The National Institutes of Health (NIH) has awarded $3.3 million over five years to Northwestern University to study the implementation of an evidence-based secure firearm storage program. The study will focus on community health centers, which serve individuals who have limited access to healthcare and those who often experience health inequities. Parents at these health centers will receive counseling around secure firearm storage and free cable locks.

The ultimate goal of implementing this program is to reduce firearm injury and mortality, which is the leading cause of death among youth in the U.S. From 2013 to 2020, firearms contributed to a staggering cumulative loss of 1.3 million years of life for young people. Secure firearm storage programs have several known benefits. They are low-cost, scalable, non-politically divisive and, most importantly, can reduce firearm injury and mortality.

“Health centers serve our highest-need populations,” said principal investigator Rinad Beidas, PhD, chair and the Ralph Seal Paffenbarger professor of Medical Social Sciences. “Our team will collaborate with key constituents to best understand how clinicians can engage parents around secure firearm storage in a way that recognizes their lived experiences. For example, how to securely store firearms in the event of insecure housing, or in the face of extreme community violence.”

‘Partnering with powerhouses in Illinois’

In the study, Northwestern scientists will partner with AllianceChicago, a nonprofit dedicated to community healthcare, focusing on care delivery transformation, technology, data and analytics, and research and evaluation, and the Illinois Primary Health Care Association (IPHCA), the statewide association for community health centers in Illinois that serve all patients — regardless of their income, insurance or immigration status — and provide a trusted medical home for 1.5 million Illinois residents. Together, the teams will deliver an adapted version of S.A.F.E. (Suicide and Accident prevention through Family Education) Firearm, an evidence-based program that includes brief counseling about secure firearm storage between a clinician and parent and free cable locks, which will provided by the Illinois Department of Public Health (IDPH) through its lock distribution program.

The Northwestern team and other external partners recently implemented the S.A.F.E. Firearm program with promising results. As part of the largest trial of its kind, researchers identified the most effective way to implement this program in more than 47,500 well-child visits in two health systems in Michigan and Colorado (findings will soon be published). With this new funding, the teams will adapt and optimize the program for 55 community health centers throughout Illinois, which have a mandate to serve all patients.

“We showed this program could be implemented in well-resourced, large health systems that use the same electronic health record system,” Beidas said. “Now we’re trying to move the spotlight to Illinois, where we’re going to partner with powerhouses in this area to bring this life-saving program to health centers that serve one in nine people in the state.”

AllianceChicago will lead data collection from the health centers and conduct follow-up surveys with parents to see if they received the program during their well-child visit and if parents change behavior in how they store their firearms, a key measure of success for the trial.

“Our community health centers can and should be on the front line to prevent gun violence,” said Fred Rachman, chief executive officer of AllianceChicago. “We are excited to be partnering in this highly important initiative.”

Understanding how parents can secure firearms given their constraints

Many patients served by health centers face multiple stressors including poverty and community violence, so the teams will adapt the program to fit their needs and constraints, Beidas said.

The study will enroll community health centers across the state of Illinois. As the state association that advocates for the more than 430 health center sites across Illinois, IPHCA will oversee the implementation of the secure firearm program for the study.

“This program addresses firearm violence, which the Surgeon General declared a public health crisis, head on,” said Ollie Idowu, president and chief executive officer at IPHCA. “Our 55 member organizations, who are all deeply embedded in the communities they serve, are instrumental in addressing health disparities and providing comprehensive care to underserved populations. Being part of this impactful program is an honor, and we feel confident we can make a difference across the state.”

Since IPHCA already helps these clinics implement other new programs and policies, and IDPH has a free cable-lock program for communities in Illinois, Beidas concludes that if this trial is successful, it will be possible for the work to continue after the five-year NIH funding ends, thus saving lives in a sustainable manner.

“Firearm violence is a public health crisis that needs new, innovative solutions,” said IDPH director Sameer Vohra. “IDPH is proud to partner with Northwestern University and its collaborators on this important NIH-funded study. IDPH is pleased with the initial success of our gun lock program, and the findings of this research will be critical as public health and healthcare systems implement and grow evidence-based secure firearm storage programs.”

This research was supported by the National Institute of Nursing Research of the National Institutes of Health under award number R01NR021291.