Profiles of Community Violence Exposure Among African American Youth: An Examination of Desensitization to Violence Using Latent Class Analysis

Firearm Violence Exposure and Functional Disability among Black Men and Women in the United States

This study investigates the relationship between firearm violence exposure and functional health among Black adults in the United States (US). We examined associations between different forms of firearm violence exposure (direct, indirect, and community) and functional health with particular attention to differences across sex groups. We used survey data from a nationally representative sample of 3015 Black adult Americans to analyze associations between types of firearm violence exposure and four aspects of functional disability including: the ability to concentrate, walk/use stairs, dress/bathe, and run errands among males and females. The findings indicate notable disparities in exposure and health outcomes based on the exposure type and cumulative exposure to violence. Among males, functional disability was associated most closely with community violence exposure, while direct threats of firearm violence were most consequential for functional health among females. High cumulative exposure to firearm violence was linked to significant risks to functional health, particularly among females. The results shed light on sex differences in the repercussions of firearm violence exposure and emphasize its implications for daily functioning and health. This study contributes to the understanding of the multifaceted impacts of firearm violence on functional well-being and highlights the need for inclusive and culturally sensitive healing approaches based in community settings. There is a critical need for heightened awareness and strategies to enhance the well-being of those disproportionately affected by firearm violence in the US.

Interpersonal school violence and mother-child communication about violence in relation to empathy in early adolescence

INTRODUCTION

Exposure to interpersonal violence at school has been linked with lower empathy, but less is known about factors that may moderate this relationship. Positive parent-child communication has been associated with higher empathy during adolescence and children of parents that communicate their disapproval of violent behavior respond more peacefully in situations involving violence. Mother-child communication about violence may therefore reduce the risk of desensitization to violent behavior and promote empathy in youth that are frequently exposed to violence. Thus, this study examines whether mother-child communication about violence mitigates the association between exposure to interpersonal school violence and adolescents' empathy.

METHODS

This study addressed this question using a diverse sample of early adolescents from the Southeastern United States in 2003 (N = 642; mean age 11.3 years; 52% male; 76% Black, 22% non-Hispanic White). Adolescents reported on how often they witness or experience interpersonal violence at school and how often they communicate with their mother about violence and how to avoid it. Adolescents also self-reported on their level of empathy.

RESULTS

Results from a hierarchical regression model showed that exposure to interpersonal school violence and lower mother-child communication about violence were uniquely associated with lower empathy, but communication about violence did not moderate the link between interpersonal school violence exposure and empathy. There were no sex differences in these relationships.

CONCLUSIONS

Contrary to the hypothesis, youth who experience and witness interpersonal violence at school show lower empathy independent of whether youth communicate with their mother about violence and responding to violent situations.

Black mothers' ethnic-racial socialization one year after highly publicized anti-Black murders during the pandemic

Although research on ethnic-racial socialization is well established, limited studies have examined the influence of specific, highly publicized anti-Black murders. We assessed Black mothers' (N = 12, mean age = 37.45) concerns and ethnic-racial socialization with adolescents aged 11-18 years old approximately 1 year following the murders of George Floyd and other unarmed Black people. Researchers generated the following themes using reflexive thematic analysis: protecting adolescents from physical harm; protecting adolescents from psychological harm; parents' emotional distress; and parents' lack of confidence in their ethnic-racial socialization practices. Black mothers exhibit exceptional amounts of strength and courage as they navigate pervasive physical and psychological threats to their adolescents while experiencing worry and low confidence in their ability to socialize their adolescents about anti-Black racism.

Family economic status and vulnerability to suicidal ideation among adolescents: A re-examination of recent findings

BACKGROUND

According to the "differential vulnerability hypothesis," individuals in adverse socioeconomic circumstances as less mentally resilient to stressful events. However, several recent papers radically challenged this hypothesis based on the accumulated literature on stress inoculation and presented cases in which lower-SES adolescents appear to be less vulnerable to suicidal ideation in the face of interpersonal aggression.

OBJECTIVE

We re-examine the link between psychological vulnerability to acute stressors and SES using yearly longitudinal public survey data from South Korea.

PARTICIPANTS AND SETTING

This is a secondary data analysis of a multi-year public health panel dataset on South Korean adolescents.

METHODS

Logistic regression is used to examine the association between suicidal ideation and a range of predictor variables, with a particular focus on the interaction between bullying victimhood and log family income. These variables and the sample were chosen for consistency with recent revisionist research.

RESULTS

We reaffirm the well-established finding that bullying victimhood strongly and consistently increases the odds of suicidal ideation (OR = 1.859, p < 0.01). However, we find no evidence in favor of the traditional "differential vulnerability hypothesis" or the recently proposed counterhypothesis. A subsample analysis from the latest wave (W4-W5) did produce results that are consistent with recent revisionist findings, but we suggest this is likely a false positive.

CONCLUSIONS

There appears to be no systematic association between SES and vulnerability to suicidal ideation in the face of peer aggression among South Korean adolescents. The claim that lower-SES adolescents may be more resilient to stressful events stands on limited empirical support.

Longitudinal Patterns of Multidimensional Violence Exposure and Adolescent Early Sexual Initiation

Early sexual intercourse is associated with sexually transmitted infections, pregnancy, and depressive symptoms, and delay of intercourse allows adolescents opportunities to practice relationship skills (Coker et al., 1994; Harden, 2012; Kugler et al., 2017; Spriggs & Halpern, 2008). Thus, understanding predictors of early sexual intercourse is crucial. Prior research has suggested that violence exposure is associated with early initiation of sexual intercourse in adolescence (Abajobir et al., 2018; Orihuela et al., 2020). However, most studies have looked only at a single type of violence exposure. In addition, little research has examined longitudinal patterns of violence exposure in order to determine whether there are particular periods when the violence exposure may have the strongest impact on sexual behavior. Guided by life history and cumulative disadvantage theories, we use longitudinal latent class analysis and data from the Future of Families and Child Well-being Study (N = 3,396; 51.1% female, 48.9% male) to examine how longitudinal patterns of multiple types of violence exposures across ages 3 to 15 are associated with early sexual initiation in adolescence. Findings suggest that experiencing persistent physical and emotional abuse across childhood was associated with the greatest prevalence of early sexual initiation. Early exposure to violence was not consistently associated with greater likelihood of sexual initiation; instead, early abuse was more strongly associated with sexual initiation for boys, while late childhood abuse was more strongly associated for girls. These findings suggest that gender-sensitive programs are highly needed to address unique risk factors for boys' and girls' sexual behaviors.

Suicidal Ideation Among Patients with Gastrointestinal Cancer

BACKGROUND

Mental illness (MI) and suicidal ideation (SI) often are associated with a diagnosis of cancer. We sought to define the incidence of MI and SI among patients with gastrointestinal cancers, as well as ascertain the predictive factors associated with SI.

METHODS

Patients diagnosed between 2004 and 2016 with stomach, liver, pancreatic, and colorectal cancer were identified from the SEER-Medicare database. County-level social vulnerability index (SVI) was extracted from the Centers for Disease Control database. Multivariable logistic regression was used to identify factors associated with SI.

RESULTS

Among 382,266 patients, 83,514 (21.9%) individuals had a diagnosis of MI. Only 1410 (0.4%) individuals experienced SI, and 359 (0.1%) committed suicide. Interestingly, SI was least likely among patients with pancreatic cancer (ref: hepatic cancer; odds ratio [OR] 0.67, 95% confidence interval [CI] 0.52-0.86; p = 0.002), as well as individuals with stage III/IV disease (OR 0.59, 95% CI 0.52-067; p < 0.001). In contrast, male (OR 1.34, 95% CI 1.19-1.50), White (OR 1.34, CI 1.13-1.59), and single (OR 2.03, 95% CI 1.81-2.28) patients were at higher odds of SI risk (all p < 0.001). Furthermore, individuals living in relative privilege (low SVI) had markedly higher risk of SI (OR 1.33, 95% CI 1.14-1.54; p < 0.001). Moreover, living in a county with a shortage of mental health professionals was associated with increased odds of developing SI (OR 1.21, 95% CI 1.04-1.40; p = 0.012).

CONCLUSIONS

Oncology care teams should incorporate routine mental health and SI screening in the treatment of patients with gastrointestinal cancers, as well as target suicide prevention towards patients at highest risk.

Family Matters: The Effects of Multigenerational Community Violence Exposure on Family Functioning

Exposure to community violence is known to be associated with a host of maladaptive outcomes in both youth and adult populations. Though frequently examined in other interpersonal violence literature, family functioning has yet to be examined as an outcome in community violence literature. The current study begins to address this need by exploring the impact of parent and child's exposure to community violence on parents' perception of family functioning. Two hundred parent-child dyads (sons Mage =12.39, SD = 1.22 at baseline; mothers Mage = 42.79, SD = 9.21 at Wave 5) living in under-resourced, urban neighborhoods completed self-report questionnaires about their exposure (i.e., direct or indirect) to violent events in their community within the last year. The parents then completed an additional self-report questionnaire about their perception of family functioning at one year and three years post community violence exposure, respectively. Results of general linear modeling showed that at one- and three-years post-direct and indirect exposure, family cohesion and family communication was highest when 1) neither the parent nor child were exposed and when 2) only the child was exposed. Family functioning was at its lowest levels when the group included a parent who reported direct or indirect exposure to community violence. The results highlight a need to provide family-based psychosocial interventions to families exposed to violence to help preserve both individual and family functioning after exposure.

Youth Trauma Histories are Associated with Under-diagnosis and Under-treatment of Co-occurring Youth Psychiatric Symptoms

OBJECTIVE

We examined whether in the presence of trauma exposure, non-traumatic stress-related symptoms are interpreted by mental health clinicians as less salient than the trauma exposure and are de-emphasized as a treatment target, consistent with a diagnostic overshadowing bias.

METHODS

Using an adapted version of a diagnostic overshadowing bias experimental paradigm, mental health clinicians (N = 266, M age = 34.4 years, 82% female) were randomly assigned to receive two of six clinical vignette variations. Vignette 1 described an adolescent with obsessive-compulsive disorder (OCD). Vignette 2 described a pre-adolescent with oppositional defiant disorder (ODD). Vignettes were identical except for whether the youth reported exposure to a potentially traumatic event (PTE; no PTE, sexual PTE, or physical PTE). Clinicians received one vignette with a PTE and one without, counterbalancing order. Clinicians rated the likelihood the youth met criteria for various diagnoses and the appropriateness of various treatments on 7-point scales.

RESULTS

Across both vignettes, clinicians rated the target diagnosis (OCD in Vignette 1, ODD in Vignette 2) as less likely for vignettes with a PTE than for the same vignettes without a PTE. Clinicians also rated evidence-based treatment modalities for target diagnoses as less appropriate in the presence of a PTE than when a PTE was present.

CONCLUSIONS

Consistent with possible bias, clinicians may under-recognize and under-treat non-traumatic stress-related mental health symptoms in youth with a co-occurring trauma history. Future work to validate this bias in real-world practice is indicated.

Heterogeneous effects of spatially proximate firearm homicide exposure on anxiety and depression symptoms among U.S. youth

The burden of firearm homicide in the United States is not evenly distributed across the population; rather, it disproportionately affects youth in disadvantaged and marginalized communities. Research is limited relevant to the impacts of exposure to firearm violence that occurs near where youth live or attend school - spatially proximate firearm violence - on youths' mental health and whether those impacts vary by characteristics that shape youths' risk for experiencing that exposure in the first place. Using a dataset linking the Fragile Families and Child Wellbeing Study with the Gun Violence Archive (N = 3086), we employed propensity score matching and multilevel stratification to examine average and heterogeneous associations between spatially proximate firearm homicide exposure and anxiety and depression among all youth and then separately for boys and girls. We found a statistically significant average association between firearm homicide exposure and symptoms of depression among youth. Furthermore, heterogeneous effects analyses yielded evidence that the average association is driven by youth, and particularly boys, who are the most disadvantaged and have the highest risk of firearm homicide exposure. The results of this study suggest that the accumulation of stressors associated with structural disadvantage and neighborhood disorder, coupled with exposure to spatially proximate and deadly firearm violence, may make boys and young men, particularly Black boys and young men, uniquely vulnerable to the mental health impacts of such exposure. Ancillary analyses of potential effect moderators suggest possible future areas of investigation.

Patterns of community violence exposure among urban adolescents and their associations with adjustment

Community violence exposure is prevalent among urban and marginalized adolescents. Although there is strong evidence that community violence exposure is associated with negative consequences, prior studies and theories suggest that these associations may differ as a function of specific characteristics of exposure. This study identified patterns of community violence exposure that differed in form (witnessing vs. victimization), familiarity with the victim, and severity, and in their associations with adolescents' frequency of physical aggression and anxiety symptoms. Participants were 681 eighth-grade adolescents (58% female, 95% African American). Latent class analysis identified five subgroups who reported distinct patterns of violence exposure: limited exposure; witnessed less severe violence, not victimized; witnessed severe violence, not victimized; witnessed less severe violence, some victimization; and high violence exposure. The witnessed less severe, some victimization, and high violence exposure subgroups reported the highest frequency of physical aggression and levels of anxiety compared with all other subgroups. The limited exposure subgroup reported the lowest frequencies of physical aggression. The findings suggest that the form of exposure (witnessing or victimization) is an important distinction in examining associations with adolescent adjustment. Limited support was found for differences related to familiarity with the victim and severity of violence.

The Impact of Adverse Childhood Experiences and Community Violence Exposure on a Sample of Anxious, Treatment-Seeking Children

Screening for adverse childhood experiences (ACEs) can help prevent and reduce adverse outcomes on child development, including increased risk for anxiety disorders. Emerging studies strongly support the inclusion of community-level adversities in ACE screeners to consider diverse contexts and populations. Recent studies suggest that community violence exposure (CVE) may have a distinct impact on youth mental health. Although recent studies have examined the association between ACEs, CVE, and mental health in primary care settings, this association has not been examined on treatment-seeking children in urban mental health settings. The present study employs a mediation model using the PROCESS macro to examine community violence exposure mediating the effect on the association between ACEs and somatic symptoms (SS) on a sample of anxious treatment-seeking children. A total of 98 participants (Mage = 11.7, SD = 3.79, 51.6% males, 54.1% ethnic minority children) who sought services at a specialized anxiety clinic completed self-report measures. Results indicated that exposure to ACEs is associated with endorsement of somatic symptoms as a result of reporting hearing, witnessing, or experiencing CVE. Evidence of mediation was found in a statistically significant indirect effect of ACEs on SS through CREV (Effect = .17, 95% CI = .069-.294). These findings support recent evidence that CVE is a distinct ACE as it contributes to toxic stress similar to individual-level ACEs. The use of a comprehensive ACE screening that includes CVE is warranted, particularly when working with culturally and socioeconomically diverse populations, as it would better capture a broader range of adversities across demographic groups.

A Person-centered Approach to Violence Exposure in Postwar Colombian Youth: Demographic Covariates and Positive Youth Development Outcomes

While the negative impact of extensive exposure to community violence and armed conflict is known, less emphasis has been focused on outcomes supportive of resilience. It is critical to begin exploring these constructs to both promote healing from decades-long conflict and to inform targeted interventions that focus on positive youth development in contexts of adversity. This study thus utilized a person-centered approach to estimate violence exposure profiles among 3,443 Colombian youth to explore what demographic covariates and positive youth development outcomes, such as school engagement, hope, goals, social competence, future expectations, and barriers to education were associated with each violence exposure profile. Four profiles emerged: a low exposure profile, a high community violence profile, a some combined exposure profile, and a high combined exposure profile, each with various levels of community violence witnessing and victimization as well as armed conflict exposure. Demographic covariance results showed older, urban, male youth were more likely to be in the high violence exposure profiles compared to the low exposure group. Youth in the high combined exposure profile were more likely to have lower hope, educational expectations, and social competence compared to the low exposure group. Findings highlight that a person-centered approach provides a more multidimensional view of adolescent violence exposure. Demographic differences suggested the importance of tailoring violence prevention initiatives to the local context. Finally, results concerning positive youth development outcomes suggest that resiliency-oriented constructs, which can be instrumental toward youth's postwar healing and growth, should be emphasized among populations who experience high levels of co-occurring exposure.

Profiles of Community Violence Exposure, Moral Disengagement, and Bullying Perpetration: Evidence from a Sample of Italian Adolescents

According to the Pathologic Adaptation Model of community violence exposure, repeated experiences of violence within the community lead youth to accept violence as a normative and legitimate strategy to cope with conflict, thus increasing their involvement in aggressive behaviors. This hypothesis has been under-investigated with reference to bullying at school. Using a person-centered analytical approach (latent profile analysis), this study examines the mediating role of moral disengagement as a type of normalizing cognition about violence, in the relationship between profiles of community violence exposure and perpetration of bullying. Eight hundred and two adolescents (11-18 years; 43.4% girls) from two different urban and societal contexts in Italy (Milan vs. Naples) participated in the study. Four profiles of exposure to community violence emerged. Context site and age influenced belonging to the four profiles. Being moderately exposed to violence, both as a victim and as a witness, was significantly associated with higher levels of moral disengagement and bullying perpetration. Being exposed as a witness and as a victim, and being exposed only as a witness were associated with bullying perpetration via the increase of moral disengagement. These findings support the Pathologic Adaptation Model and indicate that adolescents who experience higher levels of community violence, as a witness or both as a witness and a victim, are more likely to develop morally disengaged beliefs about violence, which in turn would increase the likelihood to perpetrate bullying. Results are also discussed in the context of social diversity.

Home, school, and community violence exposure and emotional and conduct problems among low-income adolescents: the moderating role of age and sex

PURPOSE

The purpose of this study is to assess whether violence exposure is associated with emotional/conduct problems, when adjusting for confounders/covariates and controlling for comorbidity, and to investigate interactions between violence exposure and sex and/or age.

METHODS

This cross-sectional study evaluated a community-based sample of 669 in-school 11-15-year-olds. A three-stage probabilistic sampling plan included a random selection of census units, eligible households, and target child. Multivariable logistic regression investigated the effect of severe physical punishment by parents, peer victimization at school, and community violence on the study outcomes (adolescent-reported emotional/conduct problems identified by the Strengths and Difficulties Questionnaire/SDQ) when controlling for confounders (resilience, parental emotional warmth, maternal education/unemployment/anxiety/depression) and covariates (age, sex, stressful life events, parental rejection).

RESULTS

Considering interactions, emotional problems were associated with community violence victimization among girls, while conduct problems were associated with severe physical punishment among the younger, suffering peer aggression among the oldest, bullying victimization among girls, and witnessing community violence among boys. Desensitization (less emotional problems with greater violence exposure) was noted among the youngest exposed to severe physical punishment and the oldest who witnessed community violence.

CONCLUSION

Age and sex are moderators of the association between violence exposure and emotional/conduct problems. Interventions at local health units, schools, and communities could reduce the use of harsh physical punishment as a parental educational method, help adolescents deal with peer aggression at school and keep them out of the streets by increasing the usual five hours in school per day and making free sports and cultural/leisure activities available near their homes.

Patterns of Community Violence Exposure among African American Adolescents Living in Low-Resourced Urban Neighborhoods

African American adolescents living in neighborhoods with concentrated economic disadvantage are disproportionately exposed to community violence. This study builds upon previous research and examines patterns, severity, and chronicity of violence exposure, within a sample of African American adolescents living in low-resourced, urban neighborhoods (n = 327). The influence of both individual- and contextual-level factors on community violence exposure (CVE) is examined. Data were collected across four time points at 6-month intervals. Latent transition analysis identified three patterns of CVE at each time point: low witnessing and low victimization (LW-LV), high witnessing and low victimization (HW-LV), and high witnessing and high victimization (HW-HV), as well as transitions between each class. Although a stable LW-LV class membership over time was the most prevalent pattern, most adolescents experienced some change in exposure. Nearly one-third of the participants were classified in the HW-HV group at some point in time. Analyses on individual- and contextual-level factors revealed that more depressive symptoms, community problems (e.g., drugs, graffiti, noise), or community resources (e.g., schools, parks, recreational facilities) were associated with an increased likelihood of experiencing high levels of violent victimization. Implications for intervention and prevention of CVE are discussed.

Individual Differences in Patterns of Community Violence Exposure and Internalizing and Externalizing Behaviors

Youth community violence has been linked with depressive and anxious symptoms, and aggressive behavior; however, little research has examined different combinations of emotional and behavioral adjustment among community-violence-exposed youth, or individual characteristics that may account for different patterns of emotional and behavioral adjustment in community-violence-exposed youth. This research used person-centered methods to examine how gender, temperament characteristics, and prior exposure to community violence were linked with classes of community violence exposure and internalizing and externalizing adjustment among a sample of urban African American youth. Participants were 464 African American adolescents (46.7% female; mean age = 14.83, SD = .43) who reported their community violence exposure in Grade 9 and for whom reports of depressive and anxious symptoms, and aggressive behavior were available. Latent class analysis identified four classes of adolescents distinguished by their exposure to community violence exposure and internalizing and externalizing behavior. The two classes with high community violence exposure were characterized by internalizing symptoms or aggressive behavior; the two classes with low community violence exposure had low internalizing symptoms with moderate aggression or had all moderate symptoms. These community violence adjustment classes were distinguished by gender, history of community violence exposure, behavioral inhibition, and fight-flight-freeze systems. Findings highlight heterogeneity in internalizing and externalizing responses of community-violence-exposed youth and suggest factors that explain community violence exposure, repeat exposure, and responses to community violence exposure.

Deconstructing the role of the exposome in youth suicidal ideation: Trauma, neighborhood environment, developmental and gender effects

Environment (E) is pivotal in explaining variability in brain and behavior development, including suicidal ideation (SI) and behavior. It is therefore critical to systematically study relationships among environmental exposures (i.e., exposome) and suicidal phenotypes. Here, we evaluated the role of individual-level adversity and neighborhood environment and their interaction (E x E) in association with youth SI. Sample included youth (N = 7,054, ages 11–21) from the Philadelphia Neurodevelopmental Cohort, which investigated clinical phenotypes in a diverse US community population. We examined cross-sectional associations of environmental exposures with lifetime history of SI (n = 671), focusing on interactions between individual-level exposures to assaultive trauma (n = 917) and neighborhood-level socioeconomic status (SES) quantified using geocoded Census data. Models included potential confounds and overall psychopathology. Results showed that assaultive trauma was strongly associated with SI (OR = 3.3, 95%CI 2.7–4, p < .001), while low SES was not (p = .395). Both assault and low SES showed stronger association with SI in females, and in early adolescence (all E X gender/age interactions, p < .05). In traumatized youths, lower SES was associated with less SI, with no SES effects on SI in non-traumatized youths (Assault X SES interaction, Wald = 8.19, p = .004). Associations remained significant controlling for overall psychopathology. No single SES variable emerged above others to explain the moderating effect of SES. These findings may suggest a stress inoculation effect in low SES, where youths from higher SES are more impacted by the deleterious trauma-SI association. Determining which environmental factors contribute to resilience may inform population specific suicide prevention interventions. The cross-sectional study design limits causal inferences.

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Environment (E) is key in shaping development of suicidal ideation (SI).

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We integrated individual-level trauma exposure and neighborhood-level data on socioeconomic status (SES) in N=7,054 youths.

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Trauma was robustly associated with youth SI in our cohort, while SES had no association with SI.

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Only in youth with history of assaultive trauma, low SES was associated with lower SI rates (trauma by SES interaction).

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Results suggest a stress inoculation effect that was shown in animal models, but has not been shown in human suicide research.

Mental Health Burden among Black Adolescents: The Need for Better Assessment, Diagnosis and Treatment Engagement

This study examines mental health symptoms among Black adolescents who were currently in mental health treatment and those who were not in treatment. The study uses a sample of Black adolescents (N=154) and logistic regression was performed to determine which psychological factors were associated with exhibiting mental health symptoms. Both groups experienced high amounts of trauma exposure history, recent suicidality, substance use, and depressive symptoms. Nearly one in four adolescents in the out of treatment group met diagnostic criteria for anxiety disorders. Implications include better screening for mental health symptoms to ensure Black adolescent have access to mental health treatment.

Impact of law enforcement-related deaths of unarmed black New Yorkers on emergency department rates, New York 2013-2016

BACKGROUND

Law enforcement-related deaths of unarmed black Americans may lead black communities to distrust public institutions. Our study quantifies the impact of law enforcement-related deaths of black New York residents on the use of hospital emergency departments (ED) during 2013-2016.

METHODS

We used regression discontinuity models stratified by race and time period (2013-2015 and 2015-2016) to estimate the impact of law enforcement-related deaths on ED rates. Dates of deaths and media reports were from the Mapping Police Violence database. We calculated the daily overall and condition-specific ED visit rates from the New York's Statewide Planning and Research Cooperative System.

RESULTS

There were 14 law enforcement-related deaths of unarmed black New York residents from 2013 to 2016. In 2013-2014, the ED rate among black New Yorkers decreased by 7.7 visits per 100 000 black New Yorkers (5% less than the average ED rate) using the date of media report as the cut-off with a 2-week exposure window. No changes in ED rates were noted for black New Yorkers in 2015-2016 or for white New Yorkers in either time period. Models using the date of death followed a similar pattern.

CONCLUSION

The decrease in ED rates among black New Yorkers immediately following media reports of law enforcement-related deaths involving unarmed black New Yorkers during 2013-2014 may represent potentially harmful delays in healthcare. Reforms implemented during 2015-2016 might have modified the impact of these deaths. Further investigation into the population health impacts of law enforcement-related deaths is needed.

A latent class analysis to identify how patterns of Intimate Partner Violence influence Early Childhood Development outcomes in Honduras

BACKGROUND

Intimate Partner Violence (IPV) against women is a complex phenomenon with long-term consequences for victims and their families.

OBJECTIVE

The goals of this study are two-fold: to identify common patterns of co-occurring and/or successive experiences with IPV; and to study the association between these IPV patterns and outcomes of Early Childhood Development (ECD) among the victim's children.

DATA AND PARTICIPANTS

Data was obtained from the 2011-12 Honduras Demographic Health Survey (DHS).

METHODS

A Latent Class Analysis (LCA) was conducted to define homogeneous patterns of experiences with IPV in terms of the type, severity, timing of the last event, and perpetrator of the violence. Outcomes of interest were binary variables indicating if a child is developmentally on track according to the ECD index and its four domains. LCA with distal outcomes and multivariate logistic regressions were used to measure the association between IPV patterns and ECD outcomes.

RESULTS

Five patterns of lifetime experiences with IPV were identified: (1)"no violence"; (2)"physical and sexual violence by an ex-partner"; (3)"current emotional violence"; (4)"current controlling, emotional and physical violence"; and (5)"past controlling, emotional and physical violence". Multivariate results show that children were less likely to be developmentally on track if their mothers were exposed to patterns of "physical and sexual violence by an ex-partner" or "current controlling, emotional and physical violence", relative to children whose mothers had not experienced violence. Further analysis of specific ECDI domains suggested that IPV hampers children's socioemotional development, but it is not associated with other domains of ECD.

CONCLUSION

Experiencing a pattern of co-occurrent forms of IPV negatively influences ECD and the socio-emotional development of the victim's children in low and middle-income countries. This study provides initial evidence about the complexity of this phenomenon and its long-lasting sequels.

Hopelessness and Delinquent Behavior as Predictors of Community Violence Exposure in Ethnic Minority Male Adolescent Offenders

Justice-involved boys from urban communities are disproportionately impacted by community violence exposure (ECV) and despite decades of research, rates of ECV in youth continue to increase particularly for youth involved in the juvenile justice system. Despite the increased risk of exposure, the majority of research focuses on what may protect youth from the deleterious outcomes associated with violence exposure, rather than strategies that may prevent the violence exposure from occurring. The current study seeks to shift the focus of research in this area to examining factors that may predict future violence exposure. Specifically, the purpose of the current study is to examine the role of hopelessness as a predictor of the risk for violence exposure in a sample of 831 justice-involved, urban boys ages 14-18 (52.2% African American, 42.1% Hispanic, 5.7% other). Results revealed that baseline levels of low aspirations and hopelessness towards the future indirectly predicted violence exposure 1 year later through engagement in delinquent behavior. Clinical implications for targeting youth with elevated risk and preventing future violence exposure are discussed.

The Prevalence and Longitudinal Patterns of Continuous Community Violence Exposure and Trauma-Related Symptoms in Adolescent Male Serious Offenders

The current study examined the longitudinal patterns of continuous exposure to community violence (ECV) and associated symptoms in serious adolescent male offenders. Using data from the Pathways to Desistance Study (Schubert et al., 2004), the current study examined the prevalence of continuous ECV and the stability in exposure over a 3-year period in 1,170 adolescent male offenders (M age at baseline = 16.05 years, SD = 1.15). The results revealed variability in adolescent offenders' ECV and trauma-related symptoms. A latent class analysis identified three classes of participants at each time point: "witnessed with hostility," "dually exposed [i.e., high probability of both witnessing and victimization] with anxiety and hostility," and "no/low exposure with anxiety and hostility." Participants in the witnessed with hostility class reported more baseline ECV than those in the other classes, ds = 0.62-1.37, and more violent offenses than those in the dually exposed with anxiety and hostility class, d = 0.48. In addition, participants in the witnessed with hostility class were older, d = 0.10, and reported more violent offenses at baseline, d = 0.07, than those in the no/low exposure class; however, participants in the no/low exposure class reported spending more time in secure settings with no community access than those in the witnessed with hostility class, d = 0.20. A latent transition analysis over a 3-year period revealed relatively high stability in ECV and trauma-related symptoms over time, with a large proportion of participants remaining in the same violence and trauma class at each transition.

The role of relationship proximity to witnessed community violence and youth outcomes

AIMS

This study examines whether the relational proximity to the victim or perpetrator of witnessed community violence is associated with youth symptoms.

METHODS

Data come from the Longitudinal Studies of Child Abuse and Neglect, a national high-risk sample. The sample included 12-year-old youth (N = 720) who had witnessed violence in their lifetimes. Ordinary least squares (OLS) regressions tested whether relationship proximity differentiated youth functioning (social competency, withdrawal, anxiety/depression, delinquency, and aggression), and whether gender moderated these effects.

RESULTS

Witnessing violence toward a parent was associated with greater withdrawal, delinquency, and aggression symptoms. Witnessing violence perpetrated by a stranger was associated with lower social competency, higher anxiety/depression, and higher delinquency. Two perpetrator associations differed by gender.

CONCLUSION

Findings suggest important differences in outcomes based on relational proximity to victims and perpetrators. The particularly widespread associations between witnessing violence against a parent and youth functioning underscore the importance of targeting interventions toward youth with parent victims.

Children's Exposure to Violence across Contexts in Relation to Posttraumatic Stress Symptoms

OBJECTIVE

Children in low-income, urban neighborhoods are at high risk of exposure to violence (ETV) across settings and subsequent posttraumatic stress symptoms (PTSS). Little research has examined how multiple forms of ETV co-occur and relate to variations in children's posttraumatic responses. Furthermore, previous research primarily uses variable-centered methods, which can obscure person-level differences. The current study used person-centered methods to derive commonly occurring patterns of ETV by examining frequency of witnessing and victimization across family, school, and community contexts. The current study related profiles of ETV to demographic variables and PTSS, with the goal of obtaining nuanced representations of urban children's experiences of, risk factors for, and responses to violence.

METHOD

Patterns of ETV were examined in a sample of 239 African American 7^th grade youth using latent profile analysis. Profiles were related to demographic variables and PTSS using logistic regression.

RESULTS

Results showed three profiles: Low (N = 130, 54.4%), Moderate (N = 87; 36.4%), and High (N = 22; 9.2%) Exposure groups. The High Exposure group showed the highest levels of PTSS. The Moderate group showed the lowest levels of all PTSS, except dissociation. In contrast, the Low Exposure group showed significantly higher numbing and hypervigilance than the Moderate Exposure group.

CONCLUSIONS

Results support a dose-response model of ETV and PTSS, but implicate situational factors (e.g., setting) as important in understanding posttraumatic responses. The systematic variation in ETV and subsequent differences in PTSS expression illustrate the need for individualized trauma-informed intervention and thorough screenings in low-income, urban neighborhoods.

The contribution of financial well-being, social support, and trait emotional intelligence on psychological distress

OBJECTIVES

While financial deprivation, social isolation, and low emotional intelligence (EI) have been separately identified as important predictors of mental illness, no research has assessed the contribution of these factors together in understanding early markers of severe psychological distress. This information can have key implications for the development of comprehensive interventions and psychological treatment programmes. This study investigated the shared and unique contribution of financial well-being, social support, and trait EI on different types of psychological distress.

DESIGN

A total of 309 patients seeking psychological treatment at an outpatient mental health clinic in the United States provided consent to participate in this study. Patients responded to online questionnaires corresponding to symptomatology, demographic characteristics, and psychometric assessments.

METHODS

Hierarchical linear regressions identified the common and unique role of each set of variables in predicting nine different symptom clusters of psychological distress.

RESULTS

Financial well-being, social support, and trait EI were negatively related to the majority of symptom clusters, together explaining between 20% and 53% of the variance. Whereas financial well-being and social support uniquely captured a significant amount of the variance in all outcomes, trait EI, most notably the well-being and self-control dimensions, captured the most.

CONCLUSIONS

The results highlight the importance of all factors in understanding variations in mental health among help-seeking urban individuals. Furthermore, the results identify well-being and self-control as emotional facets to consider in therapeutic programmes in as much as to mitigate the risk of severe psychological distress within this population.

PRACTITIONER POINTS

Together, financial well-being, social support, and trait emotional intelligence (EI) can help prevent psychological distress in help-seeking urban individuals. Perceived social support and social contact differentially contributed to improved symptoms of psychological distress. Studies should examine the impact of targeting well-being and self-control in psychological treatment. The correlational nature of this study highlights the need to replicate findings via experimental or longitudinal designs.

Indirect violence exposure and mental health symptoms among an urban public-school population: Prevalence and correlates

Available literature identifies the need for a deeper understanding of the role of gender, age and socioeconomic status in children's exposure to violence and associations with mental health (MH) outcomes. The 1548 participants for this study were enrolled from 28 public charter schools and 9 community-based settings; youth were administered a screener that assessed exposure to traumatic events and symptoms of post-traumatic stress disorder (PTSD) and depression. Respondents reported extremely high levels of exposure to indirect violence: 41.7% witnessed shooting/stabbing/beating; 18.3% witnessed murder; and 53.8% experienced the murder of someone close. Frequency of adverse MH outcomes was high: 21.2% screened positive for depression; 45.7% for lifetime PTSD; and 26.9% for current PTSD. More males than females reported witnessing shooting/stabbing/beating (p = .04); females more often reported experiencing the murder of someone close (p = .001). Indirect violence exposure generally increased with age. Youth attending schools with ≥90% free/reduced lunch participation (FRLP) showed significantly higher levels of violence exposure compared to youth in schools with <90% FRLP. Females endorsed significantly higher levels of depression (21.4% vs. 9.7%), and lifetime (53.9% vs. 34.9%) and current (32.5% vs. 19.6%) PTSD, compared with males (p < .0001, all comparisons). Female sex (aOR = 2.6), FRLP (aOR = 1.4 for ≥90% vs. <90%) and the number of different indirect violence exposures (aORs from 1.3 to 10.4), were significantly associated with a positive screen for any adverse MH outcome. Our data add important insights into gender heterogeneity of viewed violence, mental health symptoms, and their association-all of which are critical to guiding effective intervention efforts.

Interpersonal Gun Violence Research in the Social Work Literature

Interpersonal gun violence remains a major public health issue in the United States and beyond. This article explores the research on interpersonal gun violence published in peer-reviewed social work journals since the mid-1990s. Findings from this review indicate that the existing scholarship offers some important insights into this topic, particularly related to risk factors for and the effects of exposure to gun violence. These findings, however, also point to some shortcomings in the literature, including problems with the measurement and analytic treatment of exposure to gun violence and a lack of research with direct victims and perpetrators of gun violence. Implications for future research are discussed.

Violent Behaviors, Weapon Carrying, and Firearm Homicide Trends in African American Adolescents, 2001-2015

African American youths have the highest risk for firearm and other weapon related homicides. This study utilized the national Youth Risk Behavior Surveys from 2001 to 2015 to assess trends in violence related behaviors and weapon carrying of African American adolescents. Our analyses found statistically significant reductions in physical fighting and weapon carrying among African American male adolescents from 2007 to 2015. Planning suicide increased in both male and female African American adolescents since 2007. In addition, the number of firearm homicides increased in African American males. African American females and males had groups of items highly predictive of weapon carrying behaviors: alcohol, tobacco, and other drug use and violent risk behaviors. Both female and male students who made mostly A's or B's in school were significantly less likely to carry weapons in and out of school. Our findings indicate that firearm homicides have increased in African American adolescents, but weapon carrying in school going adolescents has significantly declined. School engagement and satisfactory school performance seems to have a significant protective effect on firearm homicides and violent behavior risks in African American adolescents.

The Longitudinal Relations between Dimensions of Community Violence Exposure and Developmental Outcomes among Adolescent Ethnic Minority Males

OBJECTIVE

Community violence exposure is multi-dimensional, yet the majority of studies examining the relation of exposure and developmental outcomes employ measures that collapse a wide range of experiences into a global summed scale. Building on research conducted in child maltreatment indicating that the impact of exposure varies as a function of the nature of maltreatment, the present study examines the contribution of dimensions of exposure to community violence (i.e., type - hearing about violence, witnessing violence, victimization - and relationship to perpetrator) on three areas of adolescent functioning: depression, aggression, and attention problems.

METHOD

Longitudinal data was gathered from a sample of racial/ethnic minority male adolescents (N = 246) living in impoverished urban neighborhoods. Multiple regression analyses assessed the relation between dimensions and outcomes cross-sectionally and longitudinally.

RESULTS

In line with findings from maltreatment, dimensions of violence exposure mattered differentially for developmental outcomes when examined concurrently. However, when relations are examined longitudinally, controlling for initial levels of functioning, the majority these relations disappear.

CONCLUSIONS

Assessing exposure to specific dimensions of exposure might improve understanding of adolescent concurrent, but not later functioning. Findings underscore the value of prospective data when examining the impact of dimensions of community violence exposure on functioning.

Nurturing Environments for Boys and Men of Color with Trauma Exposure

Boys and men of color are exposed to traumatic experiences at significantly higher rates than are other demographic groups. To understand and address the mental and behavioral health effects of trauma, including violent incidents, on this population, we review the literature showing the context for, outcomes of, and potential responses to trauma exposure. We present the existing research about the unique challenges and associated negative outcomes for boys and men of color, as well as identify the gaps in the literature. We present the potential nurturing responses by systems such as schools, law enforcement, and communities to trauma-exposed boys and men of color, and we describe evidence-based programs and practices that directly address trauma. Finally, we argue that, rather than using a deficit model, a model of optimal development can be used to understand how to support and protect boys and men of color through nurturing environments.

Understanding periviable birth: A microeconomic alternative to the dysregulation narrative

Periviable infants (i.e., those born in the 20th through 26th weeks of gestation) suffer much morbidity and approximately half die in the first year of life. Attempts to explain and predict these births disproportionately invoke a "dysregulation" narrative. Research inspired by this narrative has not led to efficacious interventions. The clinical community has, therefore, urged novel approaches to the problem. We aim to provoke debate by offering the theory, inferred from microeconomics, that risk tolerant women carry, without cognitive involvement, high risk fetuses farther into pregnancy than do other women. These extended high-risk pregnancies historically ended in stillbirth but modern obstetric practices now convert a fraction to periviable births. We argue that this theory deserves testing because it suggests inexpensive and noninvasive screening for pregnancies that might benefit from the costly and invasive interventions clinical research will likely devise.

Victimization and Human Immunodeficiency Virus-Related Risk Among Transgender Women in India: A Latent Profile Analysis

Globally, transgender women (TGW) experience multiple forms of victimization such as violence and discrimination that can place them at risk for poor sexual health. To date, research overlooks the heterogeneity in experiences of victimization among TGW. Furthermore, few studies have examined the association between victimization and sexual risk among TGW in India, despite the high burden of HIV and victimization in this community. Latent profile analysis was performed to identify patterns of victimization in a convenience sample of 299 TGW recruited from nongovernmental organizations across four states in India. Analysis of covariance was performed to examine differences in sexual risk (i.e., alcohol use before sex; inconsistent condom use with a male regular partner, a male causal partner, and a male paying partner; and having multiple sexual partners) between latent profiles. Five distinct profiles of Indian TGW were identified based on the type and severity of victimization: (1) Low victimization, (2) High verbal police victimization, (3) High verbal and physical police victimization, (4) Moderate victimization, and (5) High victimization. While controlling for age, education, income, HIV status, and marital status, results revealed that TGW in the moderate victimization and high victimization profiles had higher sexual risk than TGW in the low victimization and high verbal police victimization profiles. In addition, TGW in high verbal and physical police victimization profile had higher sexual risk than TGW in low victimization profile. These findings underscore the importance of tailoring sexual risk reduction interventions to the specific needs of TGW based on patterns of victimization.

Numbing of Positive, Negative, and General Emotions: Associations With Trauma Exposure, Posttraumatic Stress, and Depressive Symptoms Among Justice-Involved Youth

Increasing attention has been drawn to the symptom of emotional numbing in the phenomenology of posttraumatic stress disorder (PTSD), particularly regarding its implications for maladaptive outcomes in adolescence such as delinquent behavior. One change in the definition of emotional numbing according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) was the limitation to the numbing of positive emotions. Previous research with youth, however, has implicated general numbing or numbing of negative emotions in PTSD, whereas numbing of positive emotions may overlap with other disorders, particularly depression. Consequently, the goal of this study was to investigate whether numbing of positive emotions was associated with PTSD symptoms above and beyond numbing of negative emotions, general emotional numbing, or depressive symptoms among at-risk adolescents. In a sample of 221 detained youth (mean age = 15.98 years, SD = 1.25; 50.7% ethnic minority), results of hierarchical multiple regressions indicated that only general emotional numbing and numbing of anger accounted for significant variance in PTSD symptoms (total R(2) = .37). In contrast, numbing of sadness and positive emotions were statistical correlates of depressive symptoms (total R(2) = .24). Further tests using Hayes' Process macro showed that general numbing, 95% CI [.02, .45], and numbing of anger, 95% CI [.01, .42], demonstrated indirect effects on the association between trauma exposure and PTSD symptoms.