PROJECT SUMMARY: Suicide is the second leading cause of death among adolescents in the United States.16 The National Strategy for Suicide Prevention calls for the development of community preventive services that will reduce the risk for suicidal behaviors.1 Yet there is a substantial gap in our knowledge of community level variables associated with suicide risk.2 A critical next step toward developing community suicide prevention approaches is the identification of modifiable target mechanisms for use in public health interventions. Our objective in this proposal is to identify modifiable candidate mechanisms associated with suicide risk at the neighborhood level. Our team has proposed and examined a statistical method for identifying localized areas with elevated rates of suicidal ideation and attempts within the community, the Geospatial Identification of Elevated Suicide Risk (GIESR) method. The GIESR method capitalizes on routine suicide risk screening conducted within the healthcare settings. GIESR draws on electronic health records data to map the prevalence of suicide ideation and attempts within a defined geographic catchment area. Further evaluation of the GIESR model, to replicate and extend this methodological approach, will support the identification of neighborhood level risk and protective factors for youth suicidal ideation and attempts. The project has two primary aims: Aim 1 will replicate and extend the GIESR method to evaluate its psychometric properties, and to create an implementation guide, so that the GIESR method can be independently replicated and used by others for the development of community-based suicide prevention programs. The GIESR method will be examined using data from Texas Children’s Hospital and mapping youth suicide risk within the greater Houston metropolitan area. In Aim 2, we will apply the GIESR method to identify risk and protective factors associated with rates of youth suicide ideation and attempts at the neighborhood level. Aim 2 includes the merging of multiple public health focused data sets, including socioeconomic, firearm licensing, crime, and safety data, along with data generated by the GIESR method, to allow the identification of salient risk and protective factors for suicide at the community level. This proposal advances the goals of the NIMH Strategic Plan, Goal 4, Strategy 4.1, to utilize “electronic health records… to identify mutable targets for improving service access, delivery, and outcomes” and to promote data-driven approaches to identify novel targets for preventive interventions.15 Findings will inform use of the GIESR method to identify areas of elevated risk in other communities and will inform the development of community-based suicide prevention efforts targeting identified risk and protective factors.