Firearm Safety Counseling With and Without Providing a Safe Storage Device: A Systematic Review

Introduction: Firearm injury is a leading cause of morbidity and mortality in the United States, especially among youth and marginalized populations. Safe firearm storage is a proven strategy to reduce firearm-related harms from suicide, homicide, and unintentional injuries. A comprehensive assessment of the literature examining safe storage programs is needed to optimize clinical practice in this area. We conducted a systematic review to characterize the state of the evidence for safe storage interventions and their effectiveness at improving safe storage behaviors.


Methods: Using PRISMA guidelines, we conducted a systematic review of randomized and quasi-experimental controlled studies from May 27, 2015, to March 21, 2025. Eight databases were searched with a specified strategy, aligning with a prior systematic review from 2016. Eligible studies evaluated interventions promoting safe firearm storage, with or without provision of storage devices. Two reviewers independently screened titles, abstracts, and full texts, with adjudication by a senior investigator.


Results: Eleven studies met inclusion criteria and were grouped into: studies examining (1) education, counseling, or outreach; (2) counseling with and without device provision; and (3) comparing free and reduced-cost devices. Of seven randomized controlled trials (RCTs) focused on education or outreach, two showed that web-based interventions significantly improved safe storage; five showed no effect. One stepped-wedge trial demonstrated that lethal means counseling doubled the odds of safe storage. Of two RCTs involving device provision, one found cable lock distribution improved both storage device use and firearm locking, and the other showed within-group improvement from baseline but no between-group difference. Finally, one cost-focused study found free device distribution increased acceptance and pledging but did not improve actual storage behavior.


Conclusions: Interventions that include direct provision of safe storage devices are more likely to improve firearm storage behaviors than interventions of education alone. For critical care providers, integrating device distribution into lethal means counseling may enhance injury prevention efforts in vulnerable populations.