Efficacy of an App-Based Intervention on Shifting Attitudes Toward Gun Violence, Aggression, and Improving Mental Health Among Young Black Men: Pilot Intervention Study (Preprint)

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Abstract
BACKGROUND Pediatric and adolescent firearm injuries and fatalities have reached levels not seen since the mid-1990s, indicating a critical juncture in US public health. Young Black males, ages 15-24, represent the worst affected demographic, exhibiting a 24-fold higher probability of firearm-related fatalities compared to their White peers. This crisis is compounded by low engagement in firearm violence intervention programs among young Black males, emphasizing the urgent need for timely, culturally appropriate, and innovative interventions addressing the socioemotional, relational, and behavioral factors driving violence in this demographic. OBJECTIVE This pilot study aims to evaluate the efficacy of a novel app-based intervention (BrotherlyACT)—a nurse-led, culturally tailored, multicomponent smartphone application—to reduce the risk and effects of firearm injuries and homicides and to improve access to pre-crisis and mental health resources for young Black male individuals (aged 15-24 years) in low-resource and high-violence settings. METHODS Seventy young Black males with a SaFETy score between 1 and 5 (indicating low to moderate firearm violence risk) were enrolled in this prospective pretest/posttest study. The study assessed a psychoeducational intervention (seven video-based modules) via the BrotherlyACT app. Following consent, participants completed a 63-item survey battery pre- and post-intervention, evaluating Attitudes Towards Guns and Violence (AGVQTM), aggression (Reactive-Proactive Aggression Questionnaire), Psychological Distress (Kessler Psychological Distress Scale [K10]), and depression (Patient Health Questionnaire [PHQ-8]). Surveys were re-administered 4 weeks after the pretest. Outcome measures were reported as total and subscale scores. Paired-sample t-tests analyzed pre-post outcome changes. RESULTS 70 YBM enrolled (Mage = 21.21 ± 3.16 years, 10% Hispanic); 26.3% had some high school education. Nearly half (48.6%) worked part-time, with 66.4% reporting an annual household income of US $40,000-$59,999. Almost all participants (96.9%) finished the video modules in one session, and 67.7% did so within an hour. Statistically significant reductions in attitudes towards guns and violence were observed from pretest (M = 29.8) to posttest (M = 26.1), with a mean difference of 3.69 (p < .0001, Cohen’s d = 0.53). The ‘Aggressive Response to Shame’ subscale showed the highest reduction (↓28%), followed by ‘Excitement Towards Guns and Violence’ (↓14.8%). Reactive aggression scores significantly decreased from 10.48 to 8.67 (p = 0.003), while proactive aggression scores showed no significant reduction (p = 0.305). No significant changes were observed in depression, anxiety, or overall psychological distress. CONCLUSIONS BrotherlyACT demonstrated efficacy in reducing negative attitudes towards firearms and violence, and reactive aggression among young Black males. These findings indicate that this digital intervention has the potential to address both attitudinal and behavioral factors in a medium to high-risk population, presenting a unique opportunity for the primary prevention of firearm violence and associated risk factors for youth violence. CLINICALTRIAL Title Registration: ClinicalTrials.gov NCT06359990. IRRID: RR2-10.2196/43842 INTERNATIONAL REGISTERED REPORT RR2-10.2196/43842

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