Family Safety Net: Developing an upstream suicide prevention approach to encourage safe firearm storage in rural and remote Alaskan homes

家庭安全网：制定上游自杀预防方法，鼓励阿拉斯加农村和偏远家庭安全存放枪支

• 批准号: 10163970
• 负责人: Lisa M. Wexler
• 金额: $ 121.04万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-21 至 2024-06-21
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10163970
• 关键词: Address; Adolescent; Adult; Affect; Age; Alaska; Alaska Native; Alaskan; American; Behavior Therapy; Belief; Child; Clinic; Communication; Communities; Counseling; Cross-Sectional Studies; Data; Development; Devices; Elements; Environmental Risk Factor; Family; Family health status; Family member; Feedback; Firearms; Focus Groups; Gender; Guns; Health Promotion; Home environment; Household; Improve Access; Individual; Intervention; Interview; Liquid substance; Mental Health; Mental Health Services; Native-Born; Ownership; Parents; Participant; Pattern; Persons; Population; Prevention approach; Prevention strategy; Primary Health Care; Public Health; Randomized; Research; Risk; Role; Rural; Safety; Sampling; Shapes; Suicide; Suicide prevention; Surveys; Teenagers; Testing; Text Messaging; Theoretical model; Time; Underserved Population; United States; Woman; Youth; base; behavior change; control trial; efficacy testing; follow-up; gun control laws; health care settings; high risk; high risk population; improved; innovation; member; men; motivational enhancement therapy; native youth; preference; primary care setting; randomized trial; recruit; rural Alaska; safety net; safety practice; satisfaction; social stigma; suicidal morbidity; suicidal risk; suicide rate; therapy development; treatment as usual; uptake; virtual

Summary: Suicide is a major and rising public health problem in the United States.1 In Alaska, suicide rates are consistently triple the national rate8,10 and fully 60% of the suicide fatalities are due to firearms.11,12 In rural Alaska Native (AN) communities, virtually all homes have multiple guns, which increases suicide risk significantly.13,14 In the AN study region, youth suicide rates are 18 times that of other American teens.15,16 This context presents an important opportunity to enhance safety and prevent suicide deaths by restricting access to firearms in the people's homes. Restricting `lethal means' for suicide prevention is one of the most effective strategies to date.17-19 Key challenges are widespread uptake, particularly within high-risk and hard-to-reach populations.17,18, 20-22 The proposed research will inform the development of the Family Safety Net (FSN), a public health approach that builds on the collectivist, family-centric orientation of AN people by universally engaging adult family members of youth in increasing their home safety. Our central hypothesis is that by supporting adult family members in locking and unloading all household firearms, we can reduce a key environmental risk factor that contributes to youth suicide in rural AN communities. Using a community-based participatory approach, the study will integrate important culturally-specific considerations to support, encourage, and assess safe firearm storage practices relevant to AN families. The formative research will result in a feasible and acceptable FSN intervention that will undergo preliminary efficacy testing. Our aims are to: (1) Characterize AN household firearm storage practices to inform intervention development; (2) Iteratively develop and focus test the Family Safety Net (FSN) intervention; and (3) Conduct a pilot randomized control trial (n=70, 35/group) to assess feasibility, acceptability, and fidelity of the Family Safety Net (FSN) intervention, as well as examine preliminary efficacy at increasing safe storage practices and expected mechanisms of change based on our theoretical model. The proposed research is significant because effective safe storage interventions are needed to address: 1) elevated rates of U.S. adolescent firearm suicides; and 2) disparities in AN youth suicide rates. Key innovations include: 1) an upstream focus on universal youth suicide prevention and family safe storage practices in a firearm-owning population; 2) addressing collectivist cultural norms, as compared to individualistic norms, which can be an important for other populations; and 3) a focus on tailoring intervention content to address the role of the family member, both gun owners and others, in controlling firearm access. This formative research sets the stage for a larger fully powered randomized trial to evaluate FSN efficacy to increase safe household firearm storage of people who have multiple firearms, and whose youth are at extremely high risk for suicide.

摘要：自杀是美国的一个重大公共卫生问题。1在阿拉斯加， 自杀率始终是全国税率8,10和60％的自杀死亡人数的三倍 在阿拉斯加农村（AN）社区中，11,12枪支，几乎所有房屋都有多个枪支 13,14个研究区域，青年自杀率是18倍 在其他美国青少年中。15,16这种情况为提高安全性和 通过限制人们在人民家中获得枪支的机会来防止自杀死亡。限制致命 手段“预防自杀是迄今为止最有效的策略之一。17-19的主要挑战是 广泛的吸收，尤其是在高风险和难以到达的人群中。17,18，20-22提议 研究将为家庭安全网（FSN）的发展提供信息，这是一种公共卫生方法 建立在人们普遍吸引人的成年家庭的集体主义者以家庭为中心的基础上 青年人提高家庭安全的成员。我们的中心假设是通过支持成人 锁定和卸载所有家用枪支的家庭成员，我们可以减少关键的环境 在农村社区中导致青年自杀的危险因素。使用基于社区的 参与性方法，该研究将整合重要的文化特定考虑因素以支持， 鼓励并评估与家庭有关的安全枪支存储实践。形成性研究 将导致可行且可接受的FSN干预措施，将进行初步疗效测试。 我们的目的是：（1）特征是家庭枪支存储实践以告知干预措施 发展; （2）迭代开发和重点测试家庭安全网（FSN）干预； （3） 进行试验随机对照试验（n = 70，35/组），以评估可行性，可接受性和 家庭安全网（FSN）干预的保真度，并检查初步功效 根据我们的理论提高安全存储实践和预期变化的预期机制 模型。拟议的研究很重要，因为有效的安全存储干预措施是 需要解决：1）美国青少年枪支自杀率提高； 2）差异 青年自杀率。关键创新包括：1）上游关注普遍青年自杀 持有枪支的人口中的预防和家庭安全储存习惯； 2）解决集体主义者 与个人主义规范相比，文化规范对其他人群很重要； 3）专注于调整干预内容以解决家庭成员的角色，都 业主和其他人控制枪支访问。这项形成性研究为更大的 完全动力的随机试验评估FSN功效，以增加安全的家用枪支存储 拥有多个枪支的人，其年轻人的自杀风险极高。