Safe storage safe kids: Be SMART counseling in the inpatient setting: Protocol for a multicenter randomized controlled trial

BACKGROUND: Firearm injuries are the leading cause of death for American youth. Safe storage counseling in clinical settings offers a potential opportunity for preventive intervention. We present the protocol for a multicenter, randomized controlled trial evaluating the effectiveness of a multicomponent intervention consisting of Be SMART firearm storage videos, printed materials, and a cable firearm lock delivered in the inpatient setting to guardians of hospitalized children. METHODS: Guardians of hospitalized children at two pediatric medical centers are randomized 1:1 to receive either Be SMART firearm storage counseling videos, printed firearm safety materials, and a cable firearm lock or receive medication storage videos and printed medication storage materials as the control arm. The planned sample size is 400 participants (200 per arm), providing 80% power to detect a clinically meaningful between-group difference in secure firearm storage among firearm-owning guardians at 1-month follow-up. The co-primary outcomes are adoption of secure firearm storage among firearm-owning guardians and firearm safety-related asking behavior among all participants at 1-month post-discharge. Exploratory analyses will evaluate firearm safety knowledge and beliefs, any adoption of firearm locking behavior, and the durability of intervention effects at 3 months. DISCUSSION: We aim to evaluate the effectiveness of a multicomponent firearm storage intervention on firearm storage practice among guardians of hospitalized children in the inpatient setting. If the intervention demonstrates effectiveness, findings may support integration of firearm safety counseling into routine inpatient care to reduce preventable firearm injuries in youth.