. Her work has underscored the need for clinicians to be non-judgmental and acknowledge patients’ reasons for owning a firearm.
Phung believes it is possible to find common ground, despite pervasive gun culture and stark political divides.
“It helps when having conversations to remember that regardless of whether people agree or disagree with you, they want to be safe. It can be a very sensitive topic, but remembering that we all have a mutual goal is really important.”