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Northwestern University Feinberg School of Medicine
Center for Dissemination & Implementation Science

Community ASPIRE

Reducing Youth Firearm-Related Injury and Mortality Through Implementation of A Secure Firearm Storage Program During Pediatric Well-Visits

In the United States, firearms are now the leading cause of death of youth aged 0-19. Secure firearm storage promotion is one of the simplest and most scalable, non-partisan, population-based approaches to firearm injury and mortality prevention; even a modest increase in secure storage could prevent up to 32% of firearm deaths in youth. This study aims to increase the implementation of S.A.F.E. Firearm, an evidence-based secure firearm storage program, during pediatric well-visits in health centers.

S.A.F.E. Firearm includes (a) brief counseling around secure firearm storage using a harm reduction approach and (b) offering free cable locks. Despite its capacity to reduce the burden of firearm-related injury and mortality, and recommendations from the American Academy of Pediatrics, S.A.F.E. Firearm or its components are rarely delivered during pediatric primary care visits. In our prior National Institute of Mental Health-funded R01 study, ASPIRE (Adolescent and child Suicide Prevention In Routine Clinical Encounters; R01MH123491), we tested two approaches to bolster the delivery of S.A.F.E. Firearm. Study conditions were (1) nudge, the integration of a new EHR documentation template into the standard well-child visit workflow, and (2) nudge+, the nudge protocol combined with facilitation. A higher percentage of well-child visits received both program components of the firearm storage program (i.e. reach) as documented by the clinician in the EHR in the nudge+ condition (49%) compared to nudge (22%). Both conditions led to an increase in the number of patients receiving S.A.F.E. Firearm compared to baseline (2%) as estimated by our prior work.

In the current project, Community ASPIRE, we are partnering with the Illinois Primary Health Care Association and AllianceChicago to expand this work to Illinois health centers. Specifically, we aim to:

  1. Use the ADAPT-ITT approach in collaboration with key partners to adapt and optimize S.A.F.E. Firearm and our implementation approach for Illinois health centers (e.g., making the intervention easier to administer), building off previous work
  2. Test the effectiveness of our adapted implementation approach on S.A.F.E. Firearm delivery and assess secondary implementation outcomes (i.e., stage of implementation, cost, acceptability) and an effectiveness outcome (i.e., parent firearm storage behavior)
  3. Use mixed methods to understand parent/guardian, clinician, and health center leader perspectives on implementation mechanisms and intervention receipt, as well as evaluate program reach and firearm storage behavior by demographic characteristics and social determinants of health

Current efforts to implement secure firearm storage programs generally occur in ambulatory and acute care settings in large health systems. Given the disproportionate burden of firearm injury and mortality in communities served by health centers, this project has important implications for health equity. Study results will guide future implementation of secure firearm storage programs in health centers, which may be taken to scale nationally to combat firearm violence and save lives.

Project Details

  • Dates: 2024 - 2029
  • Funding source: National Institute of Nursing Research
  • Grant number: R01NR021291

Contact

  • Sub-award Principal investigator: Rinad Beidas, PhD
  • Partner Organizations: Illinois Primary Health Care Association, AllianceChicago
  • Co-investigators:Ashley Colwell, MS, PHR; Cheri Hoots, RN; Katelin Hoskins, PhD; Kristin Linn, PhD; Maryann Mason, PhD; Katie McAuliff, PhD
  • Project Staff:Grace Godwin, BA; Christina Johnson, MPH; Kendall Kubis, MPH; Mirta Milanes, MPH
  • Project Trainee:Hannah Cheng, PhD student