• Research Highlight
Firearm injuries and deaths among youth are a major public health problem. While safe storage is a proven safety measure, less than 30% of households with children Report storage of closed and unloaded firearms. . In a new study funded by the National Institute of Mental Health, researchers set out to address this gap by testing the effectiveness of two scalable approaches to promote safe firearm storage when used during routine well-child visits.
What is the firearms safe storage program?
Multiple medical associations and the US Office of the Surgeon General support clinicians as a critical source of firearms safety guidance. Pediatric physicians are trusted messengers who regularly discuss safety issues with parents and other guardians, and both parents and doctors consider it appropriate include firearm storage along with other safety discussions. Teaching parents how to store firearms safely can help save lives, and studies show that doctors who talk to parents about firearm safety improve home storage practices.
With this in mind, a team of researchers and clinicians (in partnership with health leaders, firearms safety experts, and caregivers) developed a safe firearm storage program called Firearm SAFE (Suicide and Accident Prevention through Family Education) .
Pediatric physicians teach the program during well-child visits. It involves having a brief conversation with parents about the importance of safe firearm storage and offering them a free cable lock. The program is easy to implement and takes less than a minute during well-child visits. in a previous clinical trial Parents who received the original SAFE Firearm program were twice as likely to store firearms safely at home. However, the program has not been widely implemented and this study sought to facilitate that task.
What did the researchers do in the study?
The research team, led by Rinad Beidas, Ph.D. from Northwestern University Feinberg School of Medicine, tested two approaches to implementing the SAFE Firearm program in pediatric primary care.
Doctors saw more than 47,300 children ages 5 to 17 for well-child visits during the study. Visits took place at 30 pediatric clinics in two large, diverse health care systems in Michigan and Colorado. The participating clinics were part of the Mental health research network a consortium of research centers located in healthcare systems and dedicated to improving the mental health of patients.
The researchers randomly assigned clinics to use one of two simple support strategies and compared the effectiveness of the strategies in promoting delivery of the firearms program:
- Push: Physicians were reminded to deliver the program via an automated reminder in patients’ electronic medical records.
- Push+: Clinicians received the reminder plus 1 year of facilitation to implement the program (examples of facilitation included guidance on how to talk to parents, help with implementation barriers, and feedback on clinic performance).
What did the study find?
Before the study, about 2% of pediatric doctors reported offering advice on secure storage and cable locks during well-child visits. After the use of Nudge or Nudge+, the number of physicians who engaged in those behaviors increased significantly.
While both strategies led to an increase in delivery of both components of safe firearm storage, the Nudge+ (reminder and facilitation) strategy proved to be much more impactful. Significantly more physicians who received Nudge+ delivered the intervention (49%) compared to those who received the Nudge reminder alone (22%).
The additional support not only increased program delivery, but did not require many additional resources or efforts. Nudge+ clinics received just 8.7 hours of additional support per clinic each year, which came primarily from email or chat.
What do the results mean?
This is one of the first and largest studies conducted in the United States focused on implementing universal safe firearm storage as a routine and regular part of well-child visits. The findings demonstrate the large positive impact of using relatively inexpensive, low-burden supportive strategies to deliver a safe firearm storage program during pediatric primary care. Combined with the results of a previous NIMH-funded study By demonstrating the strong support among clinicians for engaging with parents about firearm storage safety, a compelling picture emerges about how best to support clinicians and clinics in engaging with parents around this. topic that saves lives.
The study had many strengths, including the diversity of participants, a randomized study design, and an evidence-based approach. However, it also had some limitations. For example, there was no control group providing care as usual. There are also the limitations of electronic medical records: The data do not indicate how long or to what degree doctors discussed firearm storage with parents, nor is it guaranteed that doctors always documented those conversations. Additionally, the study focused only on cable locks, and there may be other methods of securing firearms that are more effective or more acceptable to parents.
Next steps for researchers include analyzing data from surveys conducted with parents throughout the study to determine whether receiving the safe firearm storage program improved actual safety practices at home. The researchers also plan to test these strategies to implement the program in other settings that serve youth, such as community centers, after-school programs, and faith-based organizations.
Reference
Beidas, RS, Linn, KA, Boggs, JM, Marcus, SC, Hoskins, K., Jager-Hyman, S., Johnson, C., Maye, M., Quintana, L., Wolk, CB, Wright, L. ., Pappas, C., Beck, A., Bedjeti, K., Buttenheim, AM, Daley, MF, Elias, M., Lyons, J., Martin, ML,… Ahmedani, B. K. (2024). Implementation of a safe firearm storage program in pediatric primary care: a cluster randomized trial. JAMA Pediatrics, 178(11), 1104-1113. https://www.doi.org/10.1001/jamapediatrics.2024.3274
