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

摘要：自杀是美国一个主要且日益严重的公共卫生问题。 自杀率一直是全国自杀率的三倍8，10，而且整整60%的自杀死亡是由于 在阿拉斯加原住民(AN)的农村社区，几乎所有的家庭都有多把枪，这 极大地增加了自杀风险。13，14在AN研究区域，青少年自杀率是 15、16这一背景提供了一个重要的机会来加强安全和 通过限制人们在家里使用枪支来防止自杀死亡。限制致命性 预防自杀的手段是迄今为止最有效的策略之一。 广泛普及，特别是在高风险和难以接触的人群中。17、18、20-22拟议的 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， 通过普遍参与成人家庭，建立在一个民族的集体主义、以家庭为中心的导向基础上 青年成员在提高他们的家庭安全方面的作用。我们的中心假设是，通过支持成年人 家庭成员在锁定和卸载所有家用枪支时，可以减少一个关键的环境 农村社区青少年自杀的危险因素。使用基于社区的 通过参与式的方法，研究将纳入重要的文化方面的考虑，以支持、 鼓励和评估与家庭有关的安全枪支储存做法。形成性研究 将产生可行和可接受的FSN干预措施，并将进行初步疗效测试。 我们的目标是：(1)描述一个家庭的枪支储存做法，以告知干预 开发；(2)反复开发和重点测试家庭安全网络(FSN)干预；以及(3) 进行试点随机对照试验(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，以及在 根据我们的理论，增加安全存储实践和预期的更改机制 模特。这项拟议的研究意义重大，因为有效的安全存储干预措施 需要解决的问题：1)美国青少年枪支自杀率上升；2)在 青年自杀率。主要创新包括：1)上游关注普遍的青少年自杀 拥有枪支人口中的预防和家庭安全储存做法；2)解决集体主义 文化规范，与个人主义规范相比，这对其他人群可能是重要的； 以及3)侧重于调整干预内容，以解决家庭成员的角色，两人都有枪 拥有者和其他人在控制枪支使用方面发挥了重要作用。这项形成性研究为更大规模的 评估FSN增加安全家用枪支储存效率的全功率随机试验 拥有多种枪支的人，而且他们的年轻人自杀的风险极高。

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.