SAFER Study: Multilevel Risks and Resilience-Promotive Factors of Firearm Injury

Elevated exposure to violence undermines safety and health and, in turn, is a risk factor for firearm carriage, mental distress, and substance use, which are the most consistent predictors of firearm injury and death. In addition, contextual stressors may further contribute to mental distress, substance use, and other risky firearm behaviors (e.g., storing guns unloaded and unlocked). Based on the socio-ecological framework, Resilience Theory, and emerging evidence in firearm injury prevention research, this project seeks to understand these links through assessment of multi-level risk and protective factors and the use of a strength-based approach. Utilizing mixed methods, including focus groups, longitudinal surveys, and data from Geographic Information Systems, we will build on extant firearm injury prevention research to investigate the links between violence exposure and firearm injury risks, and the moderating effects of contextual stressors and promotive factors. Project goals are: 1) Use focus groups to understand contextual stressors and resilience- promotive factors of firearm injury risks and inform survey instrument development; 2) Conduct three waves of annual, longitudinal surveys with a sample of 1000 adults who reside in the United States to examine the mechanisms by which exposure to violence increases firearm injury risk through increased substance use, mental distress, and firearm behavior; 3) Identify distinct profiles with selected contextual stressors operating at the neighborhood-level that are influential and examine their associations with firearm injury risk; and 4) Examine whether cumulative promotive factors mitigate the risks from person-level and contextual stressors. The expected outcomes of the project will include advancing knowledge of contextual and behavioral factors associated with firearm injury risk and identifying modifiable protective factors. Findings will provide a solid basis to inform evidence-based interventions that prevent firearm injury risks.