Efficacy of Technology-Augmented Behavioral Counseling for Risky Firearm Behaviors: A Randomized Clinical Trial.
Patrick M Carter, Ken Resnicow, Philip Stallworth et al.
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In 30 seconds
This two-arm randomized clinical trial tested IntERact, a 30-day program combining telehealth behavioral counseling and tailored smartphone content, against enhanced usual care among 373 emergency department patients aged 16 to 30 years who reported recent firearm carriage. At 6 months, risky firearm behaviors declined more with IntERact than with enhanced usual care (-57.4% vs -25.4%; rate ratio, 0.51; 95% CI, 0.33-0.79). The intervention group also had a greater reduction in experiencing physical violence at 3 months. Several exploratory violence, criminal justice, substance use, and mental health outcomes favored IntERact, though the authors characterize the intervention as showing promise.
Key findings
- At 6 months, risky firearm behaviors declined by -57.4% with IntERact and -25.4% with enhanced usual care (rate ratio, 0.51; 95% CI, 0.33-0.79).
- At 3 months, IntERact was associated with a greater reduction in experiencing physical violence than enhanced usual care (rate ratio, 0.46; 95% CI, 0.26-0.81).
- Exploratory comparisons favored IntERact for violent injuries, violence consequences, substance use, anxiety, depression, delinquency, violent offending, and firearm violence at specified follow-ups.
Why it matters
Emergency department visits may provide an opportunity to address firearm-related risk among young people who report carrying firearms. This trial suggests that counseling supported by tailored digital content can reduce self-reported risky firearm behaviors and may also affect related violence and health outcomes. The findings broaden the outcomes relevant to prevention, while requiring interpretation in light of the study population and exploratory results.
What to keep in mind
Participants were recruited from two trauma center emergency departments in Michigan and had to report recent firearm carriage and smartphone ownership, limiting generalizability. Several favorable secondary outcomes were exploratory.