摘要：Objectives. We determined if the installation of gun cabinets improved household firearm storage practices. Methods. We used a wait list, randomized trial design with 2 groups. The “early” group received the intervention at baseline, and the “late” group received it at 12 months. Up to 2 gun cabinets were installed in each enrolled home, along with safety messages. In-person surveys were conducted at 12 and 18 months to determine the proportion of households reporting unlocked guns or ammunition. Direct observations of unlocked guns were also compared. Results. At baseline, 93% of homes reported having at least 1 unlocked gun in the home, and 89% reported unlocked ammunition. At 12 months, 35% of homes in the early group reported unlocked guns compared with 89% in the late group ( P < .001). Thirty-six percent of the early homes reported unlocked ammunition compared with 84% of late homes ( P < .001). The prevalence of these storage practices was maintained at 18 months. Observations of unlocked guns decreased significantly (from 20% to 8%) between groups ( P < .03). Conclusions. Gun cabinet installation in rural Alaskan households improved the storage of guns and ammunition. If these gains are sustained over time, it may lead to a reduction in gun-related injuries and deaths in this population. Rates of suicide in Alaska are far higher than in the remainder of the United States and are even higher among Alaskan Native youths living in rural parts of Alaska. 1 Between 2000 and 2006, the rate of firearm-related suicide among Alaskan Native males aged 15 to 19 years was more than 4 times higher than that among Alaskan White males in the same age group and more than 10 times higher than that among US White male teens. 2 Existing evidence associates household firearm ownership with an increased risk of suicide, both among adults and adolescents. 3–9 As in many rural parts of the United States, firearm ownership in Alaska is highly prevalent and related to the frequent use of guns for subsistence hunting. 10 Storing household guns locked or unloaded has been associated with a reduced risk of child and adolescent firearm injuries that were related to suicidal behavior or unintentional injuries. 4,5,8,11,12 Furthermore, ample evidence exists that many children in the United States live in homes with accessible firearms. 13–15 Community-based programs that improve the safe storage of household guns represent one strategy to mitigate the injury risks associated with high rates of access to household firearms by youth. 16–18 An earlier pilot project by some members of this team tested the initial feasibility and acceptability of a community-based intervention to install gun cabinets in Alaskan Native households in a southwestern Alaskan village. The proportion of homes with any self-reported unlocked guns in the participating households decreased from 85% at baseline to 14% 3 months after cabinet installations. 19 To test the durability and generalizability of these findings among other rural Alaskan households, we conducted a randomized controlled trial with households in 6 villages. The aim of this trial was to determine if the installation of gun cabinets in rural Alaskan homes would lead to an improvement, compared with control homes without cabinets, in household firearm storage practices at 12 and 18 months after installation.
