Variations in Trends and Risk and Promotive Correlates of Adolescent Handgun Carriage by Sex and Rurality From a Nationally Representative Survey

Firearm carriage is a significant risk factor for adolescent injury and violence. Prior research shows variability in antecedent factors of firearm carriage, but less is known about differential mechanisms of carriage by social identity and sociodemographic features. Identifying factors at the intersection of rurality and sex can inform tailored prevention and intervention strategies. Guided by General Strain and Resiliency Theories, this study examined risk and protective factors influencing firearm carriage using data from the National Survey on Drug Use and Health (2015–2019) for adolescents aged 12 to 17. Bivariate and multivariate Poisson models estimated the associations between these factors, handgun carriage, by sex, and rurality. Weighted analyses were conducted to account for the survey design. In this sample, 2.14% of females and 6.74% of males reported past-year handgun carriage, with higher rates among rural adolescents. Adult encouragement was negatively associated with female carriage (incident rate ratios [IRR] = 0.804, p < .001) but positively with male carriage (IRR = 1.265, p < .001). Antisocial behavior was the strongest predictor of carriage for both sexes but had a 2.5 times greater impact on females (female IRR = 32.901, male IRR = 12.905, both p < .001). Among females, the effect of antisocial behavior on carriage was 3.4 times larger in urban than rural settings. The protective effect of adult encouragement persisted for urban and rural females but not for small urban females. Despite lower overall carriage rates among females, the risk factors, particularly antisocial behavior, have a stronger impact on them. These findings suggest the need to identify early precursors to carriage for designing tailored interventions aimed at reducing firearm-related risks and violence.