Promoting Equity in Firearm Safety and Suicide Prevention to Reduce Suicide in Black Youth

Suicide rates in Black youth are rising steeply, and evidence-based interventions that prioritize health equity are urgently needed. Our team has adapted an evidence-based safe firearm storage program, SAFE Firearm, as a universal suicide prevention strategy in pediatric primary care. We were just funded to conduct the ASPIRE trial to test strategies to implement SAFE Firearm. To promote equitable implementation, we must ensure that the ASPIRE trial does not exacerbate disparities and centers Black voices. First, in Aim 1, we will leverage our already funded trial to examine if implementation of SAFE Firearm differs across racial groups (Black and white) by evaluating parent-reported program receipt, primary care provider-reported program delivery, parent-reported firearm storage, and youth suicide attempts and deaths. We hypothesize that there will be a significant difference in the proportion of Black and white parent-youth dyads who receive SAFE Firearm, with Black dyads less likely to report receiving the program. Second, in Aim 2, we will examine ecological factors, such as patient- (e.g., area deprivation index) and provider-level (e.g.,  provider caseload size)  factors that may moderate disparities between race and outcomes, with the intention of understanding how structural racism may shape avoidable and unjust differences in care receipt. We hypothesize that moderation will be present within each ecological level for the outcomes of program receipt, program delivery, and firearm storage. Third, in Aim 3, we will obtain a deeper understanding of Black parents' experiences with SAFE Firearm and decision-making processes related to firearm storage. We will identify the equity determinants (e.g., patient-provider communication in the clinical encounter) that may impact the program's overall reach and effectiveness. This study will include data from 14 pediatric clinic and 100 pediatric clinicians at Henry Ford Health System (HFHS), one of two ASPIRE study trial sites. HFHS includes the Detroit metro area and serves over 1 million patients per year, 20% of whom are Black. We will include parents and/or legal guardians at participating pediatric clinics who have a child aged 5-17 who attends a well visit. We expect to include 2,466 Black and 9,866 white youth in our sample for Aim 1 and 2 analyses (N=12,332). We will invite approximately 24 Black and 10 white parents (N=34) to participate in in-depth interviews as part of Aim 3. Quantitative data will be extracted from the electronic health record and administrative records. SAFE Firearm is one immediate intervention for means restriction and suicide prevention that can save lives of young Black people. Our inquiry advances the field of suicide research by emphasizing structural factors that may be related to equity; increasing our understanding of Black families' unique experiences with pediatric primary care; and identifying partnerships for future research to enhance firearm safety promotion in pediatric primary care as a universal suicide prevention strategy. Our findings will inform scale up the evidence-based intervention, as well as potential adaptations needed to optimize its effectiveness in increasing secure firearm storage and preventing suicide in Black youth.