Changes in Firearm and Medication Storage Practices in Homes of Youths at Risk for Suicide: Results of the SAFETY Study, a Clustered, Emergency Department–Based, Multisite, Stepped-Wedge Trial - 24/07/20
, Carmel Salhi, ScD a, Catherine Barber, MPA b, Deborah Azrael, PhD b, Elizabeth Beatriz, PhD a, John Berrigan, BS b, Sara Brandspigel, MPH c, Marian E. Betz, MPH, MD d, Carol Runyan, PhD cAbstract |
Study objective |
We evaluate whether a counseling intervention implemented at the hospital level resulted in safer firearm and medication storage by caregivers of youths aged 10 to 17 years after their child’s evaluation in the emergency department (ED) for a behavioral health concern.
Methods |
We used a stepped-wedge clustered design rolled out at 4 hospital sites to assess primary preregistered outcomes (self-reported storage changes caregivers made to household firearms and medications), assessed by survey 2 weeks after the ED visit. Three logistic models provided estimates of the intervention effect: an unadjusted model, a model with hospital-level fixed effects, and a model that further adjusts for time.
Results |
Of the 575 caregiver participants, 208 were firearm owners (123 in usual care, 85 in the intervention). Baseline (pre-ED visit) characteristics did not differ between usual care and intervention phases. During the 2-year study period, twice as many caregivers whose child visited the ED after (compared with before) a hospital adopted the intervention improved firearm storage and 3 times as many improved medication storage (odds ratio [OR]=2.1 [95% confidence interval {CI} 1.0 to ∞] and OR=3.0 [95% CI 2.2 to ∞], respectively). After adjusting for time, the intervention effect for medications persisted (OR=2.0 [95% CI 1.0 to ∞]); the effect on firearms did not (OR=0.7 [95% CI 0.1 to ∞]).
Conclusion |
To our knowledge, this study is the first controlled trial to estimate the effectiveness of an intervention on firearm and medication storage in homes of youths at elevated risk of suicide. We found evidence that caregivers’ medication storage improved after their child’s ED visit, with evidence suggestive of improvement for firearm storage.
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| Please see page 195 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Megan L. Ranney, MD, MPH. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: MM, CS, CB, DA, and CR conceptualized the study and acquired funding. SB and CR recruited hospitals and oversaw training of hospital staff, ongoing monitoring of intervention delivery and data collection, and oversight of data collection by the survey research group in Colorado. CB led development of the intervention materials. MM, CS, DA, and EB conducted the analysis. MM drafted the article. MM, CS, CB, DA, EB, JB, and MEB made substantial contributions to data analysis and interpretation. All authors contributed to revising the final article. MM takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This project was supported by funds from the American Foundation for Suicide Prevention (grant TBT-0-013-15). |
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| Trial registration number: NCT03143283 |
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| The sponsor had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the article. The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding source. No endorsement by the American Foundation for Suicide Prevention is intended or should be inferred. |
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Vol 76 - N° 2
P. 194-205 - août 2020 Retour au numéro
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