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Jahn JL, Simes JT, Jay J. Evaluating Firearm Violence After New Jersey's Cash Bail Reform. JAMA Netw Open 2024; 7:e2412535. [PMID: 38776084 PMCID: PMC11112443 DOI: 10.1001/jamanetworkopen.2024.12535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/20/2024] [Indexed: 05/25/2024] Open
Abstract
Importance Reducing the pretrial detention population has been a cornerstone of movements to end mass incarceration. Across many US cities, there are ongoing public debates on policies that would end pretrial detention due to the inability to afford bail, with some raising concerns that doing so would increase community violence. Objective To evaluate changes in firearm violence after New Jersey's 2017 bail reform policy that eliminated financial barriers to avoiding pretrial detention. Design, Setting, and Participants This case-control study used synthetic control methods to examine changes in firearm mortality and combined fatal and nonfatal shootings in New Jersey (2014-2019). New Jersey was chosen because it was one of the first states to systematically implement cash bail reform. Outcomes in New Jersey were compared with a weighted combination of 36 states that did not implement any kind of reform to pretrial detention during the study period. Data were analyzed from April 2023 to March 2024. Exposure Implementation of New Jersey's cash bail reform law in 2017. Main Outcomes and Measures Quarterly rates of fatal and nonfatal firearm assault injuries and firearm self-harm injuries per 100 000 people. Results Although New Jersey's pretrial detention population dramatically decreased under bail reform, the study did not find evidence of increases in overall firearm mortality (average treatment effect on the treated, -0.26 deaths per 100 000) or gun violence (average treatment effect on the treated, -0.24 deaths per 100 000), or within racialized groups during the postpolicy period. Conclusions and Relevance Incarceration and gun violence are major public health problems impacting racially and economically marginalized groups. Cash bail reform may be an important tool for reducing pretrial detention and advancing health equity without exacerbating community violence.
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Affiliation(s)
- Jaquelyn L. Jahn
- The Ubuntu Center on Racism, Global Movements, and Population Health Equity, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Jessica T. Simes
- Department of Sociology, Boston University, Boston, Massachusetts
| | - Jonathan Jay
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
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Iverson IA, Cook NE, Iverson GL. Adverse childhood experiences are associated with perceived cognitive difficulties among high school students in the United States. Front Psychol 2024; 15:1293013. [PMID: 38375116 PMCID: PMC10875032 DOI: 10.3389/fpsyg.2024.1293013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/04/2024] [Indexed: 02/21/2024] Open
Abstract
Objective Adverse childhood experiences (ACEs) are associated with mental health and cognitive problems, and mental health problems are associated with perceived cognitive difficulties among adolescents. The unique contribution of ACEs to cognitive difficulties after adjusting for poor mental health is not well understood and represents the purpose of this study. Methods The Adolescent Behaviors and Experiences Survey was conducted in 2021 with high school students in the United States. Cognitive difficulty was assessed with: 'Because of a physical, mental, or emotional problem, do you have serious difficulty concentrating, remembering, or making decisions?' Four ACEs were examined: sexual violence (lifetime and past 12 months), parental emotional abuse, and parental physical abuse. Students were asked about feeling sad or hopeless (past year), considering suicide (past year), and having poor mental health (past month). Binary logistic regressions examined the association between ACEs and cognitive problems, adjusting for mental health. Results Participants were 6,945 students. Students reporting poor mental health were very likely to endorse difficulty concentrating, remembering, or making decisions (girls = 81% and boys = 67%). Cognitive difficulty was uncommon among students who denied poor mental health (girls = 17% and boys = 12%). For boys [p < 0.001; R2 = 0.22] and girls [p < 0.001; R2 = 0.31], after adjusting for mental health problems, independent predictors of cognitive difficulties included parental verbal abuse and physical abuse. For girls, lifetime forced sexual intercourse and sexual violence during the past year were also independently associated. Conclusion ACEs are associated with perceived cognitive difficulty in both adolescent girls and boys, even after adjusting for poor mental health.
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Affiliation(s)
- Ila A. Iverson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Nathan E. Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Mass General for Children Sports Concussion Program, Boston, MA, United States
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Mass General for Children Sports Concussion Program, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, United States
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Frank M, Daniel L, Hays CN, Shanahan ME, Naumann RB, McNaughton Reyes HL, Austin AE. Association of Food Insecurity With Multiple Forms of Interpersonal and Self-Directed Violence: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:828-845. [PMID: 37009984 PMCID: PMC10666476 DOI: 10.1177/15248380231165689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Economic stress, broadly defined, is associated with an increased likelihood of multiple forms of violence. Food insecurity is a distinct economic stressor and material hardship that is amenable to programmatic and policy intervention. To inform intervention and identify gaps in the current evidence base, we conducted a systematic review to synthesize and critically evaluate the existing literature regarding the association between food insecurity and five forms of interpersonal and self-directed violence: intimate partner violence (IPV), suicidality, peer violence and bullying, youth dating violence, and child maltreatment, in high-income countries. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and searched six electronic databases from their start date through February of 2022. We included studies that examined food insecurity as the exposure and an outcome measure of IPV, suicide, suicidality, peer violence, bullying, youth dating violence, or child maltreatment; were peer-reviewed and published in English; reported quantitative data; and took place in a high-income country. We identified 20 relevant studies. Nineteen studies found that food insecurity was associated with an increased likelihood of these forms of violence. Results highlight the potential for programs and policies that address food insecurity to function as primary prevention strategies for multiple forms of violence and underscore the importance of trauma-informed approaches in organizations providing food assistance. Additional theory-driven research with validated measures of food insecurity and clearly established temporality between measures of food insecurity and violence is needed to strengthen the existing evidence base.
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Affiliation(s)
- Madeline Frank
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leah Daniel
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caroline N. Hays
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - Anna E. Austin
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Bryan RH, Beitz JM. Trauma-Informed Care: Positive and Adverse Childhood Experiences and WOC Nursing: An Integrative Review. J Wound Ostomy Continence Nurs 2023; 50:276-284. [PMID: 37467405 DOI: 10.1097/won.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Rebecca H Bryan
- Rebecca Bryan, DNP, AGPCNP, APN, New Jersey Department of Children and Families, Trenton, and School of Nursing, Rutgers University-Camden, Camden, New Jersey
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN-AP, CRNP, ANEF, FNAP, FAAN, School of Nursing, Rutgers University-Camden, Camden, New Jersey
| | - Janice M Beitz
- Rebecca Bryan, DNP, AGPCNP, APN, New Jersey Department of Children and Families, Trenton, and School of Nursing, Rutgers University-Camden, Camden, New Jersey
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN-AP, CRNP, ANEF, FNAP, FAAN, School of Nursing, Rutgers University-Camden, Camden, New Jersey
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Lam-Hine T, Bradshaw PT, Allen AM, Omi M, Riddell CA. A hypothetical intervention to reduce inequities in anxiety for Multiracial people: simulating an intervention on childhood adversity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.04.23290940. [PMID: 37333321 PMCID: PMC10274983 DOI: 10.1101/2023.06.04.23290940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Multiracial people report higher mean Adverse Childhood Experiences (ACEs) scores and prevalence of anxiety than other racial groups. Studies using statistical interactions to estimate racial differences in ACEs-anxiety associations do not show stronger associations for Multiracial people. Using data from Waves 1 (1995-97) through 4 (2008-09) of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we simulated a stochastic intervention over 1,000 resampled datasets to estimate the race-specific cases averted per 1,000 of anxiety if all racial groups had the same exposure distribution of ACEs as Whites. Simulated cases averted were greatest for the Multiracial group, (median = -4.17 cases per 1,000, 95% CI: -7.42, -1.86). The model also predicted smaller risk reductions for Black participants (-0.76, 95% CI: -1.53, -0.19). CIs around estimates for other racial groups included the null. An intervention to reduce racial disparities in exposure to ACEs could help reduce the inequitable burden of anxiety on the Multiracial population. Stochastic methods support consequentialist approaches to racial health equity, and can encourage greater dialogue between public health researchers, policymakers, and practitioners.
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Affiliation(s)
- Tracy Lam-Hine
- Stanford University School of Medicine, Division of Epidemiology & Population Health, Palo Alto CA
| | - Patrick T Bradshaw
- University of California Berkeley School of Public Health, Division of Epidemiology, Berkeley, CA
| | - Amani M Allen
- University of California Berkeley School of Public Health, Division of Community Health Sciences and Division of Epidemiology, Berkeley, CA
| | - Michael Omi
- University of California Berkeley Department of Ethnic Studies, Berkeley, CA
| | - Corinne A Riddell
- University of California Berkeley School of Public Health, Division of Biostatistics and Division of Epidemiology, Berkeley, CA
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Holcombe EA, Jones MS, Lehmann PS, Meldrum RC. Differential Exposure to Adverse Childhood Experiences Among Florida High School Students: The Intersection of Race, Ethnicity, and Gender. J Adolesc Health 2023; 72:553-559. [PMID: 36528515 DOI: 10.1016/j.jadohealth.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The prevalence of exposure to adverse childhood experiences (ACEs) across distinct intersections of race/ethnicity and gender among adolescents remains relatively unknown. The current study seeks to address this important gap in the literature using a statewide representative sample of Florida high school students. METHODS Data drawn from the 2020 Florida Youth Substance Abuse Survey (FYSAS) (N = 20,438) were analyzed to examine differences in ACE exposure among 26 racial/ethnic and gender subgroups of high-school aged youth. Lifetime exposure to ACEs was constructed using 10 different ACE categories to measure ACEs prevalence as reported exposure to 1+ ACEs and 4+ ACEs. RESULTS Exposure to ACEs was highly gendered and varied according to racial/ethnic subgroup. While notable differences across gender and racial/ethnic groups emerged when measuring prevalence as exposure to 1+ ACEs, several of these disparities were further amplified when prevalence was measured as exposure to 4+ ACEs. Native American female adolescents represented the group at greatest risk of high exposure to ACEs, with more than 50% of such youth reporting exposure to 4+ ACEs. DISCUSSION The prevalence of ACE exposure varies significantly across race/ethnic and gender subgroups of youth. These intersections should be considered for prevention efforts and clinical treatments of trauma exposure as ACEs may be linked to certain outcomes or behaviors based on high exposure in certain subpopulations of youth.
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Affiliation(s)
| | - Melissa S Jones
- Department of Sociology, Brigham Young University, Provo, Utah
| | - Peter S Lehmann
- Department of Criminal Justice and Criminology, Sam Houston State University, Houston, Texas
| | - Ryan C Meldrum
- Department of Criminology and Criminal Justice, Florida International University, Miami, Florida
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Walter C, Miller M, Jones V, Ryan LM. Emergency Department-Attended Injuries Resulting from School-Based Violence in Baltimore Adolescents, 2019-2020. THE JOURNAL OF SCHOOL HEALTH 2023; 93:219-225. [PMID: 36426581 DOI: 10.1111/josh.13288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/29/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Our objective is to describe violence-related injuries to early adolescents that occurred at school, resulting in emergency department (ED) evaluation. METHODS This retrospective cohort study at an urban academic pediatric ED in Baltimore, MD, identified patients 10-15 years old who presented with an injury from intentional, interpersonal violence that occurred at school between January 2019-December 2020. Descriptive statistics were used to summarize patient and event characteristics. RESULTS Of 819 youth 10-15 years of age evaluated for a violence-related injury, school was the location in 115 cases (14.0%). All events occurred prior to the statewide stay at home order (March 30, 2020). School-injured youth had a mean age of 12.7 ± 1.7 years and were predominantly male (64.3%). Of the 115 cases, 75 (65.2%) involved an altercation with a peer, 26 (22.6%) involved a teacher or school staff, 6 (5.2%) involved a family member, 1 (0.9%) involved police, 6 (5.2%) involved an unknown party, and 1 (0.9%) involved an unrelated but known adult. All injured youth were discharged from the ED. CONCLUSIONS School-based violence is a well-recognized cause of traumatic injuries to adolescents and may involve peers, teachers, or school staff.
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Affiliation(s)
- Creason Walter
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mattea Miller
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vanya Jones
- Health, Behavior, & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Leticia Manning Ryan
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Matson PA, Flessa SJ, Hoff A, Alinsky R, Alexander K, Lich KH, Johnson RM. "What Do You Consider Use?" Perspectives of Black Youth on Cannabis Use. J Adolesc Health 2023; 72:254-259. [PMID: 36443160 DOI: 10.1016/j.jadohealth.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/30/2022] [Accepted: 09/17/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Adolescent health surveillance systems are critical for understanding patterns of cannabis use; however, their limitations underscore the need for studies that generate new insights, particularly from individuals who are most impacted by negative outcomes. Our objectives were to learn about youths' cannabis use and their perceptions of their peers' cannabis use; their perspectives about trajectories of cannabis use over time and factors that influence trajectories; and perceived risks and benefits associated with cannabis use. METHODS A group model building approach was used to gather data about cannabis use from a sample of urban, Black youth. Information about participants' cannabis use was assessed on eligibility screener, enrollment survey, and through structured activities over the course of four group model building workshops. RESULTS Participants [(n = 20) mean age 18; 35% male and 95% Black] exclusively used the terms weed and blunts for cannabis. Youth who consume peers' blunts would not characterize themselves as cannabis users. Collectively, youth estimated the majority of Baltimore youth used cannabis by age 16 and that most used daily. Youth described cannabis as more beneficial than harmful. There were no gender differences in prevalence of use, but there were gender dynamics to shared use. DISCUSSION Participatory research with urban, Black youth suggests youths' perceptions are misaligned with the ways that researchers conceptualize cannabis use. To better understand the scope of youth cannabis use and its harms, it is critical to leverage input from youth with lived experience to ensure survey tools adequately capture the way youth see themselves using cannabis.
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Affiliation(s)
- Pamela A Matson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Sarah J Flessa
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Annika Hoff
- College of Arts and Sciences, Cornell University, Ithaca, New York
| | - Rachel Alinsky
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Kristen Hassmiller Lich
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Dissecting early life stress-induced adolescent depression through epigenomic approach. Mol Psychiatry 2023; 28:141-153. [PMID: 36517640 PMCID: PMC9812796 DOI: 10.1038/s41380-022-01907-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
Early life stress (ELS), such as abuse and neglect during childhood, can lead to psychiatric disorders in later life. Previous studies have suggested that ELS can cause profound changes in gene expression through epigenetic mechanisms, which can lead to psychiatric disorders in adulthood; however, studies on epigenetic modifications associated with ELS and psychiatric disorders in adolescents are limited. Moreover, how these epigenetic modifications can lead to psychiatric disorders in adolescents is not fully understood. Commonly, DNA methylation, histone modification, and the regulation of noncoding RNAs have been attributed to the reprogramming of epigenetic profiling associated with ELS. Although only a few studies have attempted to examine epigenetic modifications in adolescents with ELS, existing evidence suggests that there are commonalities and differences in epigenetic profiling between adolescents and adults. In addition, epigenetic modifications are sex-dependent and are influenced by the type of ELS. In this review, we have critically evaluated the current evidence on epigenetic modifications in adolescents with ELS, particularly DNA methylation and the expression of microRNAs in both preclinical models and humans. We have also clarified the impact of ELS on psychiatric disorders in adolescents to predict the development of neuropsychiatric disorders and to prevent and recover these disorders through personalized medicine.
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Kurani S, Webb L, Cadet K, Ma M, Gibson M, Jallah N, Park JN, Johnson RM. Area-level deprivation and adverse childhood experiences among high school students in Maryland. BMC Public Health 2022; 22:811. [PMID: 35459200 PMCID: PMC9034595 DOI: 10.1186/s12889-022-13205-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/21/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Nearly one-half of Americans have been exposed to at least one adverse childhood experience (ACE) before turning 18, contributing to a broad array of problems spanning physical health, mental and behavioral health, and psychosocial functioning. METHODS This was a cross-sectional, survey research study, using 2018 data from a state adolescent health surveillance system, i.e., Maryland Youth Risk Behavior Survey/Youth Tobacco Survey. The population-based sample of Maryland high school students (n = 41,091) is representative at the state and county levels. The outcome variables included five binary measures of ACEs (i.e., food insecurity, parental substance use/gambling, parental mental illness, family member in jail/prison, and caregiver verbal abuse), and number of ACEs. The main exposure variable, area-level socioeconomic disadvantage, was assessed at the county level using a continuous measure of the area deprivation index (ADI). Additional covariates included: rural county status, age, race/ethnicity, sex, and sexual or gender minority (SGM) status. We used mixed-effect multivariate logistic regression to estimate the odds of ACEs in association with socioeconomic deprivation. Models were adjusted for all covariates. RESULTS County-level ADI was associated with 3 of the 5 ACES [i.e., food insecurity (OR = 1.10, 95% CI: 1.07-1.13), parental substance use/gambling (OR = 1.05, 95% CI: 1.02-1.07), and incarceration of a family member (OR = 1.14, 95% CI: 1.09-1.19)]; and with having at least one ACE (i.e., OR = 1.08, 95% CI: 1.05-1.10). Odds of reporting at least one ACE were higher among girls, older adolescents (i.e., aged 16 and ≥ 17 relative to those aged ≤ 14 years), and among SGM, Black, and Latinx students (all ORs > 1.20). CONCLUSIONS ACEs greatly increase risk for adolescent risk behaviors. We observed an increased likelihood of adversity among youth in more deprived counties and among Black, Latinx, or SGM youth, suggesting that social and structural factors play a role in determining the adversity that youth face. Therefore, efforts to address structural factors (e.g., food access, family financial support, imprisonment as a sanction for criminal behavior) could be a critical strategy for primary prevention of ACEs and promoting adolescent health.
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Affiliation(s)
- Shaheen Kurani
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
| | - Lindsey Webb
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Kechna Cadet
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ming Ma
- Department of Community & Behavioral Health, Colorado School of Public Health, Denver, CO, USA
| | - Marianne Gibson
- Maryland Department of Health, Opioid Operational Command Center, Crownsville, MD, USA
| | - Nikardi Jallah
- Maryland Department of Health, Prevention & Health Promotion, Baltimore, MD, USA
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Iverson GL, Karr JE. Association Between Concussions and Suicidality in High School Students in the United States. Front Neurol 2022; 13:810361. [PMID: 35493820 PMCID: PMC9039310 DOI: 10.3389/fneur.2022.810361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Importance Prior research has shown a statistically significant association between sustaining a concussion and suicidality in adolescents, but this prior research controlled for relatively few variables predictive of suicidality. Objective To examine whether sustaining a concussion remained a significant predictor of suicidality after controlling for relevant covariates (e.g., sexual abuse/assault, bullying, substance use, depression), hypothesizing that the relationship between concussion and suicidality would become non-significant after controlling for these variables. Design This study involved secondary data analysis of the 2019 Youth Risk Behavior Surveillance (YRBS) System, a national cross-sectional study of adolescents. Analyses were stratified by gender. Setting A national sampling of U.S. high school students. Participants Eleven thousand two hundred sixty-two students in the YRBS database, including 5,483 boys and 5,779 girls. Exposure(s) Participants included in the analyses reported whether, in the last year, they experienced a concussion and/or suicidality. Main Outcomes and Measures The main outcome was suicidality (i.e., ideation, planning, attempt), which was predicted by concussion in an unadjusted analysis and by concussion along with other risk factors in a multivariable analysis. Results The final sample included 11,262 participants with available data on concussion and suicidality in the last year (14–18 years-old; 51.3% girls; 49.0% White). Per unadjusted odds ratios with 95% confidence intervals, there was a relationship between concussion and suicidal ideation [girls: OR = 1.46 (1.24, 1.73); boys: OR = 1.69 (1.41, 2.03)], planning (girls: OR = 1.39 [1.16, 1.66]; boys: OR = 1.76 [1.44, 2.14]), and attempt [girls: OR = 1.70 (1.32, 2.19); boys: OR = 3.13, (2.37, 4.15)]. These relationships became mostly non-significant after controlling for relevant risk factors for suicidality. The adjusted odds ratios showed no relationship between concussion and suicidal ideation [girls: OR = 1.11 (0.86, 1.44); boys: OR = 1.24 (0.92, 1.69)] or planning (girls: OR = 1.07 [0.82, 1.40]; boys: OR = 1.12 [0.82, 1.55]); but a significant relationship with suicide attempts in boys [OR = 1.98 (1.28, 3.04)], but not girls [OR = 1.05 (0.74, 1.49)]. Conclusions and Relevance There was an association between concussion and suicidality in U.S. high school students; however, after controlling for other variables (e.g., depression, sexual abuse/assault, illicit drug use), there was no association between concussion and suicidality aside from a significant relationship between concussion and attempts in boys.
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Affiliation(s)
- Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Spaulding Research Institute, Charlestown, MA, United States
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
- *Correspondence: Grant L. Iverson
| | - Justin E. Karr
- Department of Psychology, University of Kentucky, Lexington, KY, United States
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