A Framework for Race-Related Trauma in the Public Education System and Implications on Health for Black Youth

Factors Associated With Suicide Risk Behavior Outcomes Among Black Middle School Adolescents

OBJECTIVE

Early adolescent self-identifying Black youth present with high rates of suicidality. This study assesses associations among 7 explanatory variables (sex, weapon carrying, weight perceptions, grades, grade level, bullying at school, and cyberbullying) and suicide ideation, planning, and attempts, and identifies associations with suicidality as a composite measure among a sample of Black middle school adolescents (BMSA) in the United States.

METHOD

Data were extracted from the 2019 Middle School Youth Risk Behavior Survey. Descriptive statistics were calculated, and associations between suicide ideation, planning, and attempts were explored. A network graphical representation of polychoric and tetrachoric correlations across suicidality outcomes and explanatory variables was performed. A multivariable, multinomial logistic regression model estimated associations among explanatory variables and suicide ideation (with and without planning) and planning (with and without ideation). Both suicide attempt and a composite suicidality metric were explored using independent logistic models with multiple imputation.

RESULTS

The sample included 7,643 self-identifying BMSA. Our findings indicate that approximately 28% reported suicidality. Prevalence rates were found of about 1 in 4 BMSA for suicidal ideation, 1 in 6 for suicidal planning, and 1 in 10 for attempting suicide. Female BMSA, victims of cyberbullying, and BMSA carrying a weapon experienced significantly higher odds of all suicidality outcome measures.

CONCLUSION

Practical implications for identifying and screening suicidality among BMSA to guide suicide prevention efforts are necessary. Findings validate the need for informed cultural approaches to suicide screening and prevention efforts to reduce suicide risk outcomes, especially when identifiable environmental factors are strongly associated with those outcomes.

DIVERSITY AND INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list.

Link for Equity, a community-engaged waitlist randomized controlled trial of a culturally responsive trauma-informed care program for BIPOC students: Design features and characteristics of baseline sample

BACKGROUND

Link for Equity is a multi-tiered, school-based program of trauma-informed care and cultural humility designed to reduce the impact of Adverse Child Experiences among Black Indigenous and other children of color (BIPOC). This report describes the program, its trial design, and the study participants' baseline characteristics.

METHODS

We designed a nested waitlist-controlled trial to evaluate Link for Equity's effectiveness in reducing school violence among BIPOC students. Three pairs of school districts, matched on suspension rates and enrollment of Black/African American, Hispanic/Latinx, and American Indian/Alaska Native children, were randomized into either an intervention or delayed intervention (waitlist control) group. A community-engaged approach guided the development of protocols. Within intervention sites, BIPOC students who screened positive for ACEs or posttraumatic stress were also randomized into an immediate and waitlist control group to receive additional one-on-one support from trained school staff.

RESULTS

The trial was implemented from 2019 to 2021, which overlapped with the pandemic and civil unrest in Minnesota. At baseline, 444 staff and 188 students enrolled in the study. Over a quarter of American Indian/Alaska Native students, 18% of multiple race, 12% of Black/African American, 14% of Hispanic/Latinx students reported 4+ ACEs. Between 44 and 53% of all the BIPOC students in the study were symptomatic for PTSD. Of the enrolled students, 78.7% qualified for one-on-one Link support.

CONCLUSION

We implemented a multilevel waitlist-controlled trial of Link for Equity using community-engaged methods. Despite school closures during the pandemic, the study persisted with its methods now being employed in an expanded cohort of middle schools.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT04026477, NCT04026490).

Ke ala i ka Mauliola: Native Hawaiian Youth Experiences with Historical Trauma

Native Hawaiians (NH), like other Indigenous peoples, continue to experience the subversive impacts of colonization. The traumatic effects of colonization, especially the forced relocation from land that sustained their life and health, have led to complex, interconnected health disparities seen today. NHs have described a collective feeling of kaumaha (heavy, oppressive sadness) resulting from mass land dispossession, overthrow of the Hawaiian Kingdom, cultural loss, and early loss of loved ones. Although historical trauma is linked to high rates of substance misuse, depression, suicidality, and other mental health disparities in American Indian populations. However, the link between NH historical trauma and health disparities among NHs has been less explored. This qualitative study used Indigenous talk story interviews with 34 NH 'ōpio (youth) and ka lawelawe (service providers) to explore how NH 'ōpio understand and experience historical trauma. Eight themes and 35 sub-themes were identified covering individual, community, and systemic domains representing the first step in addressing NH historical trauma.

Misuse of Prescription Opioids and Suicidal Behaviors Among Black Adolescents: Findings from the 2017 and 2019 Youth Risk Behavior Survey

PURPOSE

Although some studies have examined the association between prescription opioid misuse and mental health outcomes, few have investigated the effects of prescription opioid misuse on suicidal behaviors among Black adolescents. The objective of this study was to investigate the cross-sectional association between prescription opioid misuse and suicidal ideation, suicide plan, and suicide attempt among Black adolescents.

METHODS

Data for this study came from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 4798 Black adolescents aged 14-18 years (51.2% female) was analyzed using binary logistic regression. The outcome variables investigated were suicidal ideation, suicide plan, and suicide attempt, and the main explanatory variable was prescription opioid misuse.

RESULTS

Of the 4798 Black adolescents, 15% reported ever misusing prescription opioids; 16.2% experienced suicidal ideation; 14% made a suicide plan; and 11.3% attempted suicide during the past 12 months. In the multivariate logistic regression models, Black adolescents who misused prescription opioids had 1.39 times higher odds of making a suicide plan and 1.65 times higher odds of making a suicide attempt during the past 12 months when compared to their counterparts who did not misuse prescription opioids. Other significant factors associated with suicidal behaviors include female sex, school bullying, cyberbullying, depressive symptoms, and illicit drug use. In addition, physical activity had a protective effect on suicide attempt.

CONCLUSION

The findings of the present study demonstrate the effects of prescription opioid misuse and its association with suicidal behaviors among Black adolescents.

Individual and Contextual Risk and Protective Factors for Suicidal Thoughts and Behaviors among Black Adolescents with Arrest Histories

Black adolescents in the United States have experienced an increase in suicidal thoughts and behaviors (STBs). Since Black adolescents are overrepresented in the youth punishment system, more research is needed to investigate correlates of STBs for this population. The purpose of this paper is to explore and establish correlates of individual, family, and community risk and protective factors and their relationship to lifetime STBs in a national sample of Black youth with arrest histories. Guided by an intersectional eco-behavioral lens, we investigated individual, family and contextual risk and protective factors for STBs among a national sample of justice-involved Black youth aged 12-17 with a history of arrest (n = 513). We used logistic regression models to test risk and protective factors for STBs. Among the sample, 9.78% endorsed suicidal ideation, and 7.17% endorsed a previous suicide attempt. Further, gender (female) and depression severity were risk factors for STBs, while positive parenting and religiosity were protective factors for STBs. School engagement was associated with lower levels of suicidal ideation. The findings suggest suicide prevention and intervention efforts should identify developmentally salient risk and protective factors to reduce mental health burden associated with STBs and concurrent alleged law-breaking activity of Black youth.

Suicide Among Black Children: An Integrated Model of the Interpersonal-Psychological Theory of Suicide and Intersectionality Theory for Researchers and Clinicians

Recently, research has reported that the rates of suicide among Black children between the ages of 5 to 12-years-old are increasing as they are now more likely to commit suicide than White children. Yet, there are very few, if any, frameworks being used by researchers to explain the risks of suicide among Black children. Suicide research has overwhelmingly been focused on White youth thus leaving a critical gap in suicide research. This conceptual paper provides an integrated framework using the Interpersonal-Psychological Theory of Suicide and Intersectionality theory, as a guide for researchers, clinicians, and practitioners to incorporate culturally appropriate techniques in their work as a way to prevent suicide among Black children. This framework highlights racial discrimination, mental health, socioeconomic status, and sexual/gender minority status to be the most preeminent, yet understudied factors leading to suicide risk among Black children in the United States. Reprinted with permission of SAGE Publications; Opara et al. J Black Stud (51:611-631), copyright 2020.

Reconceptualizing school safety for Black students

Ensuring a psychologically and physically safe learning environment for students and staff is necessary for students to learn and grow and for teachers to teach. However, for Black students and other marginalized students, the school environment is often physically and emotionally unsafe and they are targeted by anti-Black policies and practices, ultimately producing inequitable outcomes. As such, school safety must be reexamined and reconceptualized to promote a safe, secure, and welcoming environment for Black students. In this article, we will discuss the school-based experiences of Black students in American schools with a particular focus on Black students’ physical and emotional safety. Furthermore, implications and recommendations for establishing safe, affirming, and culturally relevant educational spaces for Black students are provided.

The Importance of Anti-Racism in Trauma-Informed Family Engagement

Students of color are disproportionately affected by exposure to adverse childhood experiences (ACEs), racial trauma, and traumatic stress. Trauma-informed interventions in schools can promote healing among ACE-impacted students of color. These interventions require collaboration with family members to decide upon services and referrals; however, educators commonly face challenges with engaging families. The study purpose is to understand barriers and facilitators to engaging families in trauma-informed mental health interventions for ACE-impacted students of color. As part of a larger school-based trauma-informed trial (Link for Equity), 6 focus groups were conducted with parents/guardians of color and school staff (n = 39) across 3 Midwestern school districts. Participants were asked open-ended questions about trauma, discrimination, school supports, and family engagement. Transcripts were coded by two team members, and thematic analysis was used to identify barriers/facilitators to family involvement. Results indicated that families of ACE-impacted students of color commonly experienced racism including microaggressions and stereotypes from the school community, which deterred engagement and prevented trusting relationships between families and school staff. Parents highlighted feeling excluded from decisions related to their child's education and that their voices were not heard or understood. Participants discussed the need for schools to consider how family obstacles (such as mental health and trauma) may prevent families from engaging with staff, and they recommended structural changes, such as anti-racism trainings for educators. Findings highlight the need for anti-racist work that addresses interpersonal and structural racism in schools, in order to promote family engagement in trauma-informed mental health interventions.

The Association Between Racism and Suicidality Among Young Minority Groups: A Systematic Review

INTRODUCTION

The World Health Organization states that suicide is the second leading cause of death among youngs, and racism has been proven to have detrimental effects on both physical and mental health. These two plagues represent a public health priority, especially for susceptible minorities.

METHOD

This systematic review analyzed 23 studies from multiple database searches, to understand the relationship between racism and suicidality in young minority groups.

RESULTS

The review demonstrated the correlation between racism and suicidality with the consequent development of mental disorders. There is strong evidence that the main suicide risk factor is acculturation, interpreted as the assimilation of the dominant culture with the loss of values from one's cultural background.

DISCUSSION

Health care professionals should not underestimate the risk of suicidality associated with racism. Prevention is crucial and it should be implemented from a young age, in schools, through a joint intervention with children and their families, aiming toward integration without acculturation.

Peer Victimization and Mental Health Problems: Racial-Ethnic Differences in the Buffering Role of Academic Performance

Despite research highlighting the importance of academic performance in reducing youth's bullying involvement, little attention has focused on its role in moderating the association between peer victimization and youth maladjustment, further, there have been even fewer studies examining potential racial-ethnic differences in the association. This cross-sectional study examined the function of academic performance, as a moderator, in the associations between peer victimization and youth mental health problems (i.e., internalizing, externalizing, and substance use problems) and whether and how this function varied by the youth's racial-ethnic background. Self-report data were collected from 69,244 middle and high school youth (45.96% were middle schoolers; 49.7% were females; 25.72% were Black and African American youth, 9.64% Latinx American youth, 5.95% Asian American youth, and 10.47% Bi- and Multi-racial youth, and 48.22% White American youth). Multi-level models indicated that academic performance was negatively related to internalizing problems and substance use more strongly in victimized youth than in non-victimized youth, suggesting itself as a buffering factor. Moreover, this buffering function of academic performance in victimized youth was more pronounced in some ethnic groups (i.e., Asian American) than in others (i.e., Black and Latinx American), yet, notably, it was a buffer across all ethnic groups. These findings underscore the importance of academic strength in protecting victimized youth of all ethnicities against mental health difficulties, while recognizing that additional foci on improving academic performance and addressing academic-related norms are needed for racial-ethnic minority subgroups.

How Does Insurance Status Correlate With Trauma Mechanisms and Outcomes? A Retrospective Study at a Level 1 Trauma Center

OBJECTIVE

Studies showed that a lack of insurance is associated with worse trauma outcomes. We examine insurance status and trauma mortality in a diverse metropolitan city and hypothesize that the higher risk of mortality in uninsured patients is due to insurance status and other factors.

METHODS

A retrospective analysis of patients admitted to a Level 1 Trauma center for emergent surgery in a diverse metropolitan city from Jan 2016-May 2020 was conducted. Patients of different insurance statuses were analyzed for their injury mechanism and surgical intervention outcomes. Multivariate logistic regression was performed and the results were presented as odds ratio with 95% confidence intervals and P values. Statistical significance was set at P < .05.

RESULTS

738 patients met study criteria. Medicaid patients made up the largest proportions of injury mechanisms: 65.1% of gunshot wound cases, sharp object (41.7%), and falls (32.5%). Private insurance (OR = .13, 95% CI: .05-.35, P = .000), Medicaid (OR = .19, 95% CI: .10-.35, P = .000), Medicare (OR = .65, 95% CI: 0.28-1.51, P = .31), and other insurance (OR = .44, 95% CI 0.22-.87, P = .01) were associated with survival. Uninsured patients had the highest mortality rate resulting from trauma at 32.6% (P < .001), and the lowest mortality rate belonged to the private insurance cohort (6.3%, P < .001). Uninsured patients accounted for 10.5% of gunshot wound cases, 8.5% of motor vehicle accident cases, 25% of sharp object cases, and 6.6% of falls.

CONCLUSION

Being uninsured was independently associated with mortality, while having insurance improved outcomes. Underlying mechanisms should be further elucidated to improve health equity and trauma outcomes in diverse patient populations.

Bibliometric Analysis of Suicide Research Among Black Youth

Historically, Black youth have had lower rates of suicide attempts in comparison to their peers; however, in recent years this rate has changed, with self-reported suicide attempts for Black adolescents rising by 73%. The purpose of this study was to analyze the characteristics of research on Black youth and suicide using bibliometric techniques. To conduct our analysis, we developed a search strategy utilizing the Scopus database for the time period from 1980 to 2020. Results indicated an increasing trend in the number of articles published each year related to Black youth and suicide. The most highly productive journals were the Suicide and Life Threatening Behavior, Pediatrics, and Journal of Youth and Adolescence. Authors who frequently published in this area include Nadine Kaslow, Rheeda Walker, and Sean Joe. While this research area is growing, there is a lack of published articles focused on interventions for suicide prevention and non-comparative race specific research focused on Black youth.

Restructuring Law Enforcement Agencies to Support Prosocial Values: A Behavior-Scientific Model for Addressing Police Brutality

Policing in the United States is irrefutably a component of systemic racism. The history of police brutality against the Black community can be found in our amendments, laws, and cultural practices-it is an infrastructure of oppression. Though police brutality is not a new development, it has reached a fever pitch with the deaths of George Floyd and Breonna Taylor. Recent calls to defund the police put law enforcement agencies squarely, and rightly, in the spotlight of social justice movements and reform. Current issues operating within law enforcement agencies ensure the perpetuation of a system that reinforces the status quo and gives nothing back to the communities that have been victims of brutality. A philosophical restructuring of how law enforcement agencies interact with the communities they serve is paramount. The purpose of this article is to propose a behavior-scientific model aimed at both the individual and organizational levels of law enforcement agencies using elements of acceptance and commitment training and Elinor Ostrom's core design principles, called Prosocial. The Prosocial model promotes the clarification of values within organizations and the communities they serve and reinforces values-consistent action. The model therefore has the potential to be a useful tool to combat systemic racism and police brutality within law enforcement agencies. The proposed model will be discussed in the context of who created it (White academicians), who will be implementing it (law enforcement), and ultimately who should benefit from it above and beyond the cessation of police brutality and without psychological or financial cost (Black communities).

A Mixed Methods Pilot Study of an Equity-Explicit Student-Teacher Relationship Intervention for the Ninth-Grade Transition

BACKGROUND

Student-teacher relationships are associated with the social and emotional climate of a school, a key domain of the Whole School, Whole Community, Whole Child Model. Few interventions target student-teacher relationships during the critical transition to high school, or incorporate strategies for enhancing equitable relationships. We conducted a mixed-methods feasibility study of a student-teacher relationship intervention, called Equity-Explicit Establish-Maintain-Restore (E-EMR).

METHODS

We tested whether students (N = 133) whose teachers received E-EMR training demonstrated improved relationship quality, school belonging, motivation, behavior, and academic outcomes from pre- to post-test, and whether these differences were moderated by race. We also examined how teachers (N = 16) integrated a focus on equity into their implementation of the intervention.

RESULTS

Relative to white students, students of the color showed greater improvement on belongingness, behavior, motivation, and GPA. Teachers described how they incorporated a focus on race/ethnicity, culture, and bias into E-EMR practices, and situated their relationships with students within the contexts of their own identity, the classroom/school context, and broader systems of power and privilege.

CONCLUSIONS

We provide preliminary evidence for E-EMR to change teacher practice and reduce educational disparities for students of color. We discuss implications for other school-based interventions to integrate an equity-explicit focus into program content and evaluation.

Suicide among Black Children: An Integrated Model of the Interpersonal-Psychological Theory of Suicide and Intersectionality Theory for Researchers and Clinicians

Recently, research has reported that the rates of suicide among Black children between the ages of 5 to 12-years-old are increasing as they are now more likely to commit suicide than White children. Yet, there are very few, if any, frameworks being used by researchers to explain the risks of suicide among Black children. Suicide research has overwhelmingly been focused on White youth thus leaving a critical gap in suicide research. This conceptual paper provides an integrated framework using the Interpersonal-Psychological Theory of Suicide and Intersectionality theory, as a guide for researchers, clinicians, and practitioners to incorporate culturally appropriate techniques in their work as a way to prevent suicide among Black children. This framework highlights racial discrimination, mental health, socioeconomic status, and sexual/gender minority status to be the most preeminent, yet understudied factors leading to suicide risk among Black children in the United States.