Restricting access to guns and medicines among youth at risk of suicide in rural Alaska Kyla Hagan...
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Transcript of Restricting access to guns and medicines among youth at risk of suicide in rural Alaska Kyla Hagan...
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?