Restricting access to guns Restricting access to guns and medicines among youth and medicines among youth at risk of suicide in rural at risk of suicide in rural AlaskaAlaska

Kyla HaganKyla Hagan

June 2006June 2006

Suicide among Alaska Suicide among Alaska Native YouthNative Youth

Suicide Completions, 15-19 years, 1999-2003Suicide Completions, 15-19 years, 1999-2003 Leading cause of death for Alaska Natives (AN), 15-24 Leading cause of death for Alaska Natives (AN), 15-24

yearsyears AN suicide death rate 6 times white rate (101.9 vs. 17.3 per AN suicide death rate 6 times white rate (101.9 vs. 17.3 per

100,000) (1)100,000) (1) Firearm used in 57% of suicidesFirearm used in 57% of suicides

Suicide Attempts, 15-19 YearsSuicide Attempts, 15-19 Years Leading cause of injury hospitalization for ANLeading cause of injury hospitalization for AN Overdose on medication used in 71% of suicide attempts (2)Overdose on medication used in 71% of suicide attempts (2)

1. National Center for Injury Prevention and Control, Centers for Disease Control: Web- based Injury Statistics Query and Reporting System (WISQARS). Accessed on May 21, 2006, at www.cdcgov/ncipc/wisqars.

2. Alaska Suicide Hospitalizations, 2001-2002. Alaska Injury Prevention Center, Anchorage, 2005.

IntroductionIntroductionFirearmsFirearms Study showed decreased risk of suicide among children in homes where Study showed decreased risk of suicide among children in homes where

all guns stored in a locked place (3)all guns stored in a locked place (3)

AN study showed that installation of gun lockers increased safe storage AN study showed that installation of gun lockers increased safe storage rates (4)rates (4)

MedicinesMedicines No similar studies for medicine cabinetsNo similar studies for medicine cabinets

Why this Project?Why this Project? Cost of lockers prohibitive for AN communitiesCost of lockers prohibitive for AN communities

Feasibility of targeting homes with at-risk youth for installation of gun Feasibility of targeting homes with at-risk youth for installation of gun lockers and medicine cabinets in AK Native communitylockers and medicine cabinets in AK Native community

3. Grossman DC, Mueller BA, Riedy C, et al. Gun Storage Practices and Risk of Youth Suicide and Unintentional Firearm Injuries. JAMA, February 9, 2005-Vol. 293, No 6; 707-714. 4. Horn, A, Grossman DC, Jones W, et al. Community based program to improve firearm storage practices in rural Alaska. Injury Prevention 2003;9:231-234.

MethodsMethods

Thorough Formative and Process EvaluationThorough Formative and Process Evaluation Key informant interviews with stakeholdersKey informant interviews with stakeholders Questions: willingness to refer, possible stigmaQuestions: willingness to refer, possible stigma

Level of interest in community for cabinetsLevel of interest in community for cabinetsNumber of Sign-upsNumber of Sign-ups

Success of referral processSuccess of referral processNumber of referrals madeNumber of referrals made

Ability to avoid stigmaAbility to avoid stigmarecruitment/enrollment strategyrecruitment/enrollment strategy

MethodsMethods Ability to enroll participants Ability to enroll participants

Number of Gun lockers and medicine cabinets installedNumber of Gun lockers and medicine cabinets installed

Ability to reach target familiesAbility to reach target familiesRisk Factors for youth/young adult recordedRisk Factors for youth/young adult recorded

Measure current firearm and medicine Measure current firearm and medicine storage practices storage practices Self reported survey on current storage practices and Self reported survey on current storage practices and why the family wants the locker/cabinetwhy the family wants the locker/cabinet

ResultsResultsKey informant interviews w/ stakeholdersKey informant interviews w/ stakeholders

Stigma possible, open sign up needed for Stigma possible, open sign up needed for program, especially gun lockersprogram, especially gun lockers

Willing to referWilling to refer

Level of interest in community for cabinetsLevel of interest in community for cabinets High for Gun Lockers: 70 Homes signed up High for Gun Lockers: 70 Homes signed up

Unknown for Medicine Cabinets: Few sign ups, Unknown for Medicine Cabinets: Few sign ups, list lostlist lost

ResultsResults

Success of referral processSuccess of referral process Low for Gun Lockers: 3 referrals Low for Gun Lockers: 3 referrals High for Medicine Cabinets: 30 referralsHigh for Medicine Cabinets: 30 referrals

Ability to avoid stigmaAbility to avoid stigma PromisingPromising Raffle held for most gun lockers: many who Raffle held for most gun lockers: many who

signed up had youth with risk factorssigned up had youth with risk factors

ResultsResults

Ability to enroll participants Ability to enroll participants 27 out of 29 gun lockers installed (no refusals)27 out of 29 gun lockers installed (no refusals)

19 out of 24 medicine cabinets installed (no refusals)19 out of 24 medicine cabinets installed (no refusals)

Ability to reach target familiesAbility to reach target families18 out of 27 (67%) of gun locker recipients had youth in home with 18 out of 27 (67%) of gun locker recipients had youth in home with risk factor for suiciderisk factor for suicide

12 out of 19 (63%) of medicine cabinet recipients had youth in 12 out of 19 (63%) of medicine cabinet recipients had youth in home with risk factor for suicidehome with risk factor for suicide

46

35

17

76 6 6

3

9

4

0

2

4

6

8

10

12

14

16

18

Trouble withLaw

Hx SuicideAttempts

Dx MoodDisorder/Behavioral

Health

TraumaticEvent

Alcohol/DrugAbuse

Small/largenumber ofChildren

Number of Households

Gun Locker Recipients Medicine Cabinet Recipients

Gun Locker and Medicine Cabinet recipients Gun Locker and Medicine Cabinet recipients with selected risk factorwith selected risk factor

Number of Risk Factors per Gun Locker Number of Risk Factors per Gun Locker recipientrecipient

One30%

Two11%

Three15%

Four11%

Zero33%

37% of gun locker recipients 37% of gun locker recipients had youth in the home with had youth in the home with more than one of the risk more than one of the risk factors for suicidefactors for suicide

3 of the homes (11%) had 4 3 of the homes (11%) had 4 risk factorsrisk factors

ResultsResults

Measured current firearm and medicine Measured current firearm and medicine storage practices storage practices

All firearms are stored in a locked placeAll firearms are stored in a locked place

Yes:0 Yes:0 No: 26 No: 26 Null: 1Null: 1

All medicines are stored in a locked placeAll medicines are stored in a locked place

Yes:1 Yes:1 No:18No:18

DeliveryDelivery

InstallationInstallation

DiscussionDiscussion

Referral program most successful for Referral program most successful for medicine cabinetsmedicine cabinets

Community interest for gun lockers highCommunity interest for gun lockers high The larger the community, the betterThe larger the community, the better Local support essentialLocal support essential Future studies should measure safe Future studies should measure safe

storage practicesstorage practices

RecognitionRecognition

First Responder SquadFirst Responder Squad Community Health AidesCommunity Health Aides Ryan Hill, ANTHCRyan Hill, ANTHC ANTHC Injury Prevention ProgramANTHC Injury Prevention Program

Questions?Questions?