RFA-CE-23-006, The Confluence of State Bullying Policies and Firearm Policies in Reducing Youth Gun Carrying and Fatality

我们的提案是对当前CDC RFA-CE-23-006的供资备选方案A的回应。平均有一些 在美国，每年有15,000名12至19岁的青少年死亡。以下三大主要死因 青少年被意外伤害、杀人和自杀。在这些致命的青少年伤害中，大多数杀人案 自杀与枪支有关(83%)，约一半的自杀涉及枪支(45%)。由此造成的伤害，医疗费用， 数年的潜在生命损失都是枪支暴力给我们社会造成的重大公共卫生负担的一部分。 研究一直表明，青少年枪支暴力受到个人层面的风险因素的影响，包括 人口统计数据包括性别、种族和民族、心理健康状况、人际关系、 致命手段的可获得性，以及青少年欺凌的经历。而对个人层面风险因素的关注是 有价值的是，人们对更广泛的以青年为重点的卫生政策在影响青年枪支方面的影响知之甚少 暴力，包括国家欺凌政策和枪支政策，以及它们在影响青年方面可能如何相互作用 暴力尤其是涉及枪支的暴力。与预防悖论相一致的社会生态模式 强调个人是嵌入在社会背景中的；因此，理解如何 社会背景因素，特别是卫生政策，影响青年枪支暴力。我们的目标是 建议通过开展全面的青年枪支预防工作来改善证据基础 运用倾向性评分匹配和综合控制方法进行多层次评价 国家一级的欺凌政策和枪支政策的融合，以减少青少年持枪和枪支- 1999年至2021年的相关死亡人数。青少年持枪数据将基于州为基础的青少年危险行为 调查数据和青年枪械死亡数据将以生命统计为基础。我们的目标包括：目标1：评估 影响整体国家欺凌政策环境和评估相对有效性的具体措施 关于青少年持枪和枪杀的欺凌政策组成部分；目标2：评估总体影响 国家枪支政策环境和评估面向青年的枪支政策的相对有效性 青少年持枪和枪杀；目标3：评估国家欺凌政策环境是否与 国家枪支政策环境对青少年持枪和枪支死亡的影响；目标4：发掘潜力 州一级政策与高危目标人群之间的跨级互动(例如，抑郁症；酗酒 饮酒；自杀未遂；种族/少数民族；性别少数群体)影响青少年持枪。我们在- 对这些已经收集的数据进行深入调查，将为政策的相对有效性提供证据 减少青年枪支暴力的战略，以及这些针对青年的政策如何对 某些高危青年群体。我们的建议是第一个评估两者联合影响的研究 与发展敏感的青春期相关的关键类型的健康政策。我们使用 适合于因果推理的分析方法也是新颖的。

Our proposal is responsive to the Funding Option A of the current CDC RFA-CE-23-006. An average of some 15,000 teenagers 12 to 19 years old died annually in the United States. The 3 leading causes of death among teenagers were unintentional injuries, homicide, and suicide. Among these fatal youth injuries, most homicides were gun related (83%), and about half of suicides involved a gun (45%). The resulting injuries, medical cost, and years of potential life lost are all part of significant public health burden of firearm violence to our society. Research has consistently shown that youth gun violence is influenced by individual-level risk factors including demographics including gender, race and ethnicity, mental health conditions, interpersonal relationships, accessibility of lethal means, and experience of youth bullying. While the focus on individual-level risk factors is valuable, little is known about the impact of broader youth-focused health policies in affecting youth gun violence, including state bullying policies and firearm policies, and how they may interact in affect youth violence especially involving guns. Consistent with the Prevention Paradox, the social ecological model emphasizes that an individual is embedded within a social context; therefore, it is critical to understand how social-contextual factors especially health policies influence youth firearm violence. The objective of our proposal is to improve the evidence base for youth firearm prevention by conducting a comprehensive multilevel evaluation with the use of propensity score matching and synthetic control methods to assess the confluence of state-level bullying policies and firearm policies on reducing youth gun carrying and firearm- related fatality from 1999 to 2021. Youth gun carrying data will be based on state-based Youth Risk Behavior Survey data, and youth firearm fatality data will be based on vital statistics. Our aims include: Aim 1: evaluate the impact of the overall state bullying policies environment and assess the relative effectiveness of specific bullying policy component on youth gun carrying and firearm death; Aim 2: evaluate the impact of the overall state firearm policies environment and assess the relative effectiveness of youth-oriented firearm policies on youth gun carrying and firearm death; Aim 3: assess whether state bullying policies environment interacts with state firearm policies environment in affecting youth gun-carrying and firearm death; Aim 4: explore potential cross-level interactions between state-level policies and high risk target populations (e.g., depression; binge drinking; suicidal attempt; racial/ethnic minority; gender minority group) in affecting youth gun carrying. Our in- depth investigation on these already collected data will provide evidence on the relative effectiveness of policy strategies in reducing youth firearm violence, and how these youth-specific policies have differential impact on certain high-risk youth populations. Our proposal is the first study to evaluate the combined influence of two key types of health policies that are relevant to a developmentally sensitive adolescence period. Our use of analytic methods suitable for causal inference is also novel.