Sara Warfield, Cara Mangine & Robert Bossarte, PhD

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Presentation transcript:

Sara Warfield, Cara Mangine & Robert Bossarte, PhD Designing public messaging to promote the safe storage of lethal means to Veterans Elizabeth Karras, PhD Sara Warfield, Cara Mangine & Robert Bossarte, PhD

Rose’s Theorem Goals: Cause Dissonance Spur Critical Thinking

All Veteran suicide deaths by mechanism & gender, 2001 & 2014 VA. (2016). Suicide among Veterans other Americans 2001-2014. Washington, DC.

Background: What We Know Known Risk Factor. Robust empirical link between availability of firearms and suicide risk1 Firearm owners are not inherently more suicidal2 Lethal. High case fatality rate for firearm suicides (80-90%)2 Accessible. Almost half of Veterans own firearm.3 Experts. Veterans are extensively trained in firearm handling and safety. 1. Wiebe DJ. Homicide and suicide risks associated with firearms in the home: a national case-control study. Ann Emerg Med. 06/ 2003;41(6):771-782. 2. Miller M, Azrael D, Hemenway D. The epidemiology of case fatality rates for suicide in the northeast. Ann Emerg Med. 06/ 2004;43(6):723-730. 3. M. Miller, personal communication, July 2017.

Conceptual Framework: What Drives Behavior Ajzen. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl & J. Beckman (Eds.), Action-control: From cognition to behavior (pp. 11-39). Heidelberg: Springer.

Hypotheses: What We Logically Assume H1: Veterans need reminders of risk associated with access to firearms H2: Veterans need us to define and reinforce safe storage practices to them H3: We need to talk to Veterans about their firearms

VA Education Efforts: What We’ve Done Universal Downstream

Study Design: What We’ve Learned Online survey to assess theoretical constructs related to lethal means safety conducted from 12/2015-01/2016 Implemented by GfK KnowledgePanel (large-scale online panel based on a representative sample of US population) National random sample of Veterans w/ broad inclusion criteria (18+ non-institutionalized Veterans living in U.S.) Self-Reported measures of (1) demographics; (2) injury beliefs and attitudes towards safety practices; (3) perceptions of safe storage practices; (4) safe storage practices Descriptive statistics and bivariate analyses reported (SAS 9.4) Data weighted following benchmark distributions of the adult U.S. Veteran population from the August 2014 Current Population Survey (CPS)

Sample Characteristics (N=474)

H1: Veterans Need Reminders of Risk Less than 1% missing; not reported

H1: Veterans Need Reminders of Risk 2% (n=10) refused to answer gun access Q; Less than 1% missing; not reported

H1: Veterans Need Reminders of Risk ** ** ** FIREARM ACCESS P-VALUE Less than 1% missing; not reported

H1: Veterans Need Reminders of Risk 2% (n=10) refused to answer gun access Q; Less than 1% missing; not reported

H1: Veterans Need Reminders of Risk 2% (n=10) refused to answer gun access Q; Less than 1% missing; not reported

H2: Veterans Need Safe Storage Reinforcement ** ** FIREARM ACCESS P-VALUE Less than 1% missing; not reported

H2: Veterans Need Safe Storage Reinforcement 63% stored ammunition separately Miller, et al. research CDC BRFSS, 2004 2% (n=10) refused to answer gun access Q; Less than 1% missing; not reported

H3: Talk to Veterans about their firearms Less than 1% missing; not reported

H3: Talk to Veterans about their firearms 2% (n=10) refused to answer gun access Q; Less than 1% missing; not reported

Conceptual Framework: What Drives Behavior Ajzen. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl & J. Beckman (Eds.), Action-control: From cognition to behavior (pp. 11-39). Heidelberg: Springer.

Next Steps: Where Do We Go? What are our (realistic) expectations with such interventions? Intervention effect sizes? Among Who? Are we effectively decreasing risk for unintentional injury? Suicide among household members vs. veteran? Adverse effects? Are we headed in the right direction with our strategies? Bending the curve? Address the right determinants, risk factors and behaviors to effectively reduce suicides? What can we integrate or consider moving forward? Veteran perspective .. “Let Veterans take the lead vs. solely target them” What is the best message and who are the most effective messengers? How do we message to those under duress or proximal to crises?

Contact Information Elizabeth Karras, PhD Health Communication Program Director Center of Excellence for Suicide Prevention Department of Veterans Affairs (VHA) Elizabeth.Karras@va.gov