Restricting access to guns and medicines among youth at risk of suicide in rural Alaska Kyla Hagan June 2006

Suicide among Alaska Native Youth Suicide Completions, years, Leading cause of death for Alaska Natives (AN), years Leading cause of death for Alaska Natives (AN), years AN suicide death rate 6 times white rate (101.9 vs per 100,000) (1) AN suicide death rate 6 times white rate (101.9 vs per 100,000) (1) Firearm used in 57% of suicides Firearm used in 57% of suicides Suicide Attempts, Years Leading cause of injury hospitalization for AN Leading 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 2.Alaska Suicide Hospitalizations, Alaska Injury Prevention Center, Anchorage, 2005.

Introduction Firearms Study showed decreased risk of suicide among children in homes where all guns stored in a locked place (3) Study showed decreased risk of suicide among children in homes where all guns stored in a locked place (3) AN study showed that installation of gun lockers increased safe storage rates (4) AN study showed that installation of gun lockers increased safe storage rates (4)Medicines No similar studies for medicine cabinets No similar studies for medicine cabinets Why this Project? Cost of lockers prohibitive for AN communities Cost of lockers prohibitive for AN communities Feasibility of targeting homes with at-risk youth for installation of gun lockers and medicine cabinets in AK Native community Feasibility of targeting homes with at-risk youth for installation of gun lockers 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; Horn, A, Grossman DC, Jones W, et al. Community based program to improve firearm storage practices in rural Alaska. Injury Prevention 2003;9:

Methods Thorough Formative and Process Evaluation Key informant interviews with stakeholders Key informant interviews with stakeholders Questions: willingness to refer, possible stigma Questions: willingness to refer, possible stigma Level of interest in community for cabinets Level of interest in community for cabinets Number of Sign-ups Success of referral process Success of referral process Number of referrals made Ability to avoid stigma Ability to avoid stigma recruitment/enrollment strategy

Methods Ability to enroll participants Ability to enroll participants Number of Gun lockers and medicine cabinets installed Ability to reach target families Ability to reach target families Risk Factors for youth/young adult recorded Measure current firearm and medicine storage practices Measure current firearm and medicine storage practices Self reported survey on current storage practices and why the family wants the locker/cabinet

Results Key informant interviews w/ stakeholders Stigma possible, open sign up needed for program, especially gun lockers Stigma possible, open sign up needed for program, especially gun lockers Willing to refer Willing to refer Level of interest in community for cabinets High for Gun Lockers: 70 Homes signed up Unknown for Medicine Cabinets: Few sign ups, list lost High for Gun Lockers: 70 Homes signed up Unknown for Medicine Cabinets: Few sign ups, list lost

Results Success of referral process Low for Gun Lockers: 3 referrals Low for Gun Lockers: 3 referrals High for Medicine Cabinets: 30 referrals High for Medicine Cabinets: 30 referrals Ability to avoid stigma Promising Promising Raffle held for most gun lockers: many who signed up had youth with risk factors Raffle held for most gun lockers: many who signed up had youth with risk factors

Results Ability to enroll participants Ability to enroll participants 27 out of 29 gun lockers installed (no refusals) 19 out of 24 medicine cabinets installed (no refusals) Ability to reach target families Ability to reach target families 18 out of 27 (67%) of gun locker recipients had youth in home with risk factor for suicide 12 out of 19 (63%) of medicine cabinet recipients had youth in home with risk factor for suicide

Gun Locker and Medicine Cabinet recipients with selected risk factor

Number of Risk Factors per Gun Locker recipient 37% of gun locker recipients had youth in the home with more than one of the risk factors for suicide 37% of gun locker recipients had youth in the home with more than one of the risk factors for suicide 3 of the homes (11%) had 4 risk factors 3 of the homes (11%) had 4 risk factors

Results Measured current firearm and medicine storage practices Measured current firearm and medicine storage practices All firearms are stored in a locked place Yes:0 No: 26 Null: 1 All medicines are stored in a locked place Yes:1 No:18

Delivery

Installation

Discussion Referral program most successful for medicine cabinets Referral program most successful for medicine cabinets Community interest for gun lockers high Community interest for gun lockers high The larger the community, the better The larger the community, the better Local support essential Local support essential Future studies should measure safe storage practices Future studies should measure safe storage practices

Recognition First Responder Squad First Responder Squad Community Health Aides Community Health Aides Ryan Hill, ANTHC Ryan Hill, ANTHC ANTHC Injury Prevention Program ANTHC Injury Prevention ProgramQuestions?