The Impact Of A Novel, Tailored Firearm Screening And Intervention Tool On Patients' Firearm Storage Safety Practices

Firearms were responsible for 39,740 deaths in 2018 with 60% attributed to suicide. Firearm-related injury and death continues to be a significant public health problem, with a notable increase in firearm-related death since 2015. Identifying patients at highest risk for firearm injuries is crucial if providers hope to effectively intervene. This study aims to (1) identify ED patients at high risk for firearm injury and mitigate their risk for injury by modifying access to lethal means using a culturally appropriate, tailored firearm screening and intervention tool, and (2) determine patient acceptability of firearm safety discussions with a range of health care professionals. We conducted a prospective randomized control trial using a health care-based firearm perception survey and focused screening tool for an ED population based on lethal means safety counseling and motivational interviewing. Our novel approach leverages multiple educational modalities (auditory, visual, and tactile) to augment patient learning. Patients were recruited from three urban and one rural EDs in Georgia and were eligible if they belonged to a high-risk category and had access to at least one firearm. Participants were randomly assigned to receive tailored counseling (intervention) or standard of care (control) at their index ED visit, and were surveyed at 1-month post-enrollment. Both groups received a firearm safety informational handout. Firearm storage safety practices were quantified using the Firearm Storage Safety Scale (FSSS), a novel 7-point scale (1=most safe, 7=least safe). Categorical variables were described using percentages and 95% confidence intervals. Predictors of outcomes were evaluated using binary and ordinal logistic generalized estimating equations to account for clustering within hospitals. Five complete data sets were imputed using fully conditional specification. A total of 105 patients enrolled in the study (56 in the intervention group and 49 in the control group). Patients were predominantly male (85%) and Black/African American (AA) (59%), and these rates differed between the intervention and control groups (male 89% vs. 71%, p=0.02; Black/AA 51% vs 66%, p=0.01). Overall, 32.4% of patients had at least one firearm stored loaded and unlocked (FSSS=7) at the index visit. At the 1-month follow-up there was no effect of the intervention on the FSSS (OR: 0.81 [0.32-2.07], p=0.66). A history of depression was predictive of a higher FSSS score (OR: 3.67 [1.91-7.05], p