Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Epidemiology and Population Health

Degree Program

Public Health Sciences with a specialization in Epidemiology, PhD

Committee Chair

Baumgartner, Richard

Committee Co-Chair (if applicable)

Peiper, Nicholas

Committee Member

Peiper, Nicholas

Committee Member

Baumgartner, Kathy

Committee Member

Taylor, Kira

Committee Member

Anestis, Michael

Committee Member

Illback, Robert

Author's Keywords

suicide; handguns; firearms; guns; youth; adolescent


Recent data have shown marked increases in carrying of handguns among youth. Though firearms are often discussed using a lens of prevention of violence towards others, the majority of firearm deaths are suicides. Youth suicide has also seen steady increases across the United States in the past decade, demanding urgent solutions to curb this concerning trend. Klonsky and May’s Three Step Theory (3ST) outlines three primary steps that lead to death by suicide and proposes that access to and familiarity with lethal means, such as firearms, make up a critical component of the etiology of suicide. With youth suicide and youth access to firearms both on the rise, there is a need to better understand the youth who carry guns and their risk profile for suicide. This study used data from the statewide Kentucky Incentives for Prevention (KIP) Survey to examine characteristics, subgroups, and suicide risk among the growing group of youth who carry handguns. Data for nearly 90,000 Kentucky 10thgraders were analyzed from the 2012, 2014, and 2016 KIP Survey administrations. A total of 9,268 10th graders over all three waves reported carrying handguns in the past year. Handgun carrying increased 158% among 10th graders during the study window, with more than 12% of 10th graders carrying handguns in 2016. Handgun carrying was more common among males, certain racial/ethnic groups, students receiving free/reduced lunch, and students living in more rural communities. Handgun carrying was also associated with various suicide risk factors, and students who carried handguns were more likely than their peers to have seriously considered, planned, and attempted suicide. Four subgroups were identified through latent class analysis, three of which had high probabilities for multiple risk factors for suicide. These three classes were found to have elevated likelihoods of suicidal thoughts and behaviors. An in-depth examination of each subgroup and their suicide risk is provided, contextualized within the 3ST. Prevention implications are discussed: suicide prevention among handgun-carrying youth, suicide screening/prevention among youth with related risk factors, and policies that limit access to firearms all may reduce suicide risk among youth.