3082.0 - Outcomes of a national randomized controlled trial of the “Guardians 4 Health” bystander intervention curriculum for 4-H Shooting Sports-involved youth
Program: Injury Control and Emergency Health Services
Session: Special Topics in Firearm Injury Prevention Posters
Authors: Adrianne Katrina Nelson, Megan L. Ranney
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Abstract
Background
Firearm injury is the leading cause of death for American youth ages 1-17, yet few interventions have been co-created with gun-owning communities. Bystander interventions that teach youth to identify risky situations and respond safely to prevent injury are well-suited for youth that have contact with firearms; and have shown to be effective in preventing youth violence in other settings. In partnership with 4-H Shooting Sports (4HSS) leadership, we developed and tested a novel firearm injury prevention (FIP) bystander intervention, “Guardians 4 Health” (G4H), for delivery to youth ages 12-18. The primary outcome objective of this study was to measure the impact of the G4H intervention on intention to use bystander intervention strategies.
Methods: We conducted a cluster-randomized Type 1 Hybrid Effectiveness-Implementation trial, stratified at randomization by rurality and state Child Access Prevention (CAP) laws, consenting 4HSS sites, parents, and youth. With confirmed construct validity, we aggregated two items measuring bystander intervention intention across five hypothetical scenarios to create one continuous outcome variable assessed at 0, 3- and 6-months. Using intention-to-treat approach, we applied linear mixed models adjusting for baseline outcomes, then performed multilevel multiple imputation accounting for the potential within-site correlation in missingness, with covariate adjustment on baseline outcomes and sociodemographic backgrounds. Finally, we conducted subgroup analyses for select sociodemographic groups.
Results
Fifty 4HSS sites from 28 states were randomized to intervention (M = 26 sites; N = 250 youths) or control (M = 24 sites; N = 174 youths). Most youth were aged 12-14 (54.7%), male (53.3%), and White (68.2%). Most caregivers had at least some college education (68.3%), were married (73.0%), and employed (56.4%). Compared to control youth, G4H youth had more participants aged 12–14 years (61.9% vs. 47.9%, p = 0.007). Racial composition varied (p = 0.022), with the intervention group having a higher proportion of White participants (p=0.02). At 3 months, bystander intervention intention was higher in G4H than in control youth (β = 0.13, 95% CI: [0.03, 0.24]) but not significant at 6 months (β = 0.10, 95% CI: [-0.02, 0.22]). At 3 months, younger participants (12–14 years) showed a stronger intervention effect than older adolescents, and responses were stronger among those whose parents had lower education (high school), were unemployed, non-veterans, and unmarried.
Conclusions
To our knowledge, this is the first national trial focused on FIP occurring through partnership between a shooting sports organization and public health researchers, and the first to use bystander intervention for FIP in youth. At 3 months post-intervention, we observed a positive effect on behavioral intention, a strong predictor of behavior. These findings provide initial support for the value of the G4H intervention within 4HSS, with continued evaluation in larger samples and other settings warranted.