1. 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

2. Rose’s Theorem
Goals:
Cause Dissonance
Spur Critical Thinking

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

4. 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):
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):
3. M. Miller, personal communication, July 2017.

5. 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 ). Heidelberg: Springer.

6. 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

7. VA Education Efforts: What We’ve Done
Universal
Downstream

8. Study Design: What We’ve Learned
Online survey to assess theoretical constructs related to lethal means safety conducted from 12/ /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)

9. Sample Characteristics (N=474)

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

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

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

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

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

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

16. 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

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

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

19. 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 ). Heidelberg: Springer.

20. 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?

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