Home Safety Project

Abstract

Injuries related to firearms are the leading cause of death in the U.S. among children and teens (ages 1-19),1 and responsible for over 26,000 pediatric deaths from 2018-2021 for ages 1-11 years. Firearm deaths among children differ from those of adolescents and teens, where suicide and interpersonal violence are responsible for most firearm deaths.2 Among children age 1-11, the Centers for Disease Control and Prevention data highlight that 65-75% of firearm deaths result from violence, 20-25% from unintentional causes, and 5-10% due to other causes.3 Unintentional firearm deaths for children 1-11 years often result from playing with firearms or cleaning firearms.4   Further, many of these deaths occur in homes where the firearm was stored unlocked and loaded, which is concerning as children as young as three years possess the dexterity and strength to depress a firearm trigger.5  This highlights the importance of considering a child’s developmental stage in regards to firearm access/storage; and prior work demonstrates that the risk for unintentional firearm fatalities is lower among households practicing secure storage (e.g., where the firearm is stored locked and unloaded, with ammunition stored separately).6-8 While educational programs exist that are designed to teach children to stay away from and/or not play with firearms, findings suggest that such interventions are not efficacious.9-13 Pediatric emergency departments (EDs) offer a novel site for examining the efficacy of a secure storage intervention for caregivers of children 1-11 years, as pediatric EDs serve large catchment areas for diverse samples of pediatric caregivers.14 Efficacious, tailored interventions addressing household firearm storage practices are needed for caregivers of children ages 1-11 years. The risks to human subjects are minimal and are reasonable in relation to the importance of the knowledge to be gained and the potential public health impact of informing the development of an effective intervention to address household firearm storage practices are needed for caregivers of children ages 1-11 years seeking ED treatment. The specific aims of this study are to: AIM #1. To conduct a pilot trial enrolling 80 eligible participants (age >18 years) caring for at least one child aged 1-11 years old presenting to the ED who report a firearm in the household and examine the acceptability, feasibility, and fidelity of two parallel ED-based firearm safety interventions [an ED-based brief intervention (BI) and a health coach (HC) intervention]. AIM #2. Examine preliminary behavioral outcomes around secure storage behaviors to inform a future, fully powered clinical trial (R01). We will also examine potential intervention mediators, including caregiver self-efficacy, autonomous motivation, behavioral intention, and readiness to change.