Abstract
Firearm-related encounters have the potential for high risk of injury, but few studies have estimated the prevalence and co-occurrence among offensive gun use (OGU), defensive gun use (DGU), and nonfatal firearm victimization (NFV) in a national sample. We did so with data from the National Firearms, Alcohol, Cannabis, and Suicide survey (N = 7034) of US adults that assessed broad definitions of gun use and victimization (e.g., gun displays to shootings). Lifetime prevalence was 5.2% (95% CI 4.5% to 6.0%) for OGU, 12.6% (95% CI 11.5% to 13.7%) for DGU, and 31.5% (95% CI 30.0% to 33.0%) for NFV. Using survey weights to extrapolate to the US adult population, we estimate nearly 13.9 million adults have used a gun offensively, 33.3 million have used a gun defensively, and 83.3 million have experienced NFV in their lifetime. Most respondents (~80%) only reported gun use and victimization that did not involve firing a gun. There was a high rate of co-occurrence between OGU and DGU (OR = 33.8, 95% CI 23.7 to 48.0), and between NFV and OGU (OR = 5.3, 95% CI 3.9 to 7.2) and DGU (OR = 4.5, 95% CI 3.7 to 5.6). Rates of OGU, DGU, and/or NFV were higher among respondents who were males, lower income, lived in more dangerous neighborhoods, current gun owners, and had a job that required carrying a firearm. Occupational firearm carriage was associated with especially high rates of OGU (20.5%, 95% CI 15.8% to 26.1%), DGU (49.6%, 95% CI 43.9% to 55.2%), and NFV (50.9%, 95% CI 45.2% to 56.5%). A large minority of Americans have had a firearm-related victimization experience, and a smaller but substantial proportion have used a gun for defense. OGU, DGU, and NFV frequently co-occur but event-level information is needed to delineate the mechanisms of overlap.