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Systematic review of the impact of interventions changing access to lethal means on suicide attempts and deaths

Objective

The study objective was to examine if interventions changing access to lethal means are associated with changes in suicide deaths and/or attempts by conducting a systematic review of controlled intervention studies.

Methods

Authors searched key databases (PubMed, PsycInfo, CINAHL) from inception to March 2024 for longitudinal controlled intervention studies with at least one contemporaneous comparator group evaluating the impact of interventions changing access to lethal means on suicide attempts and/or deaths in a primarily adult population. Reviewers dually screened articles, then extracted study characteristics and assessed methodological quality.

Results

Researchers screened 8522 studies and 36 articles met eligibility for inclusion. Most studies evaluated the impact of population-level firearm interventions on suicide deaths and found that stricter regulations were associated with a small reduction, if any, in total and/or firearm-specific suicide deaths. The ecological level of analysis precluded individual-level causal inference. Findings within interventions targeting methods other than firearms were limited, mixed and/or inconclusive. Notably, no high-quality randomised controlled trials (RCTs) were identified that met our eligibility criteria.

Conclusion

Future studies should use an RCT design or advanced statistical causal inference techniques to further elucidate the effectiveness of these interventions on suicide deaths and/or attempts.

PROSPERO registration number

CRD42022364775.

Acceptability and feasibility of video-based firearm safety education in a Colorado emergency department for caregivers of adolescents in firearm-owning households

Background

Easy firearm access increases injury risk among adolescents. We evaluated the acceptability and feasibility of improving knowledge of a 3 min safe firearm storage education video in the paediatric emergency department.

Methods

We conducted a single-centre block trial in a large paediatric emergency department (August 2020–2022). Participants were caregivers of adolescents (10–17 years) in firearm-owning households. First block participants (control) completed a baseline survey about child safety behaviours (including firearms). Second block participants (intervention) completed a baseline survey, watched the safe firearm storage video and evaluated acceptability. Participants completed a 3-month follow-up survey about firearm safety behaviours and knowledge recall. Demographic and clinical variables were compared between the intervention and control groups using Fisher’s exact and 2 tests. McNemar’s test was used to compare firearm storage behaviours at the initial and 3-month visit within each group.

Results

Research staff approached 1264 caregivers; 371 consented to participate (29.4%) and 144 (38.8%) endorsed firearm ownership. There were 95 participants in the control group and 62 in the intervention group. Follow-up was lower in the intervention group (53.7% vs 37.1%, p=0.04). Among participants viewing the video, 80.3% liked the video and 50.0% felt they learnt something new from the video.

Conclusions

Video-based firearm education in a paediatric emergency department is acceptable among a population of caregivers of adolescents with household firearms. This is a higher-risk group that may uniquely benefit from consistent education in the paediatric emergency department. Further study with larger populations is needed to evaluate intervention effectiveness.

Trial registration

The study was registered with ClinicalTrials.gov (NCT05168878).

Firearm access, carriage and use; sample of young adults in Texas

Background Despite the high rates of firearm ownership and firearm-related injuries and mortalities in Southern US states, understandings on the factors contributing to these are lacking.

Methods Using wave 10 (2021) data from a longitudinal study, we examined firearm-related experiences among 636 ethnically diverse young adults (mean age=26 years; 62% female) in Texas, USA.

Results Just over half of participants had ready access to firearms, with 22.3% having carried a firearm outside of their home, 4.9% having been threatened with a firearm by a romantic partner and 4.4% by a non-romantic partner. More firearm access and carriage were reported in males, white participants and those with >US$50 000 income. More females than males had been threatened with a firearm by a romantic partner, but more males than females had been threatened by a non-partner. Participants with recent financial difficulties were proportionally more likely to be threatened with a firearm than those without difficulties.

Conclusion Findings emphasise the alarming rate of firearm access and carriage in Texas and highlight the disparities in firearms experiences by sociodemographic characteristics.

Advances in data linkage and science for IP research

The recent COVID-19 pandemic stimulated unprecedented linkage of datasets worldwide, and while injury is endemic rather than pandemic, there is much to be learned by the injury prevention community from the data science approaches taken to respond to the pandemic to support research into the primary, secondary and tertiary prevention of injuries. The use of routinely collected data to produce real-world evidence, as an alternative to clinical trials, has been gaining in popularity as the availability and quality of digital health platforms grow and the linkage landscape, and the analytics required to make best use of linked and unstructured data, is rapidly evolving. Capitalising on existing data sources, innovative linkage and advanced analytic approaches provides the opportunity to undertake novel injury prevention research and generate new knowledge, while avoiding data waste and additional burden to participants. We provide a tangible, but not exhaustive, list of examples showing the breadth and value of data linkage, along with the emerging capabilities of natural language processing techniques to enhance injury research. To optimise data science approaches to injury prevention, injury researchers in this area need to share methods, code, models and tools to improve consistence and efficiencies in this field. Increased collaboration between injury prevention researchers and data scientists working on population data linkage systems has much to offer this field of research.

Firearm death in US vs other countries

Gun violence in the US is the leading cause of death among children and teenagers, drives down life expectancy, and cost the economy around $557bn in 2022, says a report from the Commonwealth Fund, a non-profit organisation that researches healthcare issues and promotes improved quality and efficiency in healthcare.1The study used data from the global burden of disease study from the Institute for Health Metrics and Evaluation at the University of Washington in Seattle.Mass shootings in the US get much media attention but represent less than 2% of gun deaths in the US, the report says. Mass shootings are those in which four or more people are shot or killed, excluding the shooter. There were 656 mass shootings in the US in 2023, reports the Gun Violence Archive,2 and at least 385 so far this year.An earlier Commonwealth Fund study showed that in 2019 the US had 10.4 deaths per…

Saving Lives by Regulating Guns: Evidence for Policy

Gun violence is a leading cause of death in the United States, where over 36,000 people were killed by gunshot in 2015 [including homicide, suicide, and accident (1)]. The gun-murder rate is 25 times as high in the United States as in other high-income nations, and the gun-suicide rate is eight times as high (2). Interpersonal gun violence has deleterious effects on economic development and standard of living in heavily impacted neighborhoods (3). Given this heavy burden, it is greatly concerning that many aspects of the body of research on gun violence have been deemed inadequate and inconclusive by expert panels of the U.S. Centers for Disease Control and Prevention (CDC) and of the National Academies of Sciences, Engineering, and Medicine (4–6). Fortunately, the flow of high-quality research has increased in recent years. Although the CDC largely withdrew from funding research on gun violence more than 20 years ago (under intense congressional pressure), there are active research programs in medicine, public health, law, and the social sciences under way in universities and think tanks. This good news, often lost in the well-justified complaints about the lack of federal funding, deserves greater recognition. New findings are providing a sound evidence base for policy-making and, among other contributions, have helped demonstrate efficacy in three important domains of gun policy: add-on sentences for gun use in violent crime, bans on gun possession by those convicted of domestic violence, and restrictions on carrying concealed firearms in public.