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

补充：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: 10653325
• 负责人: Lisa M. Wexler
• 金额: $ 19.5万
• 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 2023-09-20
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10653325
• 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; Group Interviews; Guns; Health Promotion; Home; Household; Improve Access; Individual; Intervention; Interview; Liquid substance; Mental Health Services; Native-Born; Ownership; Parents; Participant; Pattern; Persons; Population; Prevention approach; Prevention strategy; Primary Health Care; Public Health; Randomized; Randomized Controlled Trials; 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; 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; 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：自杀是美国一个严重且日益严重的公共卫生问题。1 在阿拉斯加， 自杀率始终是全国自杀率的三倍8,10，并且 60% 的自杀死亡是由于自杀造成的 11,12 在阿拉斯加原住民 (AN) 农村社区，几乎所有家庭都拥有多支枪，这 自杀风险显着增加。13,14 在 AN 研究地区，青少年自杀率是青少年的 18 倍 15,16 这种情况为加强安全和 通过限制人们在家中使用枪支来防止自杀死亡。限制“致命” 预防自杀的手段是迄今为止最有效的策略之一。17-19 主要挑战是 广泛采用，特别是在高风险和难以接触的人群中。17,18, 20-22 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， 通过成人家庭的普遍参与，建立在 AN 人的集体主义、以家庭为中心的取向之上 青年成员加强家庭安全。我们的中心假设是，通过支持成人 家庭成员在锁定和卸下所有家庭枪支时，我们可以减少一个关键的环境 导致农村 AN 社区青少年自杀的危险因素。使用基于社区的 参与式方法，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 AN 家庭相关的安全枪支储存做法。形成性研究 将产生可行且可接受的粮食安全和营养干预措施，并将进行初步功效测试。 我们的目标是：(1) 描述家庭枪支储存做法的特征，为干预措施提供信息 发展; （2）迭代制定并重点测试家庭安全网（FSN）干预措施；和（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，并检查初步效果 根据我们的理论，增加安全存储实践和预期的变化机制 模型。拟议的研究意义重大，因为有效的安全存储干预措施是 需要解决：1）美国青少年持枪自杀率上升； 2) AN 的差异 青少年自杀率。主要创新包括：1）上游关注普遍青少年自杀问题 拥有枪支人群的预防和家庭安全储存做法； 2）针对集体主义 与个人主义规范相比，文化规范对于其他人群来说可能很重要； 3) 重点关注定制干预内容，以解决家庭成员（均持有枪支）的角色 所有者和其他人控制枪支的使用。这项形成性研究为更大规模的研究奠定了基础 评估 FSN 功效的全动力随机试验，以提高家庭枪支的安全储存 拥有多支枪支且青少年自杀风险极高的人。