PROJECT SUMMARY/ABSTRACT: Firearm injuries are the single leading cause of death among adolescents and young adults (“youth”) in the US. Risk for firearm-related suicide, homicide, and other injuries rises during adolescence and into young adulthood, as do rates of drug and alcohol use. Substance use increases the risk of firearm injuries, and identifying and addressing substance use may be a critical strategy for preventing firearm-related morbidity and mortality. Youth at risk for firearm injuries commonly present to healthcare settings, where evidence-based interventions can be delivered to address substance use and prevent future injuries. However, clinicians, health systems, and policymakers need clear data on the optimal location and timing for such interventions. Additionally, owing to longstanding systemic inequities, youth of color experience disproportionately elevated firearm injury rates and substance involvement, and studies to reduce firearm morbidity and mortality must have a clear focus on health equity. The central objective of this project is to provide a comprehensive, national picture of the links between substance use, firearm injuries, and reinjury in a sample of 42 million Medicaid- enrolled youth aged 13-25 from across the US during 2016-2020, and throughout, to detail opportunities to reduce disparities by race and ethnicity. The Specific Aims are to: (1) Identify substance use-related visits in youth prior to a firearm injury, with a focus on the location and timing of such visits; and (2) Determine the extent to which substance use is associated with risk for reinjury after an incident firearm injury. The project will be guided by a diverse Youth and Family Advisory Board to inform protocol development, analysis, interpretation, and dissemination of findings, with a goal of maximizing relevance and delivery of results to youth, families, and key stakeholders across the US. Using the research project as an opportunity for mentored experience, this K18 Career Enhancement Award will support the PI, Dr. Scott Hadland, an expert in youth substance use, to develop new knowledge and skills in the field of firearm injury prevention. Specifically, he will acquire foundational knowledge in firearm injury epidemiology and policy, and skills in building and partnering with an advisory board of individuals with lived experience. The project is supported by an interdisciplinary mentorship team with expertise across these topics, as well as in racial and ethnic disparities, and linkage and analysis of large datasets. The variables and associations identified in this study will serve as critical inputs to future, independently conducted research of the PI, including machine-learning models, decision analysis, and electronic health record-based interventions.

PROJECT NARRATIVE: Risk for substance use and firearm injuries increases rapidly during adolescence and into young adulthood, and intervening in substance use could prevent morbidity and mortality from firearms. This project will identify links between substance use and firearm injury/reinjury in Medicaid-enrolled youth from across the US. By pursuing a career enhancement plan and completing the proposed project, the Principal Investigator, an established clinician-scientist with expertise in youth substance use, will acquire the knowledge and skills to become a firearm researcher.