Changing Perceptions of Risk Reduction Among First Responders: Outcomes of a Training Program in Louisiana.

Background: Existing opioid overdose reversal (OOR) trainings for first responders frequently demonstrate improvements in naloxone knowledge and overdose response competencies. While some programs have incorporated broader risk reduction and stigma-related content, these domains are less commonly evaluated directly, particularly using instruments designed for first responder populations. The ULM HERO program implemented a comprehensive risk reduction curriculum for Louisiana first responders and developed the Risk Reduction Attitude Scale (RRAS) to evaluate changes in risk reduction attitudes following training. Objective: To evaluate the impact of the ULM HERO program on first responders' risk reduction attitudes using the RRAS. Methods: This IRB-approved study (October 2023-March 2025) used a single-group pre-post design to evaluate 2-hour in-person risk reduction training for first responders. Participants completed pre- and post-training surveys including demographics and the 22-item Risk Reduction Attitude Scale (RRAS). The RRAS demonstrated acceptable reliability and validity using pre-training data. Pre-post changes were assessed using paired t-tests, effect sizes, and adjusted regression models examining occupation and parish differences statewide. Results: The sample included 861 Louisiana first responders, primarily law enforcement (80.8%), representing multiple parishes, most commonly Orleans/Jefferson (60.8%) and Ouachita (14.2%). Overall RRAS scores improved significantly post-training (mean increase 3.73 points; dᶻ = 0.65; p < .001). All occupation-parish subgroups demonstrated significant gains (1.99-7.20 points). The largest improvements and highest adjusted post-training scores occurred among non-law enforcement personnel in Ouachita Parish, indicating differential impact by occupational role and geographic context after accounting for baseline scores and participant demographics statewide. Conclusions: This study demonstrates that a risk reduction focused training program can meaningfully improve attitudes among first responders across multiple parishes in Louisiana. Importantly, improvements were observed across urban and non-urban parishes, including regions traditionally perceived as more conservative. These findings support the scalability of a risk reduction focused training as an effective strategy statewide.