Bystander intervention to prevent firearm injury: A qualitative study of 4-H shooting sports participants.

This qualitative study examines how youth and adult members of 4-H Shooting Sports clubs perceive firearm injury risk and risk reduction, and the applicability of a bystander intervention (BI) risk reduction framework in this community. Semistructured interviews were conducted with 11 youth and 13 adult members of 4-H Shooting Sports clubs across nine US states from March to December of 2021 until thematic saturation was reached. Deductive and inductive thematic qualitative analyses were performed. Six overarching themes emerged: (1) The tendency to view firearm injury as predominantly unintentional in nature; (2) Acknowledgment of a wide array of risks for firearm injury; (3) Perceived barriers to bystander action to prevent firearm injury including knowledge, confidence, and consequences of action; (4) Facilitators of bystander action including a sense of civic responsibility; (5) Direct and indirect strategies to address potential risks for firearm injury; and (6) Belief that BI skills training would be useful for 4-H Shooting Sports. Findings lay the groundwork for applying BI skills training as an approach to firearm injury prevention in 4-H Shooting Sports, similar to how BI has been applied to other types of injury (i.e., sexual assault). 4-H Shooting Sports club members' sense of civic responsibility is a key facilitator. Prevention efforts should attend to the broad array of ways in which firearm injury occurs, including suicide, mass shootings, homicide, and intimate partner violence, as well as unintentional injury.

Implementation of an evidence-based tobacco control intervention for school teachers in India: Evaluating the effects of a capacity-building strategy.

Background: Tobacco-Free Teachers, Tobacco-Free Society (TFT-TFS) is an evidence-based intervention that promotes tobacco use cessation among teachers and tobacco control policies among schools in India. This study tested an implementation model to build Bihar Department of Education (DOE) capacity to support and deliver TFT-TFS within schools, leveraging DOE training infrastructure. Method: We used a training-of-trainers (TOT) "cascade" implementation strategy to embed the TFT-TFS program into the Bihar DOE infrastructure. We trained 46 Cluster Coordinators to train and support Headmasters to implement TFT-TFS in their schools over one academic year. We selected three school districts, representing approximately 46 clusters and 219 schools. We used the RE-AIM framework to assess program adoption (Headmaster participation in at least one of six TFT-TFS trainings), implementation (of four core program components), and reach (teachers' participation in three or more group discussions). Using a non-inferiority design, we hypothesized that program adoption, implementation, and reach would not be inferior to the high standards demonstrated when TFT-TFS was originally tested in the Bihar School Teachers Study. We used self-reported checklists to measure outcomes and SPSS Version 25 to analyze data. Results: For adoption, 94% of Headmasters attended the first training, although participation declined by the sixth training. Among the 112 schools out of 219 with complete Headmaster checklist data, all met our minimum criteria for implementing TFT-TFS. Over 99% of schools posted a school tobacco control policy and distributed quit booklets. However, only 69% of schools met our criteria for program reach. Conclusions: This study outlines the processes for taking a tobacco control intervention to scale and implementing it through the Bihar DOE infrastructure. These findings provide a foundation for other Indian states and low- and middle-income countries to implement tobacco control and other health programs for schoolteachers. Trial registration: NCT05346991. Plain Language Summary: Each year in India, more than 1.2 million people die from tobacco-related causes, and India has the world's highest oral cancer burden. The world needs more evidence on how to bring cost-effective tobacco control interventions to scale, especially in low- and middle-income countries (LMICs). To address this gap, from 2017 to 2021, we examined the process of scaling up Tobacco-Free Teachers, Tobacco-Free Society (TFT-TFS), an evidence-based intervention promoting tobacco use cessation among teachers and tobacco control policies in schools. Our study tested an implementation model aimed at building the Bihar State Department of Education (DOE) capacity to support and deliver TFT-TFS. We used a training-of-trainers model to embed TFT-TFS into Bihar DOE infrastructure, training 46 Cluster Coordinators to in turn train and support Headmasters to implement TFT-TFS over one academic year. We hypothesized that program adoption, implementation, and reach would not be inferior to the high standards demonstrated when we originally tested TFT-TFS through the Bihar School Teachers Study (2013-2017). For adoption, 94% of Headmasters attended the first training, although participation declined by the sixth training. Of 112 schools (out of 219 with complete Headmaster checklist data), all met our minimum criteria for implementing TFT-TFS. Over 99% of schools posted a school tobacco control policy and distributed quit booklets. However, only 69% of schools met our criteria for program reach. Study findings offer other Indian states and LMICs lessons to implement tobacco control and other health programs for schoolteachers within educational systems.

Selection and Use of Firearm and Medication Locking Devices in a Lethal Means Counseling Intervention.

Background: While some suicide prevention initiatives distribute locking devices for firearms and medication, little evidence exists to guide the selection of devices. Aims: This study aimed to describe safety standards for locking devices and compare parental acceptance rates for different types of devices. Method: As part of the larger SAFETY Study, behavioral health clinicians provided free locking devices to parents whose child was evaluated in the emergency department (ED) for a suicide-related or behavioral health-related problem. For logistical reasons, we changed the specific devices offered midstudy. Data on device use came from follow-up interviews with 226 parents. Results: Few effective standards exist for locking devices for home use; we could easily break into some. At follow-up, twice as many gun-owning parents were using ED-provided handgun lockboxes as cable locks (28% vs. 14%, p = .02). Overall, 55% of parents reported using an ED-provided medication lockbox, with more using the drawer-sized lockbox than the larger, steel toolbox (60% vs. 42%, p < .01). Limitations: Storage outcomes are from parents' self-report and from one state only. Conclusion: Parents appeared to prefer some devices over others. Our findings suggest the need for (a) effective safety standards, (b) affordable devices meeting these standards, and (c) further research on consumer preferences to ensure use.

How to ask: Surveying nursing directors of nursing homes.

BACKGROUND AND AIMS: Nursing home research may involve eliciting information from managers, yet response rates for Directors of Nursing have not been recently studied. As a part of a more extensive study, we surveyed all nursing homes in three states in 2018 and 2019, updating how to survey these leaders effectively. We focus on response rates as a measure of non-response error and comparison of nursing home's characteristics to their population values as a measure of representation error. METHODS: We surveyed Directors of Nursing or their designees in nursing homes serving adult residents with at least 30 beds in California, Massachusetts, and Ohio (N = 2389). We collected contact information for respondents and then emailed survey invitations and links, followed by three email reminders and a paper version. Nursing home associations in two of the states contacted their members on our behalf. We compared the response rates across waves and states. We also compared the characteristics of nursing homes based on whether the response was via email or paper. In a multivariable logit regression, we used characteristics of the survey and the nursing homes to predict whether their DON responded to the survey using adjustments for multiple comparisons. RESULTS: The response rate was higher for the first wave than for the second (30% vs 20.5%). The highest response rate was in Massachusetts (31.8%), followed by Ohio (25.8%) and California (19.5%). Nursing home characteristics did not vary by response mode. Additionally, we did not find any statistically significant predictors of whether a nursing home responded. CONCLUSION: A single-mode survey may provide a reasonably representative sample at the cost of sample size. With that said, however, switching modes can increase sample size without potentially biasing the sample.

Validation of the Workplace Integrated Safety and Health (WISH) assessment in a sample of nursing homes using Item Response Theory (IRT) methods.

OBJECTIVES: To validate and test the dimensionality of six constructs from the Workplace Integrated Safety and Health (WISH) assessment, an instrument that assesses the extent to which organisations implement integrated systems approaches for protecting and promoting worker health, safety and well-being, in a sample of nursing homes in the USA. DESIGN: Validation of an assessment scale using data from a cross-sectional survey. SETTING: Nursing homes certified by the Centers for Medicaid and Medicare services in three states of the USA: Ohio, California and Massachusetts. PARTICIPANTS: 569 directors of nursing from nursing homes serving adults and with more than 30 beds participated in the study. RESULTS: Graded response Item Response Theory (IRT) models showed that five out of six constructs were unidimensional based on balanced interpretation of model fit statistics-M2 or C2 with p value >0.05, Comparative Fit Index >0.95, lower bound of the root mean squared error of approximation 90% CI <0.06 and standardised root mean square residual <0.08. Overall measure and construct reliability ranged from acceptable to good. Category boundary location parameters indicated that items were most informative for respondents in lower range of latent scores (ie, ß1, ß2, ß3 typically below 0). A few items were recommended to be dropped from future administrations of the instrument based on empirical and substantive interpretation. CONCLUSIONS: The WISH instrument has utility to understand to what extent organisations integrate protection and promotion of worker health, safety and well-being; however, it is most informative in organisations that present lower scores.

A suicide prevention campaign for firearm dealers in New Hampshire.

A spate of suicides involving a just-purchased firearm led a statewide coalition of firearm dealers, firearm rights advocates, and suicide prevention professionals to discuss the role of gun shops in preventing suicide. The group developed and mailed materials for (1) firearm retailers on avoiding sales to suicidal customers and (2) their customers on suicide and firearm safety. All storefront retailers were identified (n = 65), visited unannounced 6 months after receiving materials, and asked to complete a survey. Nearly half (48%) had at least one campaign product on display. Belief that reducing a suicidal person's access to firearms might save a life was associated with displaying materials (69% vs. 41%, p = .06). Public health and gun groups can successfully collaborate on suicide prevention activities.

Gun carrying by high school students in Boston, MA: does overestimation of peer gun carrying matter?

This paper investigates: (1) whether high school students overestimate gun carrying by their peers, and (2) whether those students who overestimate peer gun carrying are more likely to carry firearms. Data come from a randomly sampled survey conducted in 2008 of over 1,700 high school students in Boston, MA. Over 5% of students reported carrying a gun, 9% of boys and 2% of girls. Students substantially overestimated the percentage of their peers who carried guns; the likelihood that a respondent carried a gun was strongly associated with their perception of the level of peer gun carrying. Most respondents believed it was easier for other youth to obtain guns than it was for them. Social marketing campaigns designed to lower young people's perceptions about the prevalence of peer gun carrying may be a promising strategy for reducing actual gun carrying among youth.

Are household firearms stored less safely in homes with adolescents?: Analysis of a national random sample of parents.

OBJECTIVE: To examine whether firearms are more frequently stored loaded, unlocked, or both in households with adolescents only (aged 13-17 years) compared with households with younger children only (aged 0-12 years). DESIGN: Random-digit-dial survey on firearms (n = 2770). We computed bivariate associations between the presence of adolescents and firearm storage practices. Statistical significance was assessed using prevalence ratios with 95% confidence intervals. SETTING: United States. PARTICIPANTS: Survey respondents with children (aged <18 years) who reported the presence of a household firearm. MAIN OUTCOME MEASURES: Prevalence of firearms in the home stored loaded and/or unlocked. RESULTS: Of the 392 respondents, 22% had a loaded firearm, 32% had an unlocked firearm, and 8% had a firearm stored loaded and unlocked. Compared with households with younger children, households with adolescents only were somewhat more likely to store a firearm unlocked (42% vs 29%; prevalence ratio, 1.48; 95% confidence interval, 1.04-2.02), loaded (26% vs 20%; prevalence ratio, 1.25; 95% confidence interval, 0.82-1.91), or both (10% vs 8%; prevalence ratio, 1.43; 95% confidence interval, 0.64-3.19). CONCLUSIONS: Parents of adolescents appear to be more likely to keep household firearms stored unsafely, especially with regard to keeping firearms unlocked. This is of concern because most youth firearm injuries happen to adolescents. Firearm injury prevention programs should directly target parents of adolescents to promote safe firearm storage.

Is an armed society a polite society? Guns and road rage.

BACKGROUND: While concerns about road rage have grown over the past decade, states have made it easier for motorists to carry firearms in their vehicles. Are motorists with guns in the car more or less likely to engage in hostile and aggressive behavior? METHODS: Data come from a 2004 national random digit dial survey of over 2,400 licensed drivers. Respondents were asked whether, in the past year, they (1) made obscene or rude gestures at another motorist, (2) aggressively followed another vehicle too closely, and (3) were victims of such hostile behaviors. RESULTS: Seventeen percent admitted making obscene or rude gestures, and 9% had aggressively followed too closely. Forty-six percent reported victimization by each of these behaviors in the past year. Males, young adults, binge drinkers, those who do not believe most people can be trusted, those ever arrested for a non-traffic violation, and motorists who had been in a vehicle in which there was a gun were more likely to engage in such forms of road rage. CONCLUSION: Similar to a survey of Arizona motorists, in our survey, riding with a firearm in the vehicle was a marker for aggressive and dangerous driver behavior.

Firearm storage practices and rates of unintentional firearm deaths in the United States.

BACKGROUND: The American Academy of Pediatrics and the American Medical Association recommend storing firearms unloaded and locked up to minimize the chance of injury. Although these recommendations appeal to common sense, no study has yet addressed whether firearm storage practices influence the risk of unintentional firearm injury. METHODS: Negative binomial regression analyses were used to assess the cross sectional relation between firearm storage practices and rates of unintentional firearm death in the United States, controlling for rates of firearm prevalence, poverty and urbanization. Recently available state-level measures of household firearm prevalence and firearm storage practices were obtained from the 2002 Behavioral Risk Factor Surveillance System. Unintentional firearm death counts and population data came from the National Center for Health Statistics. RESULTS: Independent of firearm prevalence, urbanization, and poverty, a disproportionately large share of unintentional firearm fatalities occurred in states where gun owners were more likely to store their firearms loaded, the greatest risk occurring in states where loaded firearms were more likely to be stored unlocked. CONCLUSION: Our findings provide empirical support for recommendations issued by the AMA and the AAP that firearms should be stored unloaded and locked, and suggest that promoting safer storage practices could save many lives.