Dataset Information

Association of Increased Safe Household Firearm Storage With Firearm Suicide and Unintentional Death Among US Youths.

ABSTRACT: Importance:Firearm injury is the second leading cause of death in the United States for children and young adults. The risk of unintentional and self-inflicted firearm injury is lower when all household firearms are stored locked. Objective:To estimate the reduction in youth firearm suicide and unintentional firearm mortality that would result if more adults in households with youth stored household guns locked. Design, Setting, and Participants:A modeling study using Monte Carlo simulation of youth firearm suicide and unintentional firearm mortality in 2015. A simulated US national sample of firearm-owning households where youth reside was derived using nationally representative rates of firearm ownership and storage and population data from the US Census to test a hypothetical intervention, safe storage of firearms in the home, on youth accidental death and suicide. Data analyses were performed from August 3, 2017, to January 9, 2018. Exposures:Observed and counterfactual household-level safe firearm storage (ie, storing all firearms locked), the latter estimated by varying the probability that a hypothetical intervention increased safe firearm storage beyond that observed in 2015. Main Outcomes and Measures:Observed and counterfactual counts of firearm suicide and unintentional firearm mortality among youth aged 0 to 19 years, the latter estimated by incorporating an empirically based estimate of the mortality benefit expected from additional safe storage (beyond that observed in 2015). Results:A hypothetical intervention among firearm owners residing with children with a 20% probability of motivating these owners to lock all household firearms was significantly associated with a projected reduction in youth firearm mortality (median incidence rate ratio?=?0.90; interquartile range, 0.87-0.93). In the overall model, 6% to 32% of deaths were estimated to be preventable depending on the probability of motivating safer storage. Conclusions and Relevance:Results of this modeling study suggest that a relatively modest uptake of a straightforward safe storage recommendation-lock all household firearms-could result in meaningful reductions in firearm suicide and unintentional firearm fatalities among youth. Approaches that will motivate additional parents to store firearms safely are needed.

SUBMITTER: Monuteaux MC

PROVIDER: S-EPMC6515586 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Project description:ImportanceSince 2004, the suicide rate among US Army soldiers has exceeded the rate of death from combat injury. It is critical to establish factors that increase the risk of acting on suicidal thoughts to guide early intervention and suicide prevention.ObjectiveTo assess whether firearm ownership, use, storage practices, and accessibility are associated with increased risk of suicide.Design, setting, and participantsIn this case-control study, suicide cases (n = 135) were defined as US Army soldiers who died by suicide while on active duty between August 1, 2011, and November 1, 2013. Next-of-kin and Army supervisors of soldiers who died by suicide (n = 168) were compared with propensity-matched controls (n = 137); those soldiers with a suicidal ideation in the past year (n = 118) provided structured interview data. Data were analyzed from April 5, 2018, to April 2, 2019.Main outcomes and measuresFirearm ownership, storage, and accessibility were assessed by using items from the World Health Organization Composite International Diagnostic Interview screening scales along with items created for the purpose of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) study.ResultsAmong the 135 suicide decedents, next-of-kin reported that they had greater accessibility to firearms compared with propensity-matched controls. Specifically, suicide decedents were more likely to own 1 or more handguns compared with propensity-matched controls (odds ratio [OR], 1.9; 95% CI, 1.0-3.7; χ21 = 4.2; false discovery rate [FDR] P = .08), store a loaded gun at home (OR, 4.1; 95% CI, 1.9-9.1; χ21 = 12.2; FDR P = .003), and publicly carry a gun when not required for military duty (OR, 3.2; 95% CI, 1.4-7.3; χ21 = 7.4; FDR P = .02). The combination of these 3 items was associated with a 3-fold increase in the odds of suicide death (OR, 3.4; 95% CI, 1.2-9.4; χ21 = 5.4; FDR P = .05). Storing a loaded gun with ammunition at home or publicly carrying a gun when not on duty was associated with a 4-fold increase in the odds of suicide death (OR, 3.9; 95% CI, 1.9-7.9; χ21 = 14.1; FDR P = .002).Conclusions and relevanceIn this study, in addition to gun ownership, ease and immediacy of firearm access were associated with increased suicide risk. Discussion with family members and supervisors about limiting firearm accessibility should be evaluated for potential intervention.

Project description:ImportanceNearly two-thirds of military suicides involve firearms, and safe firearm storage is rare.ObjectiveTo examine whether US military service members endorse greater openness to safe firearm storage depending on the content of the visual message they are randomly assigned to view.Design, setting, and participantsThis comparative effectiveness study used a 3 × 2 × 2 factorial design to randomize US military service members to view 1 of 12 visual messages on safe firearm storage. Willingness to use safe firearm storage practices was assessed immediately before and after exposure to the message. Participants were recruited using the KnowledgePanel Calibration approach. Inclusion criteria included current membership in the US military and current firearm ownership. The KnowledgePanel sample was fielded from December 3 to 27, 2021, with a 76% completion rate and 45 individuals determined to be qualified (28% qualification rate). The opt-in sample was fielded December 7, 2021, through January 4, 2022, with 699 individuals (3%) qualified and 674 included in the final data set.ExposuresMessages shared the same image and text on safe firearm storage but varied in messenger occupation (eg, primary care physician, security forces, or combat controller), the presence of text validating the perspective of firearm owners, and the presence of text validating the drive for home protection.Main outcomes and measuresOutcomes included changes in willingness to use 4 at-home (unloaded, separate from ammunition, in a locked location, and with a locking device) and 3 away-from-home (with family or friend, at a firearm retailer, or at a law enforcement agency) firearm storage practices. All analyses, including sample descriptives, are based on weighted data.ResultsOf the 719 individuals in the data set, 367 (median [range] age, 33.64 [18-86] years; 80.4% male; 71.4% White) who endorsed not currently storing firearms using the methods assessed were included in analyses. In a multivariate analysis of variance, a significant interaction was found among time, messenger profession, gun-friendly text, and home protection text across all outcomes (Wilks' λ F = 2.09; P = .01; pη2 = 0.040); however, in a post hoc repeated-measures analysis of variance, the interaction was statistically significant only for storing firearms away from home with a trusted family member or friend (F = 5.42; P = .005; pη2 = 0.030). The profession of the messenger was more consistently associated with shifts in willingness than was the message content, although this varied across storage options.Conclusions and relevanceThe findings of this comparative effectiveness study suggest that several combinations of messenger and content may be associated with willingness to endorse safe firearm storing practices, with particularly consistent positive findings for messages featuring security forces. The scalability and dosage potential of this intervention may render visual messaging valuable for promoting safe firearm storage at the population level.

Project description:ImportanceTimely outpatient follow-up care after psychiatric hospitalization is an established mental health quality indicator and considered an important component of suicide prevention, yet little is known about whether follow-up care is associated with a reduced risk of suicide soon after hospital discharge.ObjectiveTo evaluate whether receipt of outpatient care within 7 days of psychiatric hospital discharge is associated with a reduced risk of subsequent suicide among child and adolescent inpatients and examine factors associated with timely follow-up care.Design, setting, and participantsThis population-based, retrospective, longitudinal cohort study used Medicaid data from 33 states linked with National Death Index data. The study population included all youths aged 10 to 18 years who were admitted to a psychiatric hospital from January 1, 2009, to December 31, 2013. Data analysis was completed from October 9, 2019, through May 15, 2020.ExposureMental health follow-up visits received within 7 days of hospital discharge.Main outcomes and measuresSuicides occurring in the 8 to 180 days after hospital discharge. Logistic regression modeled the association between demographic, clinical, and mental health service history factors and receipt of an outpatient visit within 7 days after discharge. Poisson regression estimated the association between suicide risk and outpatient visits within 7 days after discharge, adjusting for confounding using inverse probability of treatment weights from the logistic model.ResultsOf the total 139 694 youths admitted to a psychiatric hospital, 51.9% were female, 31.1% were aged 10 to 13 years, and 68.9% were aged 14 to 18 years. A total of 56.5% of the youths received a mental health follow-up visit within 7 days of discharge, and this was associated with a significantly lower odds of suicide (adjusted relative risk, 0.44; 95% CI, 0.23-0.83; P = .01) during the 8 to 180 days postdischarge period. Youths with longer lengths of stay (4-5 days: adjusted odds ratio [AOR], 1.20 [95% CI, 1.17-1.24]; 6-7 days: AOR, 1.47 [95% CI, 1.43-1.52]; 8-12 days AOR, 1.75 [95% CI, 1.69-1.81]; 13-30 days: AOR, 1.71 [95% CI, 1.63-1.78]), prior outpatient mental health care (AOR, 1.58; 95% CI, 1.51-1.65), and foster care placement (AOR, 1.32; 95% CI, 1.28-1.37) were more likely to receive 7-day follow-up, whereas those who were non-Hispanic Black (AOR, 0.82; 95% CI, 0.79-0.84), were older (AOR, 0.82; 95% CI, 0.80-0.84), were medically ill (AOR, 0.77; 95% CI, 0.74-0.81), and had managed care insurance (AOR, 0.88; 95% CI, 0.87-0.91) were less likely to receive follow-up visits.Conclusions and relevanceIn this cohort study, risk of suicide during the 6 months after psychiatric hospitalization was decreased among youth who had an outpatient mental health visit within 7 days after discharge. Addressing disparities in timely continuity of care may help advance health equity agendas.

Project description:BackgroundChildhood and adolescent firearm injury and death rates have increased over the past decade and remain major public health concerns in the United States. Safe firearm storage has proven to be an effective measure to prevent firearm injury and death among youth. Social media has been used as an avenue to promote safe firearm storage, but perceptions of this tool remain unknown.ObjectiveThe aim of this study was to determine receptiveness and responsiveness in promoting firearm lock box and trigger lock giveaway events on social media, and to describe the characteristics of participants who learned of these events through social media.MethodsWe performed a mixed methods study combining a content analysis of Facebook event post comments, quantitative analysis of positive and negative feedback on social media, and a descriptive analysis of event participant characteristics. Through a qualitative content analysis approach, we thematically coded comments from each event's social media page posting. Interrater reliability and κ statistics were calculated. We calculated the prevalence of positive and negative feedback data. Further, we calculated descriptive statistics for demographic characteristics gathered from day-of-event intake surveys. Differences between collected measures were analyzed with χ2 and t tests according to how the participant found out about the event (social media vs other means). Using concurrent analysis, we synthesized the results from both the qualitative and quantitative aims.ResultsThrough qualitative content analysis, 414 comments from 13 events were coded. Seven themes emerged through the comment coding process with the most common being "positive receptiveness" (294/414, 71.0%). From quantitative analysis of the social media content, we found higher levels of positive feedback compared to negative feedback. The average number of event post "likes" was 1271.3 per event, whereas the average count in which "hide post" was clicked was 72.3 times per event. Overall, 35.9% (1457/4054) of participants found out about the event through social media. The participants who learned about the event through social media were on average significantly younger than those who learned about the event through other means (-6.4 years, 95% CI -5.5 to -7.3). Among the group that learned of the event through social media, 43.9% (629/1433) identified as female, whereas 35.5% (860/2420) identified as female among the group that learned of the event through other means.ConclusionsThere was overall positive receptiveness and responsiveness toward firearm lock box and trigger lock giveaway events when promoted on social media. Compared with other promotional tools, social media has the ability to reach those who are younger and those who identify as female. Future studies should extend this research to determine whether there is a difference between rural and urban settings, and consider other social media platforms in the analysis.

Project description:ImportanceFirearms are the method of suicide used most often in the US. Acute alcohol use is associated with an increased risk of suicide by firearm. However, the dose-response association between acute alcohol use and the probability of using a firearm as the method of suicide is unknown.ObjectiveTo evaluate the association between the amount of alcohol consumed and the probability of using a firearm as the method of suicide.Design, setting, and participantsThis cross-sectional study used mortality data from the US National Violent Death Reporting System on suicide decedents aged 18 years or older with a positive blood alcohol concentration (BAC; ie, ≥0.01 g/dL). Statistical analysis was performed from January 2003 to December 2020.ExposureAcute alcohol use, ascertained via postmortem toxicologic examination.Main outcomes and measuresProbability of using a firearm as the method of suicide compared with all other methods of suicide.ResultsThe study included 45 959 male suicide decedents (mean [SD] age, 42.6 [14.8] years) and 12 136 female suicide decedents (mean [SD] age, 44.2 [13.8] years) with a positive BAC; of those, 24 720 male decedents (53.8%) and 3599 female decedents (29.7%) used a firearm as the method of suicide. The probability of using a firearm as the method of suicide when alcohol is consumed was higher for male decedents, with the probability starting at just below 0.50 and increasing to approximately 0.75. In contrast, for female decedents, the probability began at just above 0.30 and increased to approximately 0.55. For both male and female decedents, the dose-response curves were an inverted U shape; as BAC increased, the probability of firearm-involved suicide initially increased and then decreased at very high BACs (approximately 0.40 g/dL for male decedents and approximately 0.30 g/dL for female decedents; these BACs were present among only a small percentage of alcohol-involved suicides: male decedents, 589 [1.3%]; female decedents, 754 [6.2%]).Conclusions and relevanceThis cross-sectional study of suicide decedents who had consumed alcohol prior to their death suggests that, as alcohol consumption increased, the probability of a firearm-involved suicide increased until a certain BAC, at which point the probability started to decrease.

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Association of Increased Safe Household Firearm Storage With Firearm Suicide and Unintentional Death Among US Youths.

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