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

摘要：在美国，自杀是一个主要的和不断上升的公共卫生问题。 自杀率一直是全国自杀率的三倍8，10，60%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支枪， 13，14在AN研究区域，青年自杀率是 15，16这种情况提供了一个重要的机会，以加强安全和 通过限制人们在家中获得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战略之一。17 - 19主要挑战是 广泛使用，特别是在高风险和难以接触的人群中。 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， 建立在集体主义，以家庭为中心的导向，通过普遍参与成年家庭 帮助青年人提高家庭安全。我们的核心假设是，通过支持成年人 在锁定和卸载所有家庭成员的枪支，我们可以减少一个关键的环境 这是导致农村AN社区青年自杀的危险因素。使用基于社区的 该研究将采用参与性方法，纳入重要的文化特定考虑因素， 鼓励和评估与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FSN干预，并将进行初步疗效测试。 我们的目标是：（1）描述一个家庭枪支储存的做法，以告知干预 （2）反复制定和重点测试家庭安全网干预措施;以及（3） 进行初步随机对照试验（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，以及检查初步疗效， 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，因为有效的安全储存干预措施 需要解决：1）美国青少年枪支自杀率上升; 2）AN的差异 青少年自杀率主要创新包括：1）上游关注普遍的青年自杀问题 预防和家庭安全储存做法在拥有枪支的人口; 2）解决集体主义 与个人主义规范相比，文化规范对其他人群可能很重要; 和3）注重调整干预内容，以解决家庭成员的作用， #21453;人和其他人，控制枪支使用。这种形成性的研究为更大的 评估FSN有效性的完全随机试验，以增加家庭枪支的安全储存， 拥有多支枪支的人，以及青少年自杀风险极高的人。

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.