Firearm Safety Education to Reduce Morbidity and Mortality in Rural Youth

Abstract

The prevention of pediatric firearm injury is a national priority. Firearm related injuries are the second leading cause of death among youth in the US. Many of these injuries are intentional, with suicides and homicides accounting for 35% and 59% of youth firearm-related deaths, respectively. From a prevention perspective, it is notable that increased safe storage practices have been associated with reduced risk of pediatric firearm injury, including suicide, with reductions in risk of 75-80% in this age group.

The safe storage of firearms for children and families in rural areas presents a unique set of challenges. Rates of gun ownership are substantially higher in rural than suburban and urban regions with differing cultural practices and beliefs about the role of firearms in family and community life. Although protection is a common reason for firearm ownership across rural, urban, and suburban areas, individuals in rural communities are more likely to use firearms for hunting or sport, to have grown up using guns, to view ownership positively, and to report that most of their friends own guns. Gun owners who hunt are also more likely to own five or more firearms. The suicide rate among children and adolescents is higher in rural than in urban areas and this gap is widening. This information is critical to the development of culturally grounded strategies for the promotion of safe storage practices in rural communities. Although 95% of gun owners support educating children about gun safety, use of safe storage practices is limited, and this is especially true in rural communities.

Interventions targeting safe storage or means restriction with suicidal youth have typically relied on health care providers to impart safety education during well-child visits or to screen for suicide risk and counsel the parents of high-risk youth to remove lethal means from the home. Such approaches may not be as feasible in rural areas, due to limited access to health care providers.

The long-term goal for this project is to develop an effective, universal strategy to increase safe firearm storage in rural communities. In this two-phase pilot project, a community-based participatory research (CBPR) model will be used in Phase One to develop a culturally tailored firearm safety message and to identify the community-based messengers and messaging strategies that are most acceptable and perceived as having the greatest likelihood of being impactful with rural families. Phase Two will pilot test the acceptability and feasibility of implementation of the tailored strategy with two differing messengers. The project will focus on families with children between the ages of 8 and 18 because youth in this age range have higher rates of homicide and suicide than younger children.

This proposal capitalizes on existing community relationships in Marquette County, which were facilitated by Michigan’s Garrett Lee Smith Youth Suicide Prevention Grant (GSL Suicide Prevention Project; Ewell Foster, Co PI). It also capitalizes on the team’s substantial experience related to youth suicide prevention, firearm-related injuries, firearm safety education, and community-based participatory research.

Specific Aims:

(1) To develop a targeted, culturally tailored firearm safety message for universal implementation with families of children, ages 8 to 18 years, living in rural communities.

(2) To identify the specific messengers (e.g., community ‘champions’ of firearm safety which could include teachers, gun safety instructors, firearm owning parents, hunting license distributors, or community leaders) and messaging strategies (e.g., print materials, online-learning modules, printed or online decision aids, brief videos) that may be most impactful and acceptable for rural families.

(3) To conduct a pilot study to test the acceptability and feasibility of implementation of the tailored message delivered by two different identified messengers (with same or different messaging strategy).