In the rural United States, an adolescent who drinks heavily has a 43% greater probability of carrying a handgun in the following year, according to a study published this month in The Journal of Rural Health.

While there has been a lot of research on this correlation in urban areas, little is known about the association between alcohol use, particularly heavy drinking, and handgun carrying in rural areas."

Alice Ellyson, lead author, acting assistant professor of pediatrics at the University of Washington School of Medicine and investigator in UW Medicine's Firearm Injury & Policy Research Program

"Our study establishes a clear link between these two behaviors in rural areas, and there are evidence-based prevention programs to address both," she said. Heavy drinking was defined as consuming five or more alcoholic drinks in a row at least once in the previous two weeks.

The study involved a longitudinal sample of 2,002 youth ages 12 to 26 in 12 rural communities in seven states, including Washington. Survey responses were collected annually from 2004 to 2019 starting with children who were in fifth/sixth grades.

The authors say their findings can inform strategies to discourage drinking and thereby decrease the likelihood of handgun-carrying among youth and young adults in rural areas. The findings, coupled with existing evidence-based approaches, might also offer key tactics to lower the homicide and suicide rates among adolescents in rural areas, the study concluded.

The association between heavy drinking and gun-carrying also was evident (38% greater) among young adults ages 19 to 26, noted senior author Dr. Ali Rowhani-Rahbar, a professor of epidemiology at the UW School of Public Health and pediatrics at the UW School of Medicine. He is also the UW Bartley Dobb Professor for the Study and Prevention of Violence and the interim director of the UW Medicine's Firearm Injury & Policy Research Program at the University of Washington School of Medicine.

The study did not break out the differences between male and female respondents nor did it address the respondents' likelihood of firing the handgun, Rowhani-Rahbar said.

He added that a major strength of the study was its longitudinal design, which allowed for the examination of handgun carrying after alcohol use.

Understanding youth behaviors associated with carrying a firearm has significant safety implications. In 2020, suicide and homicide were among the leading causes of death among U.S. individuals ages 12-26 years. About 91% of homicides and 52% of suicides among this age group involved a firearm, the study noted.

Recent evidence suggests that rural adolescents may start carrying a handgun earlier and carry with a higher frequency and duration than their urban counterparts. Handgun-carrying is associated with bullying, physical violence, and other risk factors for violence, the study notes.

Preventing or delaying handgun-carrying among rural adolescents may be an important strategy for preventing firearm-related harm, authors noted.

During young adulthood (ages 19-26), the association between alcohol use and heavy drinking were generally similar to adolescence.

On this point, Ellyson said she was surprised that the association between heavy drinking and handgun-carrying was similar and sustained between adolescent and young adult respondents. She expected the association to weaken more or disappear with age.

She identified Communities That Care as a key program for preventing these behaviors and their consequences in rural areas. The program helps communities take a broad approach to preventing problem behaviors among youth.

"It has a good track record reducing alcohol consumption and violence in randomized controlled trials, and it is an evidence-based program designed for rural communities," she said.

For adolescents, the message is simple: Don't drink alcohol or carry a handgun. Young adults, however, will need a more nuanced message, Ellyson said.

"Both alcohol use and handgun-carrying become legal in young adulthood. We want to use a harm reduction approach for young adults who engage in both behaviors (drinking and handgun carrying) so they are done in a safe way," she said.

The study did not look into the why of this correlation, or whether the handgun was fired or crimes committed later. That will be for the next study, Rowhani-Rahbar said.

An earlier study by Ellyson and colleagues found six distinct patterns of when and how often individuals in a rural area carry a handgun. In these communities, young people carry handguns at more than twice the rate of their counterparts in urban settings. Because alcohol use is also more common among rural youth, prevention programs focusing on them are important.

The studies were funded by the Centers for Disease Control and Prevention.