Article: Silver AH, Azzarone G, et al. A Randomized Controlled Trial for Parents of Hospitalized Children: Keeping Kids Safe From Guns. Hosp Pediatr. 2021 Jul;11(7):691-702. doi: 10.1542/hpeds.2020-001214.
Fellow: Kelsey Gastineau, MD, Vanderbilt University Medical Center, Nashville, TN
Summary: : Silver et al conducted a single-center randomized controlled, 3-arm preintervention and postintervention study investigating the effect of a firearm injury prevention educational intervention utilizing the BeSMART video and written material on caregiver firearm-related behaviors, beliefs, and knowledge. BeSMART is an apolitical, nonpartisan, adult-focused firearm safety campaign designed to reduce and prevent pediatric firearm injuries and deaths(1). A total of 225 participants were enrolled with 76 participants allocated to BeSMART education, 75 participants allocated to BeSMART + physician review, and 74 participants allocated to control (tobacco smoke videos and handouts); all participants received the same verbally administered survey. For the primary outcome regarding the frequency of asking about guns in others’ homes, there was a significant increase between preintervention and 1-month postintervention mean Likert score within each of the 3 study groups, but no significant difference was found between groups (BeSMART: 1.5 to 2.3, P = .04; BeSMART + physician review: 1.4 to 1.9, P = .03; control: 1.4 to 2.3, P = .01; between group P= .81). Post-intervention, they found a significant difference between the 3 groups in parent-reported likelihood of asking about guns in other’s homes before visiting (P < .001) and an increase in firearm safety knowledge in the intervention groups.
Limitations/Flaws: The survey was administered verbally, and the study was not blinded due to the viewable educational intervention which may have contributed to social desirability bias and the Hawthorne effect altering parental responses. The study utilized a convenience sample which may alter the sample’s representativeness of the population; however, this was unlikely to have a significant impact on study outcomes. The findings may not be generalizable to other regions and settings as it was a single-center study and the variation in local gun culture, beliefs, and behaviors.
Takeaway Message: The BeSMART firearm injury prevention education delivered in a hospital setting is feasible, well-received, and increases caregiver knowledge regarding firearm safety.
Practice Impact: Firearm injuries are the leading cause of death for American youth and as hospitalists, we have a unique opportunity to make a positive impact by reducing those at risk. An encounter with a hospitalized child provides an opportunity to provide potentially life-saving counseling on firearm injury prevention when they may otherwise have not received it in the outpatient setting. While the BeSMART education was feasible and well-received, further studies are needed to examine these findings in geographic and culturally diverse locations and with longer follow up.
(1)https://besmartforkids.org
Fellow: Kelsey Gastineau, MD, Vanderbilt University Medical Center, Nashville, TN
Summary: : Silver et al conducted a single-center randomized controlled, 3-arm preintervention and postintervention study investigating the effect of a firearm injury prevention educational intervention utilizing the BeSMART video and written material on caregiver firearm-related behaviors, beliefs, and knowledge. BeSMART is an apolitical, nonpartisan, adult-focused firearm safety campaign designed to reduce and prevent pediatric firearm injuries and deaths(1). A total of 225 participants were enrolled with 76 participants allocated to BeSMART education, 75 participants allocated to BeSMART + physician review, and 74 participants allocated to control (tobacco smoke videos and handouts); all participants received the same verbally administered survey. For the primary outcome regarding the frequency of asking about guns in others’ homes, there was a significant increase between preintervention and 1-month postintervention mean Likert score within each of the 3 study groups, but no significant difference was found between groups (BeSMART: 1.5 to 2.3, P = .04; BeSMART + physician review: 1.4 to 1.9, P = .03; control: 1.4 to 2.3, P = .01; between group P= .81). Post-intervention, they found a significant difference between the 3 groups in parent-reported likelihood of asking about guns in other’s homes before visiting (P < .001) and an increase in firearm safety knowledge in the intervention groups.
Limitations/Flaws: The survey was administered verbally, and the study was not blinded due to the viewable educational intervention which may have contributed to social desirability bias and the Hawthorne effect altering parental responses. The study utilized a convenience sample which may alter the sample’s representativeness of the population; however, this was unlikely to have a significant impact on study outcomes. The findings may not be generalizable to other regions and settings as it was a single-center study and the variation in local gun culture, beliefs, and behaviors.
Takeaway Message: The BeSMART firearm injury prevention education delivered in a hospital setting is feasible, well-received, and increases caregiver knowledge regarding firearm safety.
Practice Impact: Firearm injuries are the leading cause of death for American youth and as hospitalists, we have a unique opportunity to make a positive impact by reducing those at risk. An encounter with a hospitalized child provides an opportunity to provide potentially life-saving counseling on firearm injury prevention when they may otherwise have not received it in the outpatient setting. While the BeSMART education was feasible and well-received, further studies are needed to examine these findings in geographic and culturally diverse locations and with longer follow up.
(1)https://besmartforkids.org