Abstract Firearm-related violence is a major public health problem in the United States. Between 2019 and 2020, firearm- related homicide increased by nearly 35%, and 2021 saw the highest gun-related homicide rates since 1993. The effects of the pandemic have impacted the rates of violence, and we can expect to see these lasting effects for many years. Nationally, young adults (18-35 years old) are the most at risk to die from firearm-related violence. This is a risk that is not evenly shared among subpopulations of adults, with African American men being 20 times more likely to die from firearm-related homicide than Caucasian men. Further, once discharged from a hospital, violently injured adults are at an increased risk of violent re-injury and mortality, as well as 88 times more likely to engage in retaliatory violence. The hospital has become a critical location for violence prevention. Unfortunately, patients who are most at risk of retaliatory violence are often difficult to engage in intervention, which is why new and innovative strategies are needed to meet patients where their interests and needs are. The goal of the present proposal is to develop and evaluate a virtual reality (VR) violence intervention, Brief Violence Intervention VR (BVI-VR), to prevent incidents of firearm-related violence perpetration, re-injury, and mortality. BVI-VR provides patients with culturally relevant immersive stories and gameplay while providing them with psychoeducation and intervention to increase resiliency to retaliatory firearm-related violence across five steps: (1) emotion regulation and managing trauma, (2) conflict resolution and non-violent alternatives, (3) gun safety, (4) future goals and aspirations, and (5) community resource connection. This will be the first VR intervention targeting adult firearm-related violence, injury, and mortality. BVI-VR provides the connection between an immersive individual-level intervention and exposure/connection to community resources tailored to the patient’s local community. The present study addresses Funding Option B of this funding announcement, which supports research projects that collect new data and/or implement prevention activities. This study will conduct a randomized control trial including 220 violently injured adults to assess the effectiveness of BVI-VR for preventing firearm-related violence, injury, and mortality. The study also aims to identify risk and protective factors that are most malleable (mediators) to change in response to BVI-VR. Lastly, we will assess the economic efficiency of BVI-VR as a brief hospital-based gun violence prevention strategy. The results from this study may support the use of BVI-VR as a cost-effective strategy for preventing firearm-related violence, injury, and mortality among victims of violence.

Project Narrative With the rising rates of gun violence, there is an urgency to develop innovative interventions that can effectively engage high-risk adults to prevent future firearm-related violence, injury, and death. Violently injured adults (25- 44 years) are at the highest risk for future firearm-related violence, which is why hospitals have become vital locations for violence prevention initiatives. This project will develop an innovative hospital-based brief violence intervention using virtual reality and conduct a rigorous randomized control trial to evaluate its effectiveness for preventing retaliatory firearm-related violence, injury, and mortality among violently injured adults.