A scoping review of empirical research on firearms and firearm violence among sexual and gender minority populations in the United States

Abstract

Background

Firearms-related health sciences research has documented disparities in fatal and nonfatal firearm injury impacting populations in the United States defined by race and ethnicity, age, gender, and geography. Recent reports from research and advocacy organizations have highlighted a need for this research to include sexual and gender minority (ie, lesbian, gay, bisexual, transgender, and queer [LGBTQ+]) populations to guide public health efforts to prevent homicide, suicide, and injury.

Purpose

The current review examines and summarizes existing research related to firearms and LGBTQ+ populations in the United States.

Methods

A search of PubMed, Embase, CINAHL, PsycInfo, LGBT Life, and Scopus was conducted in May 2024 using search strings related to LGBTQ+ populations, firearms, and suicide. Articles were included in this review if they were peer-reviewed, empirical studies assessing any construct related to firearms among LGBTQ+ people in the United States.

Results

Ultimately, 35 studies were included. Constructs examined in included studies were suicide (n = 6), homicide (n = 4), responses to the Pulse nightclub shooting (n = 9), nonfatal interpersonal violence (n = 4), and firearm access and ownership (n = 12).

Conclusions

Findings identified substantial gaps in the literature, underscoring an urgent need for LGBTQ+ health researchers and firearm injury prevention researchers to collaboratively extend and improve the evidence base on firearms among LGBTQ+ populations. Key recommendations include improving Sexual Orientation and Gender Identity data collection in firearms research, collecting original data to address LGBTQ+-specific and LGBTQ+-inclusive research questions regarding firearms, broadening the scope of firearms constructs assessed among LGTBQ+ populations, and using intersectionality to guide future research.

Introduction

In the past decade, production of firearm-related research in the health sciences has exponentially increased.¹ A recent synthesis of firearms injury prevention research highlighted increasing disparities in firearm homicides impacting youth (particularly Black youth), men, and people living in urban areas as well as firearm intimate partner homicides impacting women.² Moreover, firearm suicide disproportionately impacts older adults, veterans and military members, White and American Indian/Alaskan Native populations, Black youth, and people living in rural areas.^2,3 The populations at greatest risk for firearm suicide are also most likely to live in a household with firearms.⁴

Sexual and gender minority (ie, lesbian, gay, bisexual, transgender, and queer [LGBTQ+]) populations are notably absent from much of this research despite their high prevalence of suicide, intimate partner violence (IPV), and nonpartner interpersonal and bias-motivated violence across the life course.^5–11 Following the 2016 Pulse nightclub shooting, 2022 Club Q shooting, and several years of political and legislative attacks on transgender (trans) youths’ access to social and medical gender affirmation, research and advocacy organizations have devoted greater attention to firearm injury prevention among LGBTQ+ populations.^12–14 Reports from the Trevor Project, Williams Institute, and Everytown for Gun Safety call for more expansive research on firearms in LGBTQ+ youth suicide,¹⁴ anti-LGBTQ+ bias-related crimes and mass violence, community and intimate partner firearm violence involving LGBTQ+ adults,¹³ and gun ownership, access, and use among LGBTQ+ populations.¹² These reports highlight deficiencies within federal injury and death surveillance systems regarding collection of both firearm and Sexual Orientation and Gender Identity (SOGI) data as the major reason for the dearth of firearm-related health sciences studies concerning LGBTQ+ populations.^12,13

This scoping review aims to examine and summarize existing peer-reviewed literature on firearms and LGBTQ+ populations in the United States. Our goal is to form recommendations for future research focused on in mitigating inequities in firearm-related violence and injury impacting LGBTQ+ populations.

Methods

Inclusion criteria

To be included, studies needed to empirically assess firearms or firearm violence in the United States from the perspective of LGBTQ+ participants or via administrative records identifying LGBTQ+ individuals. Studies including non-LGBTQ+ participants needed to present disaggregated data or qualitative findings specific to firearms among the LGBTQ+ portion of their sample. We did not restrict the search criteria by study design or year of publication and included all peer-reviewed studies published in English.

Literature search

In May 2024, we conducted an electronic search of PubMed, Embase, CINAHL, PsycInfo, LGBT Life, and Scopus using search strings developed in consultation with a health sciences informationist to maximize sensitivity and efficiency. The first search string contained terms related to firearms including “gun,” “shooting,” and “suicide.” The second contained terms related to LGBTQ+ populations including “sexual and gender minorities” and “non-heterosexual.” For a complete list of search terms, refer to Table 1.

All retrieved abstracts were organized in EndNote X9.2 (Clarivate) and duplicates were removed using the de-duplication function. The first author performed title and abstract screening focused on excluding studies that clearly did not meet the inclusion criteria due to lack of empirical design, non-US sample, or irrelevant content focus. The first and last author independently reviewed the full-text version of the remaining references for adherence to inclusion criteria and resolved discrepancies via discussion.

Data extraction

From each study, we recorded relevant details of the methods, sample, firearms construct (eg, access, injury, homicide, suicide), noted limitations, and relevant findings regarding LGBTQ+ populations into a data extraction table. Methods included the study design (eg, primary or secondary analysis, qualitative or quantitative methods), sampling method (eg, probability, nonprobability), data collection method (eg, online, administrative records extraction), and year(s) of data collected. Sample details included sample size, specific location, demographics (eg, age, race and ethnicity, sexual orientation, gender identity), and how SOGI was measured. The first author extracted data for all included studies and the last author extracted data from a 25% sample of the studies; there were no discrepancies. This review of existing research did not require ethical approval, and the protocol was registered prior to conducting the literature search.

Results

Searches yielded a combined 20 435 records, 8701 of which remained after removing duplicates (Figure 1). Following title/abstract screening, 91 reports were retrieved for full-text review. Of these, 56 were excluded. The most common reasons for exclusion at this stage were for topic (ie, not assessing a firearms construct, n = 37) and population (ie, not including or disaggregating data among LGBTQ+ populations, n = 14). The interrater reliability of the full-text search was strong (κ = 0.88). Ultimately, 35 studies were included in this review (Table 2).

Most included studies (68.5%, n = 24) were secondary analyses of previously collected data. Commonly used data sources included the National Violent Death Reporting System (NVDRS, n = 5), state or national Youth Risk Behavior Surveys (YRBS, n = 4), and electronic health records (EHRs, n = 4). Most studies were quantitative (82.9%, n = 29), while 4 (11.8%) were qualitative and 2 (5.8%) presented both quantitative and qualitative data. Below, we summarize findings regarding firearms and firearm violence and LGBTQ+ populations in the United States by firearm topic.

Suicide

Six studies examined firearm suicide completion or attempt.^16–20 Across the 3 studies analyzing NVDRS data on suicide completion, firearms were a less commonly used suicide method for LGBTQ+ populations in comparison to non-LGBTQ+ populations.^16,19,20 One study examining sexual orientation differences in suicide method among adult decedents found that firearms were used in fewer suicides among lesbian, gay, and bisexual (LGB) decedents than heterosexual decedents or those with an unclassified sexual orientation.¹⁶ This difference was greater among men than women; furthermore, unlike heterosexual decedents, sexual minority women were overall more likely than sexual minority men to die by firearm suicide than by other means.¹⁶ A later study corroborated these results and also found that trans decedents were less likely to use firearms in suicides than both heterosexual and LGB cisgender people.¹⁹ Likewise, a study of suicide decedents aged 12-29 found that gay cisgender men, lesbian cisgender women, trans men, and trans women had lower odds of firearm suicide than cisgender heterosexual men.²⁰ A qualitative interview study of LGBTQ+ survivors of near-fatal suicide attempts reflected this trend as only one participant reported using a firearm.¹⁷ Finally, studies examining causes of death among trans veterans using data from the Veterans Health Administration (VHA) and National Death Index (NDI) found that firearms were the most common suicide method among trans veterans; they had a significantly higher risk of firearm suicide than non-trans veterans.^15,18

Homicide

Four included studies examined firearm homicide committed by or against LGBTQ+ individuals. First, a study using 1982-1992 data from the Medical Examiner’s Office in Broward County, Florida, found that fewer homicide victims who could be classified as gay or bisexual men from were killed with firearms than a presumed heterosexual male control group (22% vs 61%, respectively).²² Two studies examined firearm homicides using NVDRS data.^21,24 A study of intimate partner homicides against women found that sexual minority women were less likely to be killed with a firearm than cisgender heterosexual women, but there were no differences for trans women.²¹ Second, an examination of sex work-related homicides revealed that more trans victims were killed with firearms than cisgender female victims.²⁴ Finally, in the only included study of interpersonal violence perpetrated by LGBTQ+ individuals, firearms were used in 39% of “juvenile homosexual homicides” (ie, homicides involving sexual activity or motivation in which both the victim and perpetrator were male) recorded in the FBI homicide reports from 1976-2005.²³

Pulse nightclub shooting

Individual responses

Among the studies assessing responses to or potential impacts of the Pulse shooting among individuals, 4 used original survey data from online convenience samples,^25,27,30,32 2 combined original online survey data with data from ongoing projects unrelated to Pulse,^26,33 and 1 used nationally representative data from the National Health Interview Study.²⁸

Several studies focused on perceived threat or safety among LGBTQ+ participants following the Pulse shooting. A study of gay bar attendees in 4 cities found that participants from Tulsa, Oklahoma, felt less safe at gay bars and reduced their gay bar attendance more than participants from 3 comparison cities with more favorable climates for LGTBQ+ people.²⁶ In a study assessing demographic differences in perceived personal safety and peer safety among LGBTQ+ adults, there were no differences by race and ethnicity but significant differences by gender and sexual orientation such that cisgender men reported higher perceptions of personal and peer safety than LGBTQ+ people of other genders. Additionally, gay/lesbian participants reported higher perceptions of peer safety than bisexual, queer, and “other” participants.³³ Finally, in a sample of LGBTQ+ adults, perceived personal threat following the Pulse shooting mediated associations between LGBTQ+ identity centrality, perceived public regard for LGBTQ+ people, identification with the Pulse shooting victims, and negative affect.³⁰

Additional studies examined behavioral and psychological outcomes among LGBTQ+ populations following the Pulse shooting. First, in an online sample of lesbian, gay, and bisexual adults, participants identified alcohol use, substance use, posting on social media, and seeking social support as common coping strategies among their peers; among themselves, only posting on social media and seeking social support were commonly endorsed.²⁵ In another online sample, LGTBQ+ participants reported stronger reactions to media coverage of Pulse than cisgender heterosexual participants, which was associated with post-traumatic stress symptoms.²⁷ Lastly, one study found that sexual minority men but not women experienced a detectable spike in psychological distress in comparison to heterosexual participants in the month following the Pulse shooting.²⁸

The only qualitative study assessing individual responses to the Pulse shooting examined queer people of color’s experiences.³² This focus is notable given that among Pulse response studies reporting demographics of their sample, all other study samples were at least 60% non-Latinx White and none conducted intersectional analyses that looked within and/or across multiple social positionalities to consider how relationships between racism, anti-LGBTQ+ oppression, and/or other structural power dynamics may influence study outcomes.^25–28,30 Participants in this study described violence against queer people of color as a regular phenomenon. Some felt more frightened to be out and described feelings of guilt around concealing their identity. Importantly, participants also discussed how media coverage and community discussions about the Pulse shooting erased victims’ Latinx identities and the role of racism by framing the shooting as a homophobic hate crime.³²

Community responses

Two qualitative studies examined community responses to the Pulse shooting based on the experiences of social service providers and community-based organization leaders and staff based in Orlando.^29,31 Results highlighted how the Pulse shooting increased need for long-term mental health, social, and economic supports for LGBTQ+ Latinx people in Orlando and revealed that existing programs were not adequately serving undocumented people, monolingual Spanish speakers, and those facing unemployment and poverty due to post-traumatic stress and compounding intersectional oppression limiting work opportunities.^29,31

Nonfatal interpersonal violence

Four studies assessed nonfatal interpersonal violence involving firearms against LGBTQ+ populations, all of which used convenience sampling.^34–37 Two studies examined firearm violence in San Francisco, California. Among patients seeking care after violent crime, none of the LGB patients experienced shootings compared to 17% of the heterosexual patients.³⁴ However, there were no sexual orientation differences in the prevalence of being attacked with a gun as an adult among a community sample of women experience housing deprivation.³⁶

The remaining 2 studies examined IPV involving firearms.^35,37 In a study of IPV among same-sex female couples, 25% of participants reported their abusive partner owned a gun and 15% reported being threatened with a gun or having a gun “used against them.” The latter predicted future threats, physical IPV, and sexual IPV in a community sample.³⁵ The second study assessed numerous types of nonfatal firearm abuse among cisgender men and women in an online sample.³⁷ Of the male participants who experienced firearm IPV, 30% had a male partner; of the female participants, 3% had a female partner. However, low numbers of female survivors with female partners and male survivors overall was a noted limitation to drawing conclusions about same-sex nonfatal firearm IPV.

Firearm access and ownership

Youth

The 6 included studies that examined firearm access among youth and young adults were all secondary analyses.^{38,41,42,44–46} Two studies found no differences in reported gun carrying by sexual orientation in the national high school YRBS.^44,45 Additionally, reporting online bullying victimization was associated with gun carrying among sexual minorities (gay, lesbian, bisexual, and participants unsure of their sexual orientation).⁴⁵ In the only study to examine gun access among youth of color, gay male American Indian/Alaskan Native students were less likely to report access to a gun than heterosexual American Indian/Alaskan Native students in a national sample.³⁸

Two studies analyzed gun carrying among high school students using state-specific datasets. In an analysis of the 2015 Maine YRBS, students unsure of their sexual orientation were significantly more likely to carry a gun than heterosexual students.⁴² Furthermore, trans students in California high schools were more likely to report carrying a gun at school than cisgender students.⁴⁶

One study examined gun access among college populations with a focus on trans students using data from the National College Health Assessment.⁴¹ Overall, trans students were less likely to report access to a gun than cisgender men or women, and characteristics associated with gun access among trans students included identifying as straight, being a part-time student, and attending a school in the Midwest.⁴¹ Lastly, several measures of bullying, IPV, physical violence, and substance use were associated with having access to a gun among the trans sample.⁴¹

Adults

The 6 studies assessing firearm access and ownership among LGTBQ+ adults varied substantially in their samples, methods, and conclusions. First, a study analyzing BRFSS data from California and Texas found that sexual minorities had lower odds of firearm ownership than heterosexual adults, and, among firearm owners, there were no differences in firearm storage practices by sexual orientation.³⁹ A subsequent study of data from the General Social Survey likewise found that sexual minorities were less likely than heterosexual people to report having a gun in the house and more likely to be in favor of stronger gun control policies; these findings were driven by differences between gay/bisexual men and heterosexual men more so than differences between lesbian/bisexual women and heterosexual women.⁴⁰ Furthermore, an analysis of VHA EHRs found no differences in firearm ownership between LGBTQ+ and cisgender heterosexual veterans among those screened for firearm ownership in emergency departments.⁴³

Three studies examined the experiences of firearm owners. In a study examining suicide risk factors among firearm owners, sexual minority firearm owners were most likely to belong to a suicide risk latent class characterized by high rates of depression, chronic pain, post-traumatic stress disorder, adverse childhood experiences, and opioid use.⁴⁷ In a study of LGBTQ+ Californians, most firearm owners reported owning a single handgun, and characteristics associated with firearm ownership included male gender, older age (60+), non-Latinx White race and ethnicity, veteran status, and a preference for the Republican party.⁴⁹ Lastly, in a qualitative study assessing perspectives on firearm ownership among racial and ethnic, sexual, and political minorities in the firearms community, LGBTQ+ participants described firearm ownership as rare and unpopular within LGBTQ+ communities and characterized firearm ownership as frowned upon or shameful. Furthermore, they described “gun culture” spaces including firing ranges and gun shops as uncomfortable for LGBTQ+ people.⁴⁸

Discussion

Studies included in this scoping review of firearms research among LGBTQ+ populations in the United States examined 5 firearm-related topics: suicide, homicide, the Pulse nightclub shooting, nonfatal interpersonal violence, and access and ownership. The small number of studies and diversity of settings, populations, time periods, and outcomes researched within each topic limit our ability to draw definitive, topic-specific conclusions about firearms and firearm violence among LGBTQ+ populations. However, across topics, research suggests that LGBTQ+ populations have patterns of firearm injury, exposure, ownership, and access that are distinct from non-LGBTQ+ groups.

These patterns highlight a need for continued firearms research with LGBTQ+ populations to strengthen the evidence base and effectiveness of firearm injury prevention efforts. Specific research is needed to understand factors that are unique to LGBTQ+ populations (eg, intimate partner firearm violence, anti-LGBTQ+ firearm violence) and examine variation across topics among LGBTQ+ populations (eg, by geography, race and ethnicity, gender). Concurrently, LGBTQ+-inclusive firearms research is needed to determine the extent to which LGBTQ+ populations, overall and among subgroups, differ from non-LGBTQ+ populations in firearm suicide, homicide, and nonfatal injury, and whether and how predictors of these outcome across the social-ecological model may differ. This future research necessitates collaboration between health sciences researchers with expertise in LGBTQ+ health and firearm injury prevention. Below, we offer recommendations to shape this research based on the issues identified and gaps present in the reviewed literature.

Recommendations

Assess, analyze, and disseminate findings by SOGI in firearms research

In this review, most studies examining firearm suicide and homicide were secondary analyses of administrative or surveillance data. Researchers emphasized how the lack of systematically and accurately collected SOGI data in EHRs, NVDRS, and law enforcement systems impeded efforts to research LGBTQ+ populations.^{15,16,18–22,24} Importantly, LGBTQ+ individuals may be misclassified as heterosexual and/or cisgender if these records and their administrators do not explicitly and competently ask about SOGI characteristics. LGBTQ+ health researchers have long noted the challenges of collecting SOGI data postmortem, and efforts to develop and implement training in SOGI data collection for death investigators are underway.^50–52 As data on firearm suicide, homicide, and unintentional deaths is critical to guide all firearm injury prevention efforts, firearms researchers are well-positioned to advance SOGI data collection efforts by death investigators and in other commonly leveraged data sources in firearms research.^53,54

Additionally, researchers examining firearms topics other than deaths should follow best practices for SOGI data collection in survey research⁵⁵ and, crucially, analyze and disseminate findings regarding LGBTQ+ populations. This is particularly important in research seeking to generate large, nationally representative datasets that shape the knowledge base on firearms such as the National Survey of Gun Policy, which assesses constructs that received limited attention from studies in this review like reasons for gun ownership and support for gun policies.^56,57 Researchers unfamiliar with these procedures (including reporting findings regarding small or “hidden” populations) should consider leveraging training opportunities, consulting and collaborating with LGBTQ+ health experts, and assembling community advisory boards for additional guidance on collecting and disseminating findings regarding SOGI and firearms.

Assess firearms topics in LGBTQ+ health research

Research centered on understanding LGBTQ+ population health and health inequities should assess firearm topics across contexts and in relation to multiple health domains. First, findings from this review regarding method of suicide and firearm ownership suggest that suicide inequities impacting LGBTQ+ populations may not be driven by differences in firearm suicide rates or firearm ownership as LGBTQ+ people are less likely to die by firearm suicide or live in households with firearms than non-LGBTQ+ people.^{15,16,19,20,39,40,49} However, because of the notable potential for misclassification of LGBTQ+ people in most of the data sources used in these studies including the BRFSS, General Social Survey, and NVDRS, this conclusion should be interpreted with caution.^51,58,59 LGBTQ+-specific research is needed to understand demographic patterns of firearm ownership, reasons for firearm ownership, and the relationship between firearm ownership and suicide to determine the extent to which firearm injury prevention initiatives can reduce suicide among LGBTQ+ populations.

Furthermore, findings regarding nonfatal firearm violence highlight the need for continued examination of direct and vicarious exposure to firearm violence in LGBTQ+ health research on IPV, community violence, and bias-motivated violence. Regarding nonfatal firearm violence, the 2 included studies assessing firearm IPV among LGBTQ+ populations suggest that firearm IPV in same-sex relationships can be physical (ie, being hit with a gun) and psychological (ie, threats to shoot themselves)^35,37; therefore, firearm abuse may be inadequately captured by commonly used measures of IPV in LGBTQ+ health research.^60–62 Further research is needed to understand these multifaceted forms of interpersonal firearm violence within and beyond intimate partnerships.

Findings regarding the Pulse nightclub shooting imply that the effects of bias-motivated firearm violence against LGBTQ+ populations reverberate within local communities and beyond via traditional and social media coverage.^25–33 Since the Pulse nightclub shooting, anti-LGBTQ bias-motivated violence and hate have proliferated.^63,64 Continued research with LGBTQ+ communities is needed to understand the role of firearms in the lethality of these attacks, increased fear, and adverse impacts on local and geographically dispersed communities. Such research may help support policy recommendations intended to prevent mass shootings, develop effective strategies to deter bias-motivated violence, and prepare communities to respond to the collective impacts of anti-LGTBQ+ bias-motivated firearm violence.^65–69

Collect original data

Findings from this review demonstrate how reliance on a small number of existing data sources may result in overrepresentation of particular LGBTQ+ populations in firearms research even if SOGI and firearms measurement improves. Therefore, original data collection is critical to improving firearm injury prevention research with LGBTQ+ communities. For instance, research regarding firearm access among youth drew entirely from school-based surveys, which necessarily excludes youth who have left school for any reason.^{38,41,42,44–46} Furthermore, these surveys are prone to “mischievous responders” who falsify their responses to SOGI items and other measures.^70,71 Such responses contribute to misrepresentations of health inequities impacting LGBTQ+ adolescents and may underlie several of the results reported by included studies. Designing studies in collaboration with LGBTQ+ youth may result in more representative and accurate data regarding firearm access, exposure, and use among this population.

Original data collection can also address questions about firearms in LGBTQ+ populations that are unanswerable via analysis of administrative records or health surveillance data. First, few included studies examined health behaviors or outcomes in relation to firearms among LGBTQ+ samples. Future research should examine the relationship between firearms and outcomes such as substance use disorders, post-traumatic stress, and depression, which inequitably impact LGBTQ+ populations and are commonly examined in firearms research.^72–74 Second, research on firearm suicide and ownership among veterans included in this review demonstrates the importance of examining intragroup differences by SOGI among populations with known inequities in firearm injury.^15,18,43 In addition to veterans, future research examining firearms topics among LGBTQ+ populations should consider centering inquiry on other groups which disproportionately experience firearm homicide or suicide such as Black youth, older adults, or rural or urban populations.^2,3 Finally, original data collection can expand on research examining LGBTQ+ people’s beliefs, experiences, and perspectives on firearm ownership as these may differ from non-LGBTQ+ populations and require different consideration in firearm injury prevention efforts.⁴⁸

Broaden the scope of firearms topics researched with LGBTQ+ populations

Several critical firearms topics were not assessed in any studies included in this review. For instance, research with children, youth, and young adults has identified firearm-related cultural attitudes and socialization, firearm violence victimization, bystander and vicarious firearm exposure (eg, witnessing a shooting, knowing a friend owns a gun), the presence of guns in the household, and community firearm violence as key constructs to assess to guide firearm injury prevention efforts, yet these were absent in included studies with LGBTQ+ youth.^74–76 No included studies examined the prevalence or impacts of indirect exposure to firearm violence including mass shootings, anti-LGBTQ+ bias-motivated incidents of firearm violence, or firearm violence against members of LGBTQ+ peoples’ social networks outside the Pulse nightclub shooting. Research with other populations has demonstrated that indirect or vicarious exposure to firearm violence is associated with multiple adverse mental health outcomes and is therefore important to assess in understanding mental health inequities impacting LGBTQ+ populations.^77,78 Finally, given the extent to which certain LGBTQ+ groups, including trans people of color and Black youth, report experiencing police mistreatment, it is noteworthy that no studies examined police-perpetrated firearm violence.^79,80 These unexplored constructs reflect an overall opportunity for LGBTQ+ health and firearms injury prevention researchers to collaborate with LGBTQ+ communities to identify and address the most relevant aspects of firearm injury prevention.

Use intersectionality to identify research questions and guide analysis

Finally, intersectionality should be used as a guiding framework for pursuing research on firearms among LGBTQ+ populations as it generates research aims and analysis plans that consider how multiple structural power dynamics including racism, heterosexism, and cissexism may determine firearm exposure, behaviors, and injury. In this review, some studies examining the Pulse nightclub shooting noted how the absence of intersectional thinking in media coverage of the attack and among White-dominated LGBTQ+ communities both reflected and perpetuated racism, ethnocentrism, and xenophobia toward Latinx LGBTQ+ people in Orlando experience.^29,31,32 This absence was also apparent in studies included in this review which recruited predominantly White, socioeconomically advantaged samples to examine responses to the shooting and did not examine differences within and across social positions most reflective of the Pulse shooting victims (ie, Latinx gay, bisexual, and queer men).^25,27,30,33

Intersectionality was also absent in studies examining other firearms topics. Though some discussed or analyzed how firearm homicides and suicides are patterned along multiple axes of LGBTQ+ people’s social positions (eg, sexual orientation and gender),^15,19,21 these studies did not consider how systems of power such as racism, sexism, and heterosexism collide to drive the patterns their analyses uncovered. Future firearms research with LGTBQ+ populations should consider using intracategorical intersectionality to examine firearms constructs within LGBTQ+ populations defined by multiple axes of identity (eg, among Black trans youth) and intercategorical approaches to examine constructs between LGBTQ+ and non-LGBTQ+ populations (eg, conducting simultaneous comparisons by race and sexual orientation).⁸¹ When conducting either type of intersectional analysis, conceptualizing gender identity (eg, cisgender, transgender) separately from sexual orientation (eg, bisexual, heterosexual) is critical to avoid conflating the experiences of transgender people from cisgender sexual minorities.

Researchers should frame their aims and interpretations of results within the historical, political, and social contexts of their participants and the structural power dynamics most relevant to their social position.⁸² Given our focus on LGBTQ+ populations in the United States, this necessitates discussion of the White supremacist and patriarchal roots of US gun culture and firearm policies.⁸² Recent studies examining fatal violence against Black trans women,⁸³ the association between state firearm policies and IPV firearm homicides of women by race and ethnicity,⁸⁴ the relationship between historical redlining and contemporary racialized economic segregation on community firearm violence,⁸⁵ and the experiences and recovery needs of young Black men who have survived firearm injury^86,87 exemplify how intersectionality can be used as an analytic framework in firearms research. These studies model how intersectional, critical quantitative^83–85 and qualitative^86,87 methods can be applied to understand racialized and gendered experiences of firearm violence and generate actionable insights for public health approaches to violence prevention, providing a starting place for approaching intersectional firearms research with LGBTQ+ populations.

Limitations

As with all reviews, our results are limited by the sensitivity of our search strings. Though they were formed by an expert health sciences informationist to be as comprehensive as possible, we may have inadvertently excluded potentially relevant articles. Using a single reviewer for title/abstract screening may have resulted in further erroneous exclusions. Additionally, we did not conduct a systematized evaluation of study quality for included articles. While evaluation is a goal of many scoping reviews, our review was intended to map the breadth of firearms research among LGBTQ+ populations in the United States rather than assess the strength of evidence provided for any claims given the small number of articles we expected to include related to any one firearm construct.

Conclusion

Despite the rise of anti-LGBTQ+ violence and documented inequities in suicide, IPV, and homicide impacting LGBTQ+ populations, findings from this scoping review indicate that firearms-related research regarding these populations remains limited. There is an urgent need for collaboration between LGBTQ+ health and firearms injury prevention experts to conduct research that more fully captures the compounded vulnerabilities LGBTQ+ populations face regarding firearm injury and develop effective prevention strategies.

Acknowledgments

The authors are grateful to Kate Saylor for her guidance in developing the search strategy used in this review.

Funding

The authors are grateful for the support from the University of Michigan Population Studies Center and Institute for Firearm Injury Prevention (National Institute of Child Health and Human Development P2CHD041028; National Institute on Aging T32AG000221; National Institute for Health U24HD111315). This article does not represent the official view of the sponsors.

Author contributions

Wesley M. Correll-King (Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Writing—original draft, Writing—review & editing), Cassandra Crifasi (Supervision, Validation, Writing—review & editing), and Kristi E. Gamarel (Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Writing—review & editing)

Conflicts of interest

None declared.

Data availability

No data were collected for this review of published literature.

Open science transparency statements

Study and analytic plan preregistration: The study and analysis plan were preregistered prior to beginning the study at: https://deepblue.lib.umich.edu/handle/2027.42/167140

Analytic code: There is not analytic code associated with this study.

Materials: The search strings used to conduct the literature search are available in Table 1.

References