Rhode Island Domestic Violence Shelter Policies, Practices, and Experiences Pertaining to Survivors With Opioid Use Disorder: Results of a Qualitative Study

The purpose of this study was to fill a gap in the existing research by exploring policies and practices of domestic violence shelters in one US state pertaining to clients with opioid use disorders (OUDs), as well as documenting some of their experiences providing services to those clients. We used semi-structured key informant interviews to gather information about Rhode Island shelter practices and policies pertaining to OUD-relevant topics and make meaning of shelter workers' experiences with clients with OUDs. One researcher conducted all 30-min, telephone interviews. Qualitative data were analyzed using a content-based analysis approach. The open-ended interview questions yielded information that clustered in the following three main themes: (1) existing shelter policies and practices; (2) staff training on OUDs; and (3) ideas for improvement. Intimate partner violence (IPV) service providers reported that OUD is an issue that affects their clientele, creates problems for both IPV survivors and for staff who are helping them heal from IPV, and causes concerns about the safety of children and other shelter residents who may be housed with individuals with OUDs. Participants reported a range of policies and practices related to how IPV survivors with OUDs are served by their programs. They also offered multiple possible improvements that could be made to IPV survivor programming. Among their suggestions were the establishment of long-term housing, hiring substance use disorder specialists to work in IPV shelters, and improving interagency relationships between IPV programs, child protection services, and substance use disorder treatment providers. Some close-ended interview questions permitted calculations about the percentage of programs that had particular policies in place. For example, of the six programs, 50% (n = 3) reported that they keep naloxone on site. Only one of the six programs (18%) reported that they have a protocol for disposing of unused opioids, medications for OUD, or drug paraphernalia if it is found at the shelter. Additional data about the prevalence of OUDs among the IPV shelter population is needed, as are in-depth analyses of barriers and facilitators to OUD treatment for IPV survivors.

Association Between Health Literacy and Parental Self-Efficacy among Parents of Newborn Children

OBJECTIVE

To determine whether health literacy was associated with parental self-efficacy in a diverse sample of parents of newborns. We hypothesized that parents with lower health literacy would have lower parental self-efficacy.

STUDY DESIGN

We conducted a cross-sectional analysis of baseline surveys from 253 English and Spanish speaking parents >18 years old with newborns <28 days old enrolled in a trial testing a multisite primary care-based parenting intervention. Surveys assessed parental, child, and environmental characteristics, and used validated instruments to measure health literacy and parental self-efficacy (total and 4 subtypes). Bivariate analyses identified parental, child, and environmental characteristics associated with parental self-efficacy. Multivariable linear regression models examined the associations between health literacy and parental self-efficacy, adjusting for covariates.

RESULTS

Parents (median age, 29 years) were 92.1% female, 54.5% black/African American, and 29.6% Hispanic/Latino. More than one-half (58.9%) had completed some college education or more, 49.0% spoke mostly English, and 16.2% had low health literacy. In bivariate analyses, parental self-efficacy was significantly lower in parents with fewer household residents. In multivariable analyses, parents with low compared with high health literacy had significantly lower parental self-efficacy scores (total and 4 subtypes including caretaking procedures, evoking behaviors, reading behaviors and signaling, and situational beliefs).

CONCLUSIONS

Lower health literacy was associated with lower parental self-efficacy in parents of newborns. To maximize impact on positive parenting behaviors and child outcomes, interventions assisting parents with low parental self-efficacy should consider strategies to address low health literacy.

The escalation dating abuse workshop for college students: Results of an efficacy RCT

OBJECTIVE

Assess the efficacy of a college dating abuse (DA) prevention workshop.

PARTICIPANTS

85 students from Greek organizations.

METHODS

Two fraternities and two sororities were randomized to intervention or waitlist control. Participants completed a baseline and 3-month follow-up survey. Data were analyzed using MANOVA.

RESULTS

As compared to those in the control group, students assigned to the DA workshop felt more prepared to act as bystanders at follow-up and were more convinced that DA was a problem on campus. Those who saw the workshop also recognized more opportunities when they could intervene as bystanders with friends and strangers at follow-up than did controls.

CONCLUSIONS

The DA workshop appears to have influenced students in the desired way, although not substantially. It is likely that a longer follow-up period and larger sample would reveal more meaningful changes from pre- to post-test.

Alcohol, Marijuana, and Dating Abuse Perpetration by Young Adults: Results of a Daily Call Study

The purpose of this study was to investigate same-day alcohol or marijuana use and dating abuse (DA) perpetration in a sample of 60 noncollege-attending young adults. Participants reported daily data for 3 months. DA perpetration was more likely on days when participants also reported alcohol use (odds ratio [OR] = 2.17, 95% confidence interval [CI] = [1.38, 3.42]), but analyses of the temporal order indicated that alcohol use was not a proximal predictor of DA. Same day marijuana use was not associated with elevated risk of DA perpetration (OR = 1.40, 95% CI = [0.89, 2.21]). Results suggest the alcohol–DA relationship may vary by sample and context.

The Role of Racial Residential Segregation in Black-White Disparities in Firearm Homicide at the State Level in the United States, 1991-2015

OBJECTIVE

To investigate the relationship between racial residential segregation and differences in Black-White disparities in overall firearm homicides across U.S states.

METHODS

Using a linear regression, we evaluated the relationship between racial residential segregation, as measured by the index of dissimilarity, and the Black-White firearm homicide disparity ratio in 32 states over the period 1991-2015. To account for clustering of observations within states, we used a generalized estimating equations approach.

RESULTS

After controlling for measures of White and Black deprivation, multivariate analysis showed that racial segregation was positively associated with the Black-White firearm homicide disparity. For each 10-point increase in the index of dissimilarity, the ratio of Black to White firearm homicide rates in a state increased by 39%. After controlling for levels of White and Black deprivation, racial segregation remained negatively associated with White firearm homicide rates and positively associated with Black firearm homicide rates.

CONCLUSIONS

These findings suggest that racial segregation may increase the disparity in firearm homicide between the Black and White population.

Ethical and Practical Considerations for Collecting Research-Related Data from Commercially Sexually Exploited Children

This article presents seven challenges of collecting primary (i.e., firsthand) data from commercially sexually exploited children (CSEC). We drew on our research team's experience collecting longitudinal data from 28 CSEC survivors with a 12-month follow-up period. We used both face-to-face and electronic group brainstorming methods to nominate a list of research-related challenges. The two main themes that were identified were challenges that can limit data quality and concerns about the impact of research on participants, researchers, and others. The three challenges related to data quality are (1) the age of the research participants; (2) questions about obtaining informed consent from parents or guardians; and (3) the over-interrogation of CSEC youth. The four challenges related to concerns about the impact of research were (4) concerns that research participation may further exploit youth; (5) staying in the role of researcher and refraining from providing advocacy; (6) secondary trauma and burnout experienced by research staff; and (7) the additional burden that research and data collection may place on the advocates and direct service providers. Because the process of collecting data from CSEC youth can be complicated, and rife with ethical and practical challenges, we have relayed our experiences with seven specific research-related challenges in order to stimulate discourse and further progress in the field.

State Intimate Partner Violence-Related Firearm Laws and Intimate Partner Homicide Rates in the United States, 1991 to 2015

BACKGROUND

To prevent intimate partner homicide (IPH), some states have adopted laws restricting firearm possession by intimate partner violence (IPV) offenders. "Possession" laws prohibit the possession of firearms by these offenders. "Relinquishment" laws prohibit firearm possession and also explicitly require offenders to surrender their firearms. Few studies have assessed the effect of these policies.

OBJECTIVE

To study the association between state IPV-related firearm laws and IPH rates over a 25-year period (1991 to 2015).

DESIGN

Panel study.

SETTING

United States, 1991 to 2015.

PARTICIPANTS

Homicides committed by intimate partners, as identified in the Federal Bureau of Investigation's Uniform Crime Reports, Supplementary Homicide Reports.

MEASUREMENTS

IPV-related firearm laws (predictor) and annual, state-specific, total, and firearm-related IPH rates (outcome).

RESULTS

State laws that prohibit persons subject to IPV-related restraining orders from possessing firearms and also require them to relinquish firearms in their possession were associated with 9.7% lower total IPH rates (95% CI, 3.4% to 15.5% reduction) and 14.0% lower firearm-related IPH rates (CI, 5.1% to 22.0% reduction) than in states without these laws. Laws that did not explicitly require relinquishment of firearms were associated with a non-statistically significant 6.6% reduction in IPH rates.

LIMITATIONS

The model did not control for variation in implementation of the laws. Causal interpretation is limited by the observational and ecological nature of the analysis.

CONCLUSION

Our findings suggest that state laws restricting firearm possession by persons deemed to be at risk for perpetrating intimate partner abuse may save lives. Laws requiring at-risk persons to surrender firearms already in their possession were associated with lower IPH rates.

PRIMARY FUNDING SOURCE

Robert Wood Johnson Foundation.

Early Puberty, Friendship Group Characteristics, and Dating Abuse in US Girls

OBJECTIVES

The current study aimed to investigate the relationship between advanced pubertal development and adolescent dating abuse (ADA) and to test if this relationship is moderated by friendship group characteristics in a nationally representative sample of US girls.

METHODS

Data were drawn from wave 1 and 2 (1995-1996) of the National Longitudinal Study of Adolescent to Adult Health. The sample included 3870 girls aged 13 to 17 years, all of whom were in romantic and/or nonromantic sexual relationships. Relative pubertal development was measured as perceived physical development as compared with peers of the same age and race and age at menarche at wave 1. Participants reported at wave 2 whether they had experienced any verbal or physical abuse in their relationships. Friendship group characteristics included the percentage of boy friends, older friends, and friends' risk behavior level.

RESULTS

Negative binomial regression analyses revealed an interaction between advanced pubertal development and percentage of boy friends on ADA victimization, adjusted for age, race, parents' marital status, household income, number of relationships, self-esteem, self-control, and antisocial behavior history. Advanced pubertal development was associated with more ADA victimization when girls' friendship groups comprised a higher percentage of boys.

CONCLUSIONS

Findings highlight the importance of pubertal timing and friendship group characteristics to ADA victimization. Early pubertal development is a risk marker for ADA victimization, particularly when a higher percentage of girls' friends are boys. Pediatricians and adolescent health specialists should be sensitive to the elevated risk for ADA victimization in early-maturing girls.

Marijuana use and physical dating violence among adolescents and emerging adults: A systematic review and meta-analysis

BACKGROUND

As restrictions on marijuana are loosened, there is concern of a coming increase in marijuana use among adolescents and emerging adults, which could be coupled with commensurate increases in behavioral problems associated with use, such as physical dating violence (PDV). To summarize what is known about the association between marijuana use and PDV victimization and perpetration among 11-21year olds, we conducted a systematic review and meta-analysis of the relevant literature published between 2003 and 2015.

METHODS

Candidate articles were identified with a systematic search, and we used inclusion and exclusion criteria to review titles, abstracts, and the full text of studies for consideration. There were 13 articles examining marijuana in association with PDV; five addressed victimization and 11 addressed perpetration.

RESULTS

Findings suggest that marijuana use is associated with a 54% increase in the odds PDV victimization, and a 45% increase in the odds of perpetration.

CONCLUSIONS

Findings suggest that dating violence is a correlate of marijuana use, and that association is strongest among adolescents (vs. emerging adults) and girls (vs. boys). Therefore, it should be routinely included as a core data item in marijuana surveillance systems, so as to allow for behavioral monitoring.

PREVALENCE AND TYPES OF GENDER-AFFIRMING SURGERY AMONG A SAMPLE OF TRANSGENDER ENDOCRINOLOGY PATIENTS PRIOR TO STATE EXPANSION OF INSURANCE COVERAGE

OBJECTIVE

Transgender individuals now have many options for medical intervention, including gender-affirmation surgeries. However, it is unknown how common it is for transgender individuals to undergo these surgeries. The purpose of this cross-sectional study was to assess the prevalence of gender-affirming surgeries among transgender patients in 2015, which was immediately prior to insurance changes that made gender-affirming surgery more affordable for Massachusetts residents.

METHODS

A retrospective chart review of 99 transgender patients was performed at the Endocrinology Clinic at Boston Medical Center, an urban safety net hospital. The records for 99 transgender subjects who received treatment between 2004-2015, including 28 transmen and 71 transwomen, were examined. The outcome measures were the types of medical interventions chosen by transgender patients, which included hormone therapy, chest surgery, gonadectomy, genital surgery, and facial surgery.

RESULTS

Thirty-five percent of subjects had undergone at least one gender-affirming surgery. Transmen were more likely to have had surgery than transwomen (54% vs. 28%). Twenty-five percent of patients had chest surgery, 13% had genital surgery or gonadectomy, and 8% had facial surgery.

CONCLUSION

In 2015, a majority of transgender endocrinology clinic patients had not undergone any type of gender-affirmation surgery. Among those who did elect to have a surgery, genital surgery or gonadectomy were uncommon. The low rate of surgery among this sample of transgender patients may be attributable to the financial cost, lack of interest in surgery, or that genital surgery is not a high priority for transgender individuals relative to surgery to change visible features such as face and chest. Abbreviation: HT = hormone therapy.

Should US Physicians Support the Decriminalization of Commercial Sex?

According to the World Health Organization, "commercial sex" is the exchange of money or goods for sexual services, and this term can be applied to both consensual and nonconsensual exchanges. Some nonconsensual exchanges qualify as human trafficking. Whether the form of commercial sex that is also known as prostitution should be decriminalized is being debated contentiously around the world, in part because the percentage of commercial sex exchanges that are consensual as opposed to nonconsensual, or trafficked, is unknown. This paper explores the question of decriminalization of commercial sex with reference to the bioethical principles of beneficence, nonmaleficence, and respect for autonomy. It concludes that though there is no perfect policy solution to the various ethical problems associated with commercial sex that can arise under either criminalized or decriminalized conditions, the Nordic model offers several potential advantages. This model criminalizes the buying of sex and third-party brokering of sex (i.e., pimping) but exempts sex sellers (i.e., prostitutes, sex workers) from criminal penalties. However, ongoing support for this type of policy should be contingent upon positive results over time.

Stability of alcohol use and teen dating violence for female youth: A latent transition analysis

INTRODUCTION AND AIMS

Alcohol use is one of the most widely accepted and studied risk factors for teen dating violence (TDV). Too little research has explored longitudinally if it is true that an adolescent's alcohol use and TDV involvement simultaneously occur. In the current study, we examined whether there were latent status based on past-year TDV and alcohol use and whether female adolescents changed their statuses of TDV and alcohol use over time.

METHODS

The sample consisted of 583 female youths in seven public high schools in Texas. Three waves of longitudinal data collected from 2011 to 2013 were utilised in this study. Participants completed self-report assessments of alcohol use (past-year alcohol use, number of drinks in the past month and episodic heavy drinking within the past month) and psychological and physical TDV victimisation and perpetration. Latent transition analysis was used to examine if the latent status based on TDV and alcohol use changed over time.

RESULTS

Five separate latent statuses were identified: (i) no violence, no alcohol; (ii) alcohol; (iii) psychological violence, no alcohol; (iv) psychological violence, alcohol; and (v) physical and psychological violence, alcohol. Latent transition analysis indicated that adolescents generally remained in the same subgroup across time.

DISCUSSION

This study provides evidence on the co-occurrence of alcohol use and teen dating violence, and whether teens' status based on dating violence and alcohol use are stable over time. Findings from the current study highlight the importance of targeting both TDV and substance use in intervention and prevention programs. [Choi HJ, Elmquist J, Shorey RC, Rothman EF, Stuart GL,Temple JR. Stability of alcohol use and teen dating violence for female youth: Alatent transition analysis. Drug Alcohol Rev 2017;36:80-87].

A feasibility test of a brief motivational interview intervention to reduce dating abuse perpetration in a hospital setting

OBJECTIVE

To describe the intervention development process and feasibility testing of a hospital-based brief intervention to reduce the perpetration of adolescent dating abuse (ADA). To our knowledge, this intervention is the first to focus exclusively on ADA perpetration reduction via a motivational interview-type intervention in this setting.

METHOD

The rationale for and the six Intervention Mapping steps used to generate the intervention are described. Feasibility is conceptualized as intervention acceptability, demand, implementation, practicality, integration, and limited-efficacy.

RESULTS

The Real Talk intervention was integrated smoothly into the emergency department setting. Participants did not experience any negative impact, and the vast majority (86%) reported that they felt helped. Quantitative assessments suggest that the intervention reduced the number of participants in the pre-contemplation stage of change regarding their use of relationship violence, and may have moved them forward into the action stage. Real Talk participants were more likely than those in the control group to tell friends to help them stay calm around their partner after drinking alcohol, and to talk with their doctor to get help for their problems.

CONCLUSIONS

Real Talk was developed to meet an unmet need for tertiary ADA interventions in non-school settings. It was developed in accordance with a recommended framework, informed by theory, and subsequently tested for feasibility. Feasibility assessment results suggest that Real Talk can be implemented in health care settings and may influence attitudinal and behavioral outcomes in the desired directions.

Firearm Ownership and Suicide Rates Among US Men and Women, 1981-2013

OBJECTIVES

To examine the relationship between state-level firearm ownership rates and gender-specific, age-adjusted firearm and total suicide rates across all 50 US states from 1981 to 2013.

METHODS

We used panel data for all 50 states that included annual overall and gender-specific suicide and firearm suicide rates and a proxy for state-level household firearm ownership. We analyzed data by using linear regression and generalized estimating equations to account for clustering.

RESULTS

State-level firearm ownership was associated with an increase in both male and female firearm-related suicide rates and with a decrease in nonfirearm-related suicide rates. Higher gun ownership was associated with higher suicide rates by any means among male, but not among female, persons.

CONCLUSIONS

We found a strong relationship between state-level firearm ownership and firearm suicide rates among both genders, and a relationship between firearm ownership and suicides by any means among male, but not female, individuals.

POLICY IMPLICATIONS

For male persons, policies that reduce firearm ownership will likely reduce suicides by all means and by firearms. For female persons, such policies will likely reduce suicides by firearms.

Past 15-year trends in adolescent marijuana use: Differences by race/ethnicity and sex

BACKGROUND

The potential for increases in adolescent marijuana use is an important concern given recent changes in marijuana policy. The purpose of this study was to estimate trends in marijuana use from 1999 to 2013 among a national sample of US high school students. We examine changes over time by race/ethnicity and sex.

METHODS

Data are from the National Youth Risk Behavior Survey (YRBS), which involves biennial, school-based surveys that generate nationally representative data about 9th-12th grade students in the United States. Students self-reported sex, race/ethnicity, and marijuana use (i.e., lifetime use, past 30-day use, any use before age 13). We generated national estimates of the prevalence of marijuana use for the time period, and also tested for linear and quadratic trends (n=115,379).

RESULTS

The prevalence of lifetime marijuana use decreased modestly from 1999 to 2009 (44% to 37%), and has increased slightly since 2009 (41%). Other marijuana use variables (e.g., past 30-day use) followed a similar pattern over time. The prevalence of past 30-day use from 1999 to 2013 for all groups and both sexes was 22.5%, and it was lowest among Asians and highest among American Indian/Alaska Natives. Although boys have historically had a higher prevalence of marijuana use, results indicate that male-female differences in marijuana use decreased over time.

CONCLUSION

Despite considerable changes in state marijuana policies over the past 15 years, marijuana use among high school students has largely declined. Continued surveillance is needed to assess the impact of policy changes on adolescent marijuana use.

Fighting With Siblings and With Peers Among Urban High School Students

Understanding the determinants of fighting is important for prevention efforts. Unfortunately, there is little research on how sibling fighting is related to peer fighting. Therefore, the aim of this study was to evaluate the association between sibling fighting and peer fighting. Data are from the Boston Youth Survey 2008, a school-based sample of youth in Boston, MA. To estimate the association between sibling fighting and peer fighting, we ran four multivariate regression models and estimated adjusted prevalence ratios and 95% confidence intervals. We fit generalized estimating equation models to account for the fact that students were clustered within schools. Controlling for school clustering, race/ethnicity, sex, school failure, substance use, and caregiver aggression, youth who fought with siblings were 2.49 times more likely to have reported fighting with peers. To the extent that we can confirm that sibling violence is associated with aggressive behavior, we should incorporate it into violence prevention programming.

"Without Porn … I Wouldn't Know Half the Things I Know Now": A Qualitative Study of Pornography Use Among a Sample of Urban, Low-Income, Black and Hispanic Youth

Information about the pornography-viewing habits of urban, low-income youth of color in the United States is lacking. This study was designed to answer the following using a sample of 16- to 18-year-old urban-residing, low-income Black or Hispanic youth: (1) What types of pornography do youth report watching; where and for what purpose? (2) Do youth feel that pornography exposure has an impact on their own sexual behaviors? and (3) How do parents react to their pornography use? The following themes emerged from interviews with 23 youth: (1) Youth primarily reported watching pornography that featured one-on-one sexual intercourse but also reported having seen extreme pornography (e.g., public humiliation, incest); (2) youth reported watching pornography on home computers or smartphones, and that pornography was frequently watched in school; (3) youth reported watching for entertainment, for sexual stimulation, instructional purposes, and to alleviate boredom; many copied what they saw in pornography during their own sexual encounters; (4) pressure to make or to imitate pornography was an element of some unhealthy dating relationships; and (5) parents were generally described as unsupportive of youth's use of pornography but underequipped to discuss it. Approximately one-fifth expressed a preference for pornography featuring actors of their same race/ethnicity.

Trends in Physical Dating Violence Victimization Among U.S. High School Students, 1999-2011

Dating violence is a serious form of violence that places students at risk for injury, death, and negative mental health sequelae. The current analysis presents data on the prevalence of dating violence over a 12-year period among a nationally representative sample of high school-attending youth in the United States, stratified by race and gender. Data from the national Youth Risk Behavior Surveillance System (YRBSS) 1999-2011 revealed that physical dating violence victimization rates are similar for males and females; the 12-year prevalence rate of physical dating violence victimization was 9.4% for males and 9.2% for females. Black and Multiracial students were at increased risk for dating violence victimization in comparison to their White, Asian, and Hispanic counterparts. There were no changes in the reported rate of dating violence victimization over the 12-year period.

Beyond correlates: a review of risk and protective factors for adolescent dating violence perpetration

Dating violence is a serious public health problem. In recent years, the U.S. Centers for Disease Control and Prevention and other entities have made funding available to community based agencies for dating violence prevention. Practitioners who are tasked with developing dating violence prevention strategies should pay particular attention to risk and protective factors for dating violence perpetration that have been established in longitudinal studies. This has been challenging to date because the scientific literature on the etiology of dating violence is somewhat limited, and because there have been no comprehensive reviews of the literature that clearly distinguish correlates of dating violence perpetration from risk or protective factors that have been established through longitudinal research. This is problematic because prevention programs may then target factors that are merely correlated with dating violence perpetration, and have no causal influence, which could potentially limit the effectiveness of the programs. In this article, we review the literature on risk and protective factors for adolescent dating violence perpetration and highlight those factors for which temporal precedence has been established by one or more studies. This review is intended as a guide for researchers and practitioners as they formulate prevention programs. We reviewed articles published between 2000 and 2010 that reported on adolescent dating violence perpetration using samples from the United States or Canada. In total, 53 risk factors and six protective factors were identified from 20 studies. Next steps for etiological research in adolescent dating violence are discussed, as well as future directions for prevention program developers.