Abstract Firearm-related violence is a major public health problem in the United States. In 2020, over 40,000 people died from firearm-related violence. Beyond the significant and devastating cost of human life, firearm-related violence is an enormous economic burden to the US costing tens of billions of dollars every year. The rates of violence have risen during the pandemic, and youth have been hit hard by the rise in violence. Homicide is the leading cause of death for African American young males (10-19 years; CDC, 2019), and 7 out of 10 people treated in the hospital for firearm-related injuries were victims of assault. Once discharged from the hospital, victims of violence are 88 times more likely to violently retaliate and 40% will be reinjured within five years, thus, perpetuating the cycle of violence. Therefore, hospitals have become a critical resource to prevent retaliatory firearm violence in high-risk youth. However, high-risk youth are often difficult to engage in intervention, which is why new and innovative strategies are needed to meet youth where their interests are. The goal of the present proposal is to expand the development of a promising virtual reality (VR) violence prevention program, Elevate VR, to prevent incidents of firearm-related violence perpetration and victimization among youth. Elevate VR is a brief hospital-based violence intervention that engages violently injured youth in culturally relevant immersive stories and gameplay, all while teaching youth psychoeducational skills (i.e., positive youth development, online and in-person de-escalation training, emotion regulation skill building, trauma management, gun safety awareness, etc.). Elevate VR provides the connection between an immersive individual-level intervention and exposure to community resources tailored to the youths’ local community. This study will conduct a randomized control trial including 360 violently injured youth and their caregivers (N=720) to assess the effectiveness of Elevate VR for preventing firearm-related violence, injury, and mortality in high-risk violently injured youth. The study also aims to identify risk and protective factors that are most malleable (mediators) to change in response to Elevate VR. This knowledge is critical for improving the intervention by more efficiently targeting risk and protective factors. Lastly, we aim to assess the economic efficiency of Elevate VR as a brief hospital-based firearm-related violence prevention strategy. The results from this study may support the use of Elevate VR as a cost-effective strategy for preventing firearm-related violence, injury, and mortality among youth victims of violence.

Project Narrative With the rising rates of firearm-related violence among youth, there is an urgency to develop innovative interventions that effectively engage youth to prevent future firearm-related violence, injury, and death. Violently injured youth are particularly high-risk for future firearm-related violence, which is why hospitals have become a vital location for violence prevention initiatives. This project will develop an innovative and brief hospital-based virtual reality violence intervention and conduct a rigorous randomized control trial to evaluate its effectiveness for preventing retaliatory firearm-related violence, injury, and mortality among violently injured youth.