Trauma behind the keyboard: Exploring disparities in child sexual abuse materials exposure and mental health factors among investigators and forensic examiners - A network analysis

BACKGROUND

Despite acknowledging the detrimental impact of child sexual abuse material (CSAM) exposure on the mental and physical well-being of investigators and forensic examiners, there is a need for comprehensive exploration into the complex relationship between CSAM exposure, its various dimensions, mental health (i.e., anxiety, depression, and PTSD), and burnout, as well as the presence of positive attitudes towards the job.

OBJECTIVE

To understand how CSAM exposure, mental health and burnout interconnect and cluster within distinct networks of police investigators and forensic examiners.

PARTICIPANTS AND SETTING

Police investigators and forensic examiners from across the United States who were exposed to CSAM as part of their professions (N = 470).

METHODS

Participants, recruited through connections with the National Criminal Justice Training Center, completed an anonymous online survey.

RESULTS

The network analysis revealed differences in centrality between investigators and forensic examiners, particularly in their associations with exposure factors and mental health variables. Edges invariance tests showed differences in the strength of these associations, with some factors being more strongly linked to PTSD avoidance symptoms among investigators and others among forensic examiners. Stability analyses suggested potentially greater heterogeneity among investigators, while both groups displayed high stability in other centrality indices.

CONCLUSIONS

This study contributes to our comprehension of the distinct experiences and challenges faced by CSAM investigators and forensic examiners, and specifically the nuanced disparities between CSAM investigators and forensic examiners in terms of their exposure to CSAM content and the associated mental health factors. These insights highlight the imperative need for tailored support mechanisms and interventions that can effectively address the unique challenges encountered by individuals working tirelessly in this critical field.

"An escape from the isolation": Youth thoughts about the impact of COVID-19 on adolescent sexual behavior and alcohol use

INTRODUCTION

The COVID-19 pandemic likely affected adolescent sexual behaviors and alcohol use, although how is not well understood.

METHOD

Youth were sampled from the national, online longitudinal Growing up with Media study. They responded via text messaging to open-ended questions about how the COVID-19 pandemic may have impacted the sexual behavior and alcohol use of adolescents. Conventional content analysis summarized open-ended responses.

RESULTS

416 responses were analyzed from 335 participants (aged 15-30, US residents), 81 of whom provided data for both topics. Participants suggested that the pandemic affected some youths' sexual health precautions (increased and varying) and attitudes about sex (positive and negative). They discussed how adolescents met partners during the pandemic, including increased use of online platforms. Participants also suggested researchers investigate sexual risk in the realm of COVID-19 transmission and the practice of "safe sex." Many participants believed adolescents were drinking alcohol more as a result of the pandemic, both alone and with friends; however, others perceived adolescents were drinking less. Participants proposed researchers investigate adolescent drinking habits during the pandemic, as well as how this compares to before the pandemic and the type and quantity of alcohol consumed.

CONCLUSIONS

Young people believe adolescent sexual relationships and drinking behaviors changed due to the pandemic, though how varied. Future research could examine the contexts and individual differences that shape these varying behaviors. Overall, this study highlights the importance of directly asking youth about their pandemic experiences and the diversity of views on how the pandemic has influenced adolescent behavior.

The mental health of officials who regularly examine child sexual abuse material: strategies for harm mitigation

BACKGROUND

The current study aims to better understand the mental health and subjective well-being of investigators and forensic examiners exposed to child sexual abuse material (CSAM) by examining which components of this work are associated with elevated mental health conditions and decreased well-being, as well as the intra-personal and organizational variables that may mitigate harm and improve well-being.

METHODS

Police investigators, forensic examiners, and others connected with the criminal justice system from across the United States who were exposed to CSAM as part of their professions (N = 500) completed an anonymous online survey. Participants were recruited through connections with the National Criminal Justice Training Center.

RESULTS

Duration, frequency, amount, and content of CSAM exposure was not related to poorer mental health with the exception of exposure to violent CSAM which was related to elevated post-traumatic stress symptoms. Several agency-level practices and policies, such as the availability of an Officer Wellness Program and more frequently knowing the final case resolution, were related to better mental health and well-being. Harm mitigation strategies, such as talking to other officers investigating the case and taking breaks from the material being viewed, were also related to better mental health.

CONCLUSIONS

Findings indicate that police agencies have options for implementing agency-level procedures and practices that have the potential to reduce the negative impact of CSAM investigations. Additionally, many investigators use strategies that are correlated with greater well-being, suggesting opportunities for improving training programs.

Correlates of intimate relationship satisfaction among investigators of child sexual abuse material

Introduction

This study investigates correlates of intimate relationship satisfaction among investigators of child sexual abuse material (CSAM). Previous research has shown that exposure to CSAM content can negatively impact investigators' emotional wellbeing, but little is known about its association with their intimate relationships.

Methods

The study included 500 participants who were police investigators, forensic examiners, and other professionals connected with the criminal justice system in the United States that are exposed to CSAM as part of their profession. The study collected data through an anonymous survey administered via the Qualtrics online survey system.

Results

The findings reveal that higher levels of depressive symptoms and post-traumatic stress disorder are associated with lower relationship satisfaction among CSAM investigators. Additionally, group connectedness is positively related to relationship satisfaction for both men and women. Parent investigators also reported lower relationship satisfaction, suggesting unique challenges faced by this subgroup. Exposure to varying types of CSAM content was not significantly related to lower relationship satisfaction. This study highlights the association between depressive symptoms and PTSD with relationship satisfaction among CSAM investigators, emphasizing the role of group connectedness in promoting positive outcomes for both male and female investigators.

Discussion

Recognizing the association between depressive symptoms and PTSD with relationship satisfaction can guide interventions and support services for investigators, promoting group connectedness and addressing mental health concerns to enhance resilience and effectiveness in combating child exploitation.

Diffusion effects of a sexual violence prevention program leveraging youth-adult partnerships

The purpose of the current study was to examine the diffusion effects of a youth-led sexual violence prevention program (i.e., Youth Voices in Prevention [Youth VIP]). Specifically, social network analysis was used to measure the extent to which Youth VIP changed behaviors for 1172 middle and high school youth who did not attend program events but were friends with Youth VIP participants and completed the first and final survey (approximately 2 years apart). Findings suggest that there was considerable interpersonal communication about Youth VIP among the students generated by program participation. Specifically, youth with friends who participated in Youth VIP were more likely to report hearing their friends talk about Youth VIP and reported talking to their friends about Youth VIP compared with those not connected to Youth VIP participants. However, there were no diffusion effects found for behavioral outcomes (i.e., bystander intervention behavior, violence victimization, and perpetration). Given the mixed findings, further research is needed to determine the extent to which youth-led sexual violence prevention initiatives lead to changes in broader community-wide changes in youths' behaviors.

Event Characteristics of Sexual Violence Perpetration Against Romantic Partners Versus Non-Romantic Partners

Tactics used to perpetrate sexual violence may be crucial to understanding when and why sexual violence occurs. Moreover, most sexual violence occurs between people who know each other-including in the context of dating or sexual relationships. Little is known about the context of sexual violence that occurs with non-romantic partners. To address these research gaps, we examined online survey data from 786 young adults (weighted n = 763) aged 19 to 27 years, living across the United States. Findings suggest that 60% of sexual assault, 40% of attempted rape, 42% of rape, and 67% of coercive sex were perpetrated against a romantic partner, defined as a current or ex-boyfriend, girlfriend, spouse, or domestic partner. Contextual differences were noted by relationship type: Those who perpetrated against romantic partners were more likely than those who targeted non-romantic partners to report that it occurred because they were feeling sad or angry. They were also more likely to say that the other person was completely responsible for what happened. Conversely, those who aggressed against non-romantic partners were more likely to say that someone else found out about what happened. Making the other person feel guilty was the most common tactic for both groups. The most frequently endorsed reason for perpetrating sexual violence was "feeling really horny," although feeling "good" or being drunk/high were also common reasons noted by aggressors. Afterward, many said they felt guilty or ashamed and were worried about the other person's feelings. Fear of getting caught was universally absent. Findings support the importance of building emotion regulation and emotional awareness skills in sexual violence prevention programming. Prevention programs should also discuss coercion as a violence tactic, since perpetrators may not always recognize this to be sexual violence. More generally, violence prevention programs should also address healthy relationships, consent, and taking responsibility.

Overlap Between Exposure to Suicidal Behavior and Indirect Interpersonal Violence: Evidence for a More Integrated Approach to Violence Research

This study examines the overlap between indirect exposure to forms of interpersonal violence and suicidal behavior, and the impact of the co-occurrence of these exposures on indicators of depressed mood and substance use among adolescents. Participants were a national sample of 3,917 youth aged 14-15 years, recruited online between June 2018 and March 2020, including an oversample of sexual and gender minority youth. Eight in ten (81.3%) youth reported exposure to indirect interpersonal violence and/or suicidal behavior in their lifetimes: 39.5% reported only interpersonal violence exposure, 5.9% only suicidal behavior exposure, and 35.9% reported both. Youth who reported exposure to interpersonal violence were almost three times more likely (adjusted odds ratio [OR] = 2.78, p < .001) to also report suicidal behavior exposure. Compared with youth having no indirect violence exposure, those with only interpersonal violence exposure were 2.25 times more likely (p < .001), those with only exposure to suicidal behavior 2.93 times more likely (p < .001), and those with both were 5.63 times more likely to report recent depressed mood. The unadjusted odds of any substance use was significantly elevated for each type of indirect violence exposure, with the highest odds seen among youth with dual interpersonal violence and suicide exposure (OR = 4.87, p < .001). For both outcomes, significant findings remained but were attenuated after adjusting for demographic characteristics, non-victimization adversity exposure, and cumulative direct victimization. Findings suggest that the combination of exposure to interpersonal violence and suicidal behavior appears to be particularly impactful. Results highlight that assessment of trauma exposure among adolescents needs to be more comprehensive and include not only direct and indirect interpersonal violence, but also knowledge of other people's suicidal thoughts and behaviors.

Polyvictimization Among Sexual and Gender Minority Youth

INTRODUCTION

Polyvictimization is a significant public health issue. Sexual and gender minority youth are important to include in polyvictimization research because they report higher rates of victimization than nonsexual and gender minority youth. This study examines whether polyvictimization attenuates the associations between individual types of victimization and depressed mood and substance use across gender and sexual identities.

METHODS

Data were collected cross-sectionally from 3,838 youth aged 14-15 years. Youth were recruited through social media between October 2018 and August 2019 across the U.S. Analyses were conducted in July 2022. Sexual and gender minority youth were oversampled. Depressed mood and substance use were dependent variables.

RESULTS

Transgender boys were the most likely to be polyvictims (25%). Transgender girls (14.2%) and cisgender sexual minority girls (13.4%) also reported high rates. Cisgender heterosexual boys were the least likely to be classified as polyvictims (4.7%). When adjusting for polyvictimization, existing relationships between individual types of victimization (e.g., theft) and depressed mood became nonsignificant in most cases. Of exception, witnessing violence and peer victimization remained significant predictors of the odds of depressed mood. Most associations between individual types of victimization and substance use became nonsignificant after considering polyvictimization, with the exception of cisgender heterosexual boys and girls, for whom many remained significant but attenuated (e.g., emotional interpersonal violence).

CONCLUSIONS

Sexual and gender minority youth experience a disproportionate number of victimizations across multiple domains. A comprehensive assessment of victimization exposure may be important when considering prevention and intervention approaches for depressed mood and substance use.

Impact of the COVID-19 pandemic for youth with a history of exposure to self-directed violence

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic created a sudden shift in the social lives of youth with important negative impacts on mental health. The current article aims to understand how the pandemic may have differentially impacted the mental health of adolescents and young adults with recent (1 year or less) and past (> 1 year) exposure to self-directed violence (SDV).

METHOD

Data were collected online from 990 youth and young adults, aged 13-23 years between November 27, 2020 and December 11, 2020.

RESULTS

Participants who had recently been exposed to SDV reported being more impacted by the pandemic and had poorer mental health indicators. Participants with past SDV exposure who engaged in a high number of prosocial activities (e.g., talking with friends) were less likely to report depressive symptoms (β = -.13, p = .01) than similarly engaged nonexposed participants; the same was true for recently exposed participants (β = -.14, p = .02).

CONCLUSIONS

Findings highlight that the effects of the COVID-19 pandemic on the mental health of young people are compounded by exposure to mental health concerns of people in their network. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Implementation of a Risk Reduction Protocol in Youth Violence Research

This article presents data from the Growing up with Media study related to the implementation of a risk reduction protocol that resulted in three groups of youth: low-risk youth (no flags), youth flagged because of violence involvement and not clinically referred; and flagged youth who were referred to a team clinician due to additional risk considerations. Data is from 3,979 U.S. youth 14-15 years of age recruited through social media between October 2018-August 2019. Four in ten youth were flagged for review. Findings suggest that this methodology of identifying and reviewing cases appears to be working as intended: Not only did referred youth have more flags than non-referred youth, but post-hoc analyses suggested that these youth also had higher rates of psychosocial problems (e.g., non-victimization adversity, substance use and depressed mood). The implementation of a risk reduction protocol such as the one described in this article adds a layer of human subject protection beyond the more standard list of websites and hotlines provided to all participants in most studies. This protocol leads the way for future studies to recreate a similar process to address concerning responses collected from survey research.

Exposure to a Youth-Led Sexual Violence Prevention Program Among Adolescents: The Impact of Engagement

Objective

Most studies of peer sexual violence (SV) prevention programs for adolescents focus on program outcomes or feasibility and acceptability; few examine how exposure levels or dosage affects impact. The present study examined the effects of attending multiple community-located youth-led prevention events, as compared to attending one or none, on peer violence (PV)-related attitudes and behaviors.

Method

Middle and high school students (M age at first wave = 13.7; 53.2% female; 76.5% White; 21.0% Native American) responded to surveys across 3 years. Logistic regression analyses compared students who attended one community-based event, two or more events, and zero events on sexual violence victimization, any other violence perpetration/victimization, social norms, denial of the problem of sexual violence, and bystander behaviors.

Results

After controlling for exposure to longer prevention leadership training as well as baseline outcome levels, youth who participated in two or more community prevention events showed lower perpetration over time, improved prevention attitudes, and more helpful bystander actions in response to peer sexual violence. No significant differences were noted for attendance at one community-based event.

Conclusions

Impact of out of school prevention events on youth behavior depends on more vigorous engagement than one-time contacts. Community-based prevention programs can utilize youth-led engagement strategies to help increase youth participation and resulting benefits.

Understanding Sexual Harassment Through an Individual and Relational Lens: Are Risk Factors the Same for Female and Male Perpetrators?

Given widespread recognition of sexual violence as a public health concern, sexual harassment has garnered considerable attention from researchers and the public. Yet research with adolescent samples has typically focused on the experiences of victims rather than perpetrators, and males as perpetrators and females as victims. In the current article, we consider whether risk and protective factors operate similarly within and across sex assigned at birth. A national sample of youth, ages 14 and 15, were recruited via social media and surveyed online (N = 1,981). At the individual level, girls who sexually harassed others, were more likely to have a propensity to respond to stimuli with anger compared to boys who sexually harassed. At the relational level, girls who sexually harassed were more likely to be victims of sexual harassment compared to boys, and having a negative peer environment (have delinquent peers, seen someone get attacked, and know someone who has been sexually assaulted) was of particular importance in understanding why girls harass others. For boys who harass, family relations, having seen or heard about peer physical or sexual assault and bullying perpetration were important for contextualizing boys' sexual harassment. As empathy increased, the relative odds of sexually harassing decreased for girls. Future research should explore motivations for perpetrating sexual harassment, bystander interventions, and longitudinal frameworks to identify causal patterns to determine which factors inhibit or facilitate sexual harassment.

Violent Media in Childhood and Seriously Violent Behavior in Adolescence and Young Adulthood

PURPOSE

To quantify the relative odds of self-reported seriously violent behavior in adolescence and young adulthood given one's self-reported violent media diet in childhood.

METHODS

Baseline data were collected nationally online from 1,586 youth 10-15 years of age in 2006. Follow-up data were collected in 2010-2011 and 2016. Children reported the amount of music, video games, television, websites with real people, and cartoons that depicted "physical fighting, hurting, shooting, or killing." Seriously violent behavior was assessed 5 and 10 years later.

RESULTS

887 adolescents completed the survey at baseline and 5-year follow-up. The relative odds of reporting seriously violent behavior over time were 2.45-fold higher (p < .001) with each incremental increase in one's baseline violent media diet. After adjusting for other potentially influential characteristics, results persisted (aOR = 1.70, p = .01). The relative odds also were elevated for those frequently exposed to violence in music (aOR = 3.28, p = .03), television (aOR = 3.51, p < .001), and video games (aOR = 3.27, p = .02). 760 young adults completed measures at baseline and 10-year follow-up. The relative odds of seriously violent behavior increased 2.18-fold (p = .001) with each incremental increase in one's baseline violent media diet. After adjusting for other factors, the association persisted (aOR = 1.72, p = .03). Frequent exposure to violence in video games (aOR = 3.28, p = .03) and television (aOR = 3.14, p = .02) also were implicated.

DISCUSSION

Exposure to violent media in childhood may be one modifiable influence on seriously violent behavior in adolescence and adulthood, even for those who have other risk factors.

High School Students' Perceptions of School Personnel's Intentions to Help Prevent Teen Sexual and Dating Violence: Associations with Attitudes and Intended Behaviors. J Interpers Violence 2022;37:NP5471-NP5494. [PMID: 35369777 DOI: 10.1177/0886260520960115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Adolescents are at high risk for sexual and dating violence (SDV) at school, indicating need for both adolescents and school personnel to engage in bystander behavior to prevent SDV. Adolescents' perceptions of social norms about bystander behavior, including their perceptions about social norms among school personnel, may impact adolescents' own SDV attitudes and intended bystander behavior. Based on social norms theory, the current research examines adolescents who underestimate, accurately perceive, and overestimate school personnel's reactive (responding to a current situation) and proactive (spreading messaging about prevention) bystander behaviors. High school students (N = 3,404; mean age = 15.7; 87.2% White; 87% heterosexual) and school personnel (N = 1,150) from 25 schools completed surveys. Adolescents who underestimated school personnel's reactive and proactive bystander behavior had more accepting attitudes towards violence and less bystander behavior intentions. Correcting misperceived norms about bystander behavior may improve students' own bystander behavior.

Predictors of Multidisciplinary Team Sustainability in Work With Child Sex Trafficking Cases

A coordinated response by a trained multidisciplinary team (MDT) can help support child sex trafficking (CST) victims, but little is known about factors that influence the development and sustainability of MDTs in this work. An online survey was conducted with 171 professionals who attended a Multidisciplinary Team Child Sex Trafficking (MDT-CST) training to identify factors related to team growth. Increased MDT success was related to: (1) the presence of a CST-specific advocacy organization in the community; (2) other community agencies active in supporting CST victims (e.g., SANE nurses, faith-based organizations, and runaway shelters); (3) a greater breadth of professional representation on the MDT; and (4) agency leadership support for the CST action plan. Most of the MDTs sustained and increased their coordination with other community agencies over time, but the study identified that growth is improved when administrators support team efforts and there are resources and supports for CST victims elsewhere in the community.

What Youth Think About Participating in Research About Exposure to Self-directed Violence

PURPOSE

To help reduce suicide and other forms of self-harm, research with youth and their exposure to self-directed violence is critical. Yet, we know little about how participants feel about taking part in a survey that asks about such exposure. The present article aims to understand the survey experience of youth and young adult participants in a study about exposure to self-directed violence.

METHODS

A total of 990 participants, aged 13-23 years, were recruited through study advertisements on Facebook and Instagram between November 27, 2020, and December 4, 2020. Data for this cross-sectional study were collected in the United States.

RESULTS

A total of 37.6% of participants felt somewhat upset from their survey experience, and 14.9% were upset or extremely upset with the highest levels of upset reported by cisgender sexual minority girls and gender minority youth. Lower odds of saying one's contributions were valuable were noted for cisgender sexual minority boys and gender minority youth compared to cisgender heterosexual boys, as well as youth who reported exposure to self-directed violence. Eight in 10 youth felt it was important to ask questions about self-directed violence exposure in surveys.

CONCLUSIONS

The research and practitioner communities should be particularly mindful of high-risk populations and identify innovative ways to better support and encourage their voice in research, as well as highlight the value of their participation. The results provide some guidance for those conducting research with youth on this topic.

Evaluating the Impact of a Youth-Led Sexual Violence Prevention Program: Youth Leadership Retreat Outcomes

Involving youth in developing and implementing prevention programs to reduce sexual violence (SV) has the potential to improve prevention outcomes. However, there has been little focus on youth-led SV prevention programs, and limited evaluation research to help guide efforts. The current study examined the effectiveness of Youth Voices in Prevention (Youth VIP) leadership retreats on SV victimization and perpetration, forms of violence related to SV (e.g., bullying), SV bystander behaviors and readiness, and perceptions of norms related to SV prevention. Results identified mixed findings for program impact, with variations in outcomes that can help guide future youth-led prevention program initiatives. Youth attending a large "kick-off" leadership retreat (that was less youth-led that subsequent smaller retreats) later reported more bystander behaviors, but also reported increased perpetration and victimization, compared to non-attending youth. However, youth attending smaller, more focused leadership retreats held during the school year, reported reductions in sexual harassment perpetration and improved bystander behaviors and attitudes compared to non-attending youth. Evaluation of moderator variables suggests that program impact was generally stronger for younger participants, sexual minority youth, and non-White youth (which were largely Native American youth in this sample). Findings suggest promise for youth-led prevention work but also highlight the need for testing the impact of different training structures and modalities. Clinical trials number: NCT03207386.

Voices of Youth and Emerging Adults on Suicide Prevention: Experiences and Expectations

Self-directed violence (SDV) is a significant public health issue for adolescents and emerging adults, and yet youth exposure to prevention messaging and youth perspectives on SDV prevention needs are understudied. The current study sought to better understand the ways in which a national sample of youth and emerging adults were exposed to suicide prevention programs or conversations. A sample of 1031 young people ages 13–23 were recruited nationally through social media. Survey questions asked about SDV prevention exposure. Open-ended questions asked youth to suggest additional information they desired about SDV. A majority of participants (87%) reported that they had received prevention exposure from at least one source (i.e., family, online, attending a talk, or formal program) with few differences by demographic characteristics. However, sexual and gender minority (SGM) youth reported accessing more SDV prevention information online compared to other youth. Overall, youth had many ideas about what additional information they needed, including how to help someone at risk for SDV and how to access information about mental health. While the majority of youth are receiving some SDV prevention messages, there is variation in how they get this information, and survey participants still felt they were missing important information. Findings highlight the need to resource more comprehensive SDV prevention for youth and young adults.

Practices and Policies Around Wellness: Insights From the Internet Crimes Against Children Task Force Network

This article aims to understand what practices and training Internet Crimes Against Children (ICAC) Task Forces and affiliated agencies are currently using to help mitigate distress and promote wellbeing among investigators of child sexual abuse material (CSAM). Data were collected via telephone interviews with Commanders of 54 ICAC Task Forces as well as an online survey of 155 investigators at ICAC-affiliated agencies. Sixty-two percent of respondents said their agency had an Officer Wellness Program. Findings highlighted considerable gaps in protective practices with 46.1% of respondents mentioning the need for more wellness resources in their agency for personnel who have viewed CSAM as a high priority. Stigma created by help-seeking was the most widely acknowledged barrier discussed in relation to police wellness. A large and salient problem was the persistent lack of wellness practices in the affiliated agencies in comparison to the Task Forces themselves. Exposure to CSAM can be a source of stress for personnel and the results indicate concern about the problem and a diffusion of proactive initiatives, but barriers and inconsistent adoption remain.

Impact of the COVID-19 Pandemic on Perceptions of Health and Well-Being Among Sexual and Gender Minority Adolescents and Emerging Adults

Purpose: The study purpose was to examine how the COVID-19 pandemic may be differentially impacting the well-being of sexual and gender minority (SGM) youth compared with their non-SGM counterparts. Specifically, we looked at perceptions of mental and physical health impact and relevant aspects of coping with the pandemic such as engagement in prosocial activities that might ultimately promote resilience. Methods: Survey data were collected between November 27, 2020, and December 11, 2020, from 990 adolescents and emerging adults aged 13-23 years. Participants were recruited through advertisements on Facebook and Instagram with an effort to overrecruit SGM youth. Questions asked youth about their perception of the impact of the COVID-19 pandemic on their physical and mental health, the types of prosocial activities engaged in during the pandemic, and how they felt they were doing now versus before the pandemic. Results: SGM youth reported a significantly greater impact from the pandemic than non-SGM youth. Both SGM youth and cisgender heterosexual females reported greater impact on their mental health compared with cisgender heterosexual males, with cisgender sexual minority females and gender minority youth reporting the highest mental health impact. Gender minority youth also reported feeling less connected to their families and less safe at home as a result of the pandemic. Conclusion: Health professionals, educators, and advocates need to help assess SGM youth for negative impact from the pandemic and help them connect with other youth and support resources online as they move forward. Youth may also benefit from programs connecting them to volunteer work and neighbors.

Understanding the Impact of Seeing Gun Violence and Hearing Gunshots in Public Places: Findings From the Youth Firearm Risk and Safety Study

There is a current public health emphasis on finding strategies for reducing the risks associated with children's gun violence exposure. This article examines the impact of seeing and hearing gun violence on youth of different ages and living in urban and nonurban areas. Participants were 630 youth, aged 2 to 17. Youth, ages 10 to 17, completed a self-report survey, and caregivers of young children, ages 2 to 9, completed the survey as a proxy for that child. Participants resided in Boston, MA; Philadelphia, PA; and rural areas of eastern TN. Participants were recruited through a variety of techniques including pediatric clinics, housing authorities, youth-serving agencies, festivals, word of mouth, and local e-mail lists for classified advertisements. Data were collected between October 2017 and April 2018 and analyzed in 2019. In total, 41% of youth in this study reported ever seeing or hearing gun violence; 32% had such an experience in the past year. Among exposed youth, 50% took protective action to keep themselves safe, and 58% reported being very or extremely afraid, sad, or upset as a result of the indirect gun violence. More youth living in urban compared with nonurban areas took some protective action. Females and younger children had increased odds of experiencing high fear as a result of the violence. Current gun violence prevention has typically targeted adolescents; however, current findings suggest the need to focus on younger children as well, including the distress resulting from indirect exposure to gun violence.

Exposure to Self-Directed Violence: Understanding Intention to Help and Helping Behaviors among Adolescents and Emerging Adults

Exposure to self-directed violence (SDV) is a public health issue. Prevention trains third parties to identify SDV risk and provide help. However, we know little about the range of help provided to those who engage in SDV. The current study used a cross-sectional online survey of 1031 adolescents and emerging adults to learn about their SDV exposure, intent and attempts to help, and barriers to helping. Most participants reported SDV exposure, commonly by a peer, and provided help. Regression analyses showed that intent to help was predicted by social norms and having knowledge of resources, and such knowledge (but not social norms) was also related to actual helping behaviors. Qualitative analysis of short open-ended questions on the survey documented a range of barriers to helping. Findings support but also encourage revision of theoretical models of helping upon which prevention programs are based.

Factors Related to Providers Screening Children for Behavioral Health Risks in Primary Care Settings

PURPOSE

To provide information from a large sample of pediatric and family medicine primary care providers on practices in screening children for behavioral health risks.

DESIGN AND METHODS

Participants were a sample of physicians (n=319) and nurse practitioners (n=292) from across the U.S. who completed a confidential online survey about screening practices through a computer-assisted self-interview.

RESULTS

Almost all respondents (89%) reported screening children for depression/anxiety and behavior problems. Child substance use (82%), family social support (74%), significant household changes (73%), bullying (72%), child abuse (62%) and domestic violence (52%) were also asked about regularly, although with high rates of informal screening methods. Caregiver mental health (49%), caregiver substance use (35%), family financial strain (33%) and transportation difficulties (27%) were screened less frequently. Screening was associated with higher rates of referral for risk-related problems, and was more likely when providers reported greater confidence providing support to clients, perceived community resource availability as higher, and worked in systems with integrated primary care and behavioral health.

CONCLUSIONS

Findings suggest a great amount of diversity in how providers screen for behavioral health risks. There is reluctance to screen when options for addressing the problems are seen as limited. Research is needed to better guide healthcare providers in determining the right context and methods for screening social risks.

PRACTICE IMPLICATIONS

Protocols for screening adverse childhood events (ACES) and other social risk factors should be accompanied by adequate training and efforts to improve community resource and support networks.

Attachment and Sexual Functioning: Understanding the Mediating Role of Body Image Among LGB and Non-LGB Women

INTRODUCTION

Despite studies showing that individuals with insecure attachment suffer from poor body image, and that poor body image is a main risk factor for sexual dysfunction, the mediating role of body image between attachment insecurities and sexual functioning has not been assessed. Moreover, differences in body self-consciousness among sexual minority women have not been examined, even though LGB individuals have been found to be more conscious of stigma and the disapproval of others.

AIM

To fill this gap, the current study examines the mediating role of body image self-consciousness between insecure attachment and sexual functioning among LGB and non-LGB women.

METHODS

The study sample consisted of 1,001 women; of them, 808 defined themselves as heterosexual (80.7%), and 193 (19.3%) identified as LGB. The sample was a convenience sample of women who responded to ads on social media. Participants completed an online questionnaire (via Qualtrics) about their attachment orientation, body-image self-consciousness, and sexual functioning.

MAIN OUTCOME

Body image self-consciousness mediated the relationship between insecure attachment and sexual dysfunction among women in general and LGB women in particular.

RESULTS

Results indicated that among LGB women, the relationship between attachment and sexual functioning was fully mediated by body image self-consciousness. For non-LGB women, a full model with statistically significant direct and indirect effects was revealed. Both avoidant attachment and anxious attachment were related to body image self-consciousness which was, in turn, related to sexual functioning. A statistically significant direct path from avoidant attachment to sexual functioning was also revealed.

CONCLUSION

The study findings contribute to the literature by revealing the mediating role that body image self-consciousness plays between insecure attachment and sexual dysfunction among women in general and LGB women in particular.

CLINICAL IMPLICATIONS

This study provides support for the negative relationship between body image self-consciousness and sexual functioning of women regardless of sexual orientation, and suggests that women affected by body image concerns might be prone to more sexual dysfunction. Therefore, body image self-consciousness should be brought up in sex therapy sessions and future interventions. Clinicians should also be cognizant of differences between LGB and non-LGB women in terms of this effect, taking into account the history of stigma that LGB women may have endured and how this history affects their body image. Gewirtz-Meydan A, Mitchell KJ, Spivak-Lavi Z. Attachment and Sexual Functioning: Understanding the Mediating Role of Body Image Among LGB and Non-LGB Women. J Sex Med 2021;18:1245-1257.

Exposure to Suicidal Behavior and Social Support Among Sexual- and Gender-Minority Youth

OBJECTIVES

In this study, we examine reports of exposure to suicidal behavior by youth sexual and gender identity. We explore how exposure is related to depressed mood in the context of high social support while accounting for cumulative adversity.

METHODS

Data from a large national sample of youth aged 14 to 15 years in the United States (N = 3979) were collected online in 2018-2019.

RESULTS

Sexual- and gender-minority youth were more likely to know someone close to them who attempted suicide, relative to cisgender heterosexual youth. Cisgender heterosexual youth were buffered from recent depressed mood when they endorsed having high social support in the context of exposure to suicidal behavior; less social support did not provide such a buffer. For cisgender sexual-minority male and female youth, exposure to suicidal behavior was related to recent depressed mood regardless of the level of social support. For gender-minority youth assigned female at birth, the combination of exposure and high social support was significantly associated with elevated depressed mood. Cumulative adversity accounted for some but not all of these relationships, indicating the influential role of exposure to suicidal behavior on depressed mood for some youth.

CONCLUSIONS

These findings illustrate the complexities of social support and raise questions about its potential to magnify stress rather than serve as a buffer for some youth. Although findings need to be replicated, suicide prevention efforts should carefully consider how to promote resilience among these suicide-exposed sexual- and gender-minority youth who may themselves be at risk for suicidal ideation and behavior.

Development and Psychometrics of Instruments to Assess School Personnel's Bystander Action in Situations of Teen Relationship Abuse and Sexual Assault

This article describes recently developed instruments that assess school personnel's bystander barriers and intentions in situations of teen relationship abuse, sexual assault, and sexual harassment, as well as perceptions of school readiness specific to relationship abuse, sexual assault, and sexual harassment prevention and response. Participants were 1,150 high school personnel from 25 schools in New Hampshire, Massachusetts, and Maine. Specific instruments focused on bystander intentions, bystander action, barriers to bystander action, and perceptions of school readiness. Participants were randomly divided into two groups for analysis-the exploratory sample (ES; n = 575) and the confirmatory sample (CS; n = 575). Overall, the measures demonstrated acceptable fit indices. Results suggested that most measures and subscales had adequate reliability, but a few subscales had less than ideal internal consistency, which can likely be attributed to the small number of items. More work is needed, but these measures act as a starting point by which the role of school personnel in prevention initiatives and bystander intervention can be evaluated.

Past Year Technology-Involved Peer Harassment Victimization and Recent Depressive Symptoms and Suicide Ideation Among a National Sample of Youth

This article aims to better understand the complex role of technology in peer victimization events with recent depressive symptomatology and suicide ideation (SI). Telephone interviews were conducted with a national sample of 791 youth in the United States, aged 10 to 20 years, collected from December 2013 to March 2014. Rates of any peer harassment victimization varied by past month depressive symptomatology and SI -28% of youth with no/low depressive symptomatology reported past year peer harassment as did 43% of youth with high depressive symptomatology without SI, and 66% of youth with SI. When examining the role of technology in peer harassment, youth experiencing any mixed harassment (i.e., those incidents that occurred both in-person and through technology) were almost 4 times more likely to report past month depressive symptoms without SI (RR_adj = 3.9, 95% confidence interval [CI] = [1.5, 10.0], p ≤ .01) and 7.5 times (95% CI = [1.9, 28.9], p ≤ .01) more likely to report past month SI compared with youth who had no past year peer harassment. Given the multilayered relationships among these variables, schools, medical, and mental health professionals might screen youth who are involved in higher risk peer victimization situations, for depressive symptoms and SI to improve their access to appropriate mental health services.

The Youth Firearm Risk and Safety Tool (Youth-FiRST): Psychometrics and Validation of a Gun Attitudes and Violence Exposure Assessment Tool

This study reports on the development of a comprehensive assessment of exposure to guns and gun-related violence for evaluating the risk of gun-related trauma. Gun access, gun attitudes, gun safety education, and exposure to gun violence were measured. Participants were 630 youth, aged 2-17. Youth, ages 10-17, completed a self-report survey and caregivers of young children, ages 2-9, completed the survey as a proxy for that child. The youth were from urban (n = 286) and rural (n = 344) areas. Factor analysis, item response theory, and structural equation modeling were used. Two factors described access to guns, two factors described gun attitudes, and a single construct captured gun safety education. The gun violence exposure factor showed strong associations with trauma symptomatology. The individual constructs showed good psychometric properties and measurement noninvariance by urbanicity.

Strengthening the predictive power of screening for adverse childhood experiences (ACEs) in younger and older children

BACKGROUND

There is increasing interest in routine screening for Adverse Childhood Experiences (ACEs) to help identify high-risk children who would benefit from interventions. However, there has not yet been sufficient research concerning which particular set of ACEs would be most predictive as a potential screening tool.

OBJECTIVE

This study compared 40 Adverse Childhood Experiences (ACEs), covering 11 different conceptual domains, in their ability to predict trauma symptoms in childhood.

PARTICIPANTS AND SETTING

The current study uses pooled data from three National Surveys of Children's Exposure to Violence (NatSCEV) conducted in 2008, 2011, and 2014. Each survey collected information on children aged one month to 17 years.

METHODS

Samples were obtained from a mix of random digit dialing and address based sampling methods. Telephone interviews were conducted with children 10 years and older and with caregivers, if the randomly selected child was under age 10.

RESULTS AND CONCLUSION

A different set of 15 items best predicted trauma symptoms for younger (2-9-year-old) compared to older (10-17-year-old) youth. Some conventional ACEs, like physical and emotional abuse, proved important for both age groups. However, family-related factors were more predictive for younger children, while community and peer violence exposures were more predictive for older children. Our new proposed measures explained substantially more variance in subsequent trauma symptoms than did the original ACE measure (R² = .31 vs .18 for 2-9 year olds; R² = .43 vs .26 for 10-17 year olds; p < .001 for all) and identified a larger percentage of children with high levels of trauma.

Exposure to Multiple Forms of Bias Victimization on Youth and Young Adults: Relationships with Trauma Symptomatology and Social Support

Research has documented that a significant portion of youth are exposed to bias victimization. However, less is known about whether experiencing certain types of bias victimization (e.g., sexual orientation bias) is more or less likely to be related to a more extensive bias victimization history (i.e., experiencing multiple types of bias victimization) and whether exposure to multiple types of bias victimization explains any relationships between specific types of bias victimization and negative outcomes. To address these gaps, the current study explores relationships between exposure to multiple types of bias-motivated victimization, trauma symptomatology and perceived social support. Participants were 854 youth and young adults (60.9% female) from three higher risk communities who completed a survey on personal experiences with bias-related victimization. The average age of participants was 16.6 years; 28.5% of the sample described themselves as Black or African American; 13.4% as Hispanic or Latino (any race); 45.3% as White, and 12.8% as another race. Sixty-nine percent of the sample described their sexual orientation as heterosexual; 8.9% as gay, lesbian, or homosexual; 12.5% as bisexual; and 9.5% as another sexual orientation. Sixty-three percent of participants reported at least one type of bias victimization in their lifetime, and more than one in three youth (38.7%) experienced two or more types of bias victimization in their lifetimes (18.1% two types, 12.1% three types, and 8.5% four or more types). Experiencing multiple types of bias victimization was related to higher trauma symptomatology and less perceived social support. Experiencing multiple types of bias victimization attenuated or eliminated the association between individual types of bias victimization and well-being. The findings contribute to a growing body of research demonstrating the damaging mental health effects of occupying multiple marginalized statuses, and points to the cumulation of bias victimization experiences as an important factor contributing to significant differences in well-being and support among youth and young adults.

Peer Victimization Patterns and Trauma Symptoms in a National Longitudinal Sample of Youth

Using a nationally representative sample of 791 youth, ages 8-17 at baseline, this study identified patterns over a 2-year period in specific forms of peer victimization and examined differences in the mental health consequences of those patterns. Findings show that, among the victimized, physical assault had relatively high persistence compared to other forms, while physical intimidation and emotional bullying had relatively high rates of desistence. Emotional bullying at T1 was associated with increased risk of T2 Internet harassment and Internet harassment at T1 strongly predicted T2 dating violence. Patterns of victimization over time differed in their relationship with trauma symptoms. Findings emphasized the importance of recency and the distress of new victimization experiences, rather than the chronicity or repetition of victimization. Understanding variations in peer victimization patterns and outcomes over time can help to inform interventions that better target sources of risk across adolescence.

Preventing Teen Relationship Abuse and Sexual Assault through Bystander Training: Intervention Outcomes for School Personnel

The purpose of the current study was to examine the impact of exposure to Bringing in the Bystander-High School Curriculum (BITB-HSC) on school personnel, which included a seven session classroom curriculum for ninth through twelfth graders (student curriculum), a bystander training workshop for school personnel (school personnel workshop), and reading materials (handout). We examined how exposure to these various BITB-HSC intervention components was associated with school personnel's knowledge and bystander efficacy, intentions, and barriers specific to student relationship abuse (RA) and sexual assault (SA). Participants were 488 school personnel from 12 high schools in upper New England who completed the 4-month follow-up survey that assessed for intervention exposure (284 participants completed both the baseline and follow-up survey). Whereas 53% of participants were exposed to no intervention components, the other half of the sample were exposed to a combination of intervention components. Higher baseline knowledge and reactive bystander intentions were associated with subsequent exposure to both the student curriculum and the handout, and fewer barriers to bystander action predicted exposure to the school personnel workshop. Exposure to the school personnel workshop, student curriculum, and handout was associated with subsequent greater knowledge, exposure to the student curriculum predicted reactive bystander intentions, and exposure to the handout predicted higher reactive bystander intentions and bystander efficacy. Findings suggest that despite challenges with engagement, exposure to the BITB-HSC components may be a useful tool in improving school personnel's responses to RA and SA among high school students.

Developmental Stage of Onset, Poly-Victimization, and Persistence of Childhood Victimization: Impact on Adult Well-Being in a Rural Community-Based Study

The current study examines the persistence of victimization and poly-victimization (i.e., count of multiple types of victimization) across various stages of development (ages 0-5, 6-12, and 13-18) and the related impact on adult well-being. Participants were 2,098 adults from the Appalachian region of three Southern states. Eighty-two percent of participants reported at least one type of victimization during childhood. Among adult victims, 22.6% reported one victimization in one developmental stage (i.e., one stage, but no poly-victimization), 45.8% reported one victimization in more than one stage (i.e., persistent victimization, but no poly-victimization), 20.5% reported multiple types of victimization in one stage (i.e., poly-victimization), and 11.2% reported multiple types of victimization at more than one stage (i.e., persistent poly-victimization). Results indicated a linear decline in subjective well-being, mental health, and number of healthy days as victimization becomes more persistent across childhood and more diverse in types (i.e., poly-victimization). Study findings provide support for models of victimization that take both developmental trajectories and poly-victimization into account.

Gun Violence Exposure and Posttraumatic Symptoms Among Children and Youth

Although statistics on youth homicide and injury from gun violence are available, little research has focused on how gun violence overlaps with other victimizations or on the psychological impact of gun violence on children. Pilot survey data were collected on the experiences of 630 U.S. children (age range: 2-17 years) from Boston, Philadelphia, and rural areas of eastern Tennessee. Youth aged 10-17 years completed a self-report survey on a wide range of gun violence exposures, and parents of younger children (aged 2-9 years) completed the survey as a proxy for that child. Direct gun violence exposure, witnessing gun violence, and hearing gunshots were all significantly associated with other forms of victimization, rs = .10-.38, p < .001. The findings suggest that youth who experience direct gun violence are often exposed to multiple violent contexts. For older youth (ages 10-17 years) polyvictimization was most strongly associated with posttraumatic symptoms, β = .35, p < .001, although witnessing gun violence still uniquely predicted a higher level of symptoms, β = .18, p < .01. For younger children (ages 2-9 years), hearing and witnessing gun violence were both related to posttraumatic symptoms, β = .15, p < .01 for both, even after controlling for polyvictimization. Mental health professionals and trauma-informed services should be mindful that the traumatic impact of gun violence for children may not necessarily be attached to direct victimization experiences but may also result from simply seeing or hearing it in their neighborhoods.

A Cross-sectional Study Examining the (In)congruency of Sexual Identity, Sexual Behavior, and Romantic Attraction among Adolescents in the US

OBJECTIVE

To examine how sexual identity, romantic attraction, and sexual behavior co-relate for cisgender adolescents.

STUDY DESIGN

The Teen Health and Technology survey was a cross-sectional, self-report online survey. More than 5000 youth between 13 and 18 years of age were randomly recruited through Harris Panel OnLine's panel as well as outreach by GLSEN to over-recruit lesbian, gay, bisexual, and other sexual minority youth. Data were collected between 2010 and 2011. Analyses were conducted in 2018 and restricted to cisgender youth.

RESULTS

Overall, romantic attraction and sexual behavior most closely mapped each other. The greatest discordance was noted between sexual identity and romantic attraction. For example, 59% of girls and 16% of boys who identified with a nonheterosexual identity reported that at least 1 of their 2 most recent sexual partners was a different gender. Nine percent of heterosexually-identified girls and 3% of heterosexually-identified boys reported romantic attraction to the same sex, and 6% and 7% of heterosexually-identified girls and boys, respectively, reported that at least 1 of their 2 most recent sexual partners was the same gender.

CONCLUSIONS

Treating romantic attraction, sexual identity, and sexual behavior as synonymous assumes a unidimensionality that is unsupported by the data. Pediatricians and others working with youth, including researchers, should be mindful not to assume identity on the basis of behavior. Researchers should be clear and purposeful about how they are operationalizing "sexual minority" and how it may affect the composition of their study population. Healthy sexuality and risk reduction programs need to acknowledge that adolescents with a particular sexual identity may have romantic attractions, and even sexual encounters, with people who fall outside of that identity.

Evaluation of a Bystander-Focused Interpersonal Violence Prevention Program with High School Students

This study evaluated the effectiveness of a seven-session, bystander-focused, classroom-delivered curriculum (i.e., Bringing in the Bystander-High School Curriculum [BITB-HSC]) in reducing rates of interpersonal violence among high school students. High schools (N = 26) were randomly assigned to the treatment or control condition. In classrooms in treatment schools, students (n = 1081) completed a baseline survey, participated in the BITB-HSC, and completed an immediate post-test, a short-term post-test (approx. 2 months after intervention), and a long-term post-test (approx. 1 year after intervention). Youth in control schools (n = 1322) completed surveys at similar time points but did not participate in the BITB-HSC. Participants were 15.8 years old on average and largely White (85.1%) and heterosexual (84.5%). Students exposed to the BITB-HSC demonstrated significant short-term changes in victim empathy and bystander barriers/facilitators, and long-term changes in rape myths, media literacy, bystander readiness, and knowledge relative to youth in the control condition. Although the BITB-HSC had little long-term impact on actual bystander behavior, there were reductions in some forms of violence among students in the BITB-HSC condition relative to the control condition. Future research is needed to determine if, for whom, why, and in what contexts (e.g., classroom-based versus school-wide initiatives) bystander-focused violence prevention initiatives reduce violence.

School Personnel's Bystander Action in Situations of Teen Relationship Abuse and Sexual Assault: Prevalence and Correlates

BACKGROUND

Relationship abuse (RA) and sexual assault (SA) are major problems among high school students, and school personnel are an important part of preventing RA and SA among youth. Therefore, we examined the rates and correlates of bystander intentions among school personnel in situations of RA and SA.

METHODS

School personnel (N = 1150) from 25 high schools in New England completed surveys that assessed their RA and SA knowledge, perceptions of school climate specific to RA and SA, and RA and SA bystander efficacy and bystander intentions.

RESULTS

Across each type of bystander behavior measured, the vast majority of school personnel reported intentions to intervene. In the multilevel regression analyses, both proactive and reactive bystander intentions were related to higher levels of RA and SA bystander efficacy and perceptions of a more positive school climate and lower levels of RA and SA barriers to intervene.

CONCLUSIONS

These data support the utility of school-based interventions that seek to improve school climate and teach school personnel skills that enhance bystander efficacy and reduce bystander barriers in student situations of RA and SA. Although they would need to be evaluated, such interventions could promote positive bystander action among school personnel and untimely contribute to reductions in RA and SA among high school youth.

Evaluation of a Bystander-Focused Interpersonal Violence Prevention Program with High School Students

This study evaluated the effectiveness of a seven-session, bystander-focused, classroom-delivered curriculum (i.e., Bringing in the Bystander-High School Curriculum [BITB-HSC]) in reducing rates of interpersonal violence among high school students. High schools (N = 26) were randomly assigned to the treatment or control condition. In classrooms in treatment schools, students (n = 1081) completed a baseline survey, participated in the BITB-HSC, and completed an immediate post-test, a short-term post-test (approx. 2 months after intervention), and a long-term post-test (approx. 1 year after intervention). Youth in control schools (n = 1322) completed surveys at similar time points but did not participate in the BITB-HSC. Participants were 15.8 years old on average and largely White (85.1%) and heterosexual (84.5%). Students exposed to the BITB-HSC demonstrated significant short-term changes in victim empathy and bystander barriers/facilitators, and long-term changes in rape myths, media literacy, bystander readiness, and knowledge relative to youth in the control condition. Although the BITB-HSC had little long-term impact on actual bystander behavior, there were reductions in some forms of violence among students in the BITB-HSC condition relative to the control condition. Future research is needed to determine if, for whom, why, and in what contexts (e.g., classroom-based versus school-wide initiatives) bystander-focused violence prevention initiatives reduce violence.

Health Indicators of Lesbian, Gay, Bisexual, and Other Sexual Minority (LGB+) Youth Living in Rural Communities

OBJECTIVE

To investigate whether the intersectionality of being lesbian, gay, bisexual, and other sexual minority youth (LGB+) and living in a rural community may portend worse concurrent health indicators than identifying as heterosexual and/or living in a nonrural community.

STUDY DESIGN

Data were collected online between 2010 and 2011 from 5100 13- to-18-year-old youth across the US. Youth were randomly recruited from within the Harris Panel Online and through targeted outreach efforts to LGBT+ youth by a youth-focused nonprofit. The survey questionnaire was self-administered and included measures used in the present study and other measures related to the goal of the Teen Health and Technology study.

RESULTS

Living in a rural community was not associated with additional challenges beyond those posed by LGB+ status. Instead, most noted differences in indicators of psychosocial challenge were between LGB+ and heterosexual youth, regardless of rural vs nonrural community living status. For example, sexual minority youth, both male and female, were more likely to have used substances, have depressive symptomatology, have low self-esteem, and report being bullied in the past year compared with both rural and nonrural heterosexual youth.

CONCLUSIONS

Findings suggest that LGB+ youth living in rural areas are equally likely to face psychosocial challenges as LGB+ youth living in nonrural areas. Pediatricians and other healthcare providers who work with youth should be mindful of creating LGB+ inclusive environments that can promote self-disclosure by youth who may benefit from additional health services or clinical support for psychosocial challenges.

Youth Exposure to Suicide Attempts: Relative Impact on Personal Trauma Symptoms

INTRODUCTION

The purpose of this study is to report the prevalence of youth lifetime exposure to suicide attempts by people close to them, and its association with personal nonvictimization adversities, suicidal ideation, thoughts of self-harm, and trauma symptoms.

METHODS

Data were collected as part of the National Surveys of Children's Exposure to Violence, comprising three cross-sectional studies conducted in 2008, 2011, and 2014 in the U.S. assessing the experiences of children ages 1 month to 17 years. The current analyses utilized the self-report data from youth, ages 10-17 years (n=6,366), and was analyzed in 2017.

RESULTS

Twelve percent (n=779) of youth said someone close to them had tried to kill themselves. Exposure varied by age: 4% of youth aged 10-12 years, 13% of youth aged 13-15 years, and 21% of youth aged 16-17 years reported such exposure. Exposure to suicide attempts also varied by sex with 8% of males and 16% of females reporting this experience. After adjusting for the total number of other types of adversity experienced, the association between exposure to suicide attempts and trauma symptoms (β=0.5, 95% CI=0.3, 0.7, p≤0.001); suicidal ideation (OR=2.4, 95% CI=1.4, 4.1, p≤0.001); and thoughts of self-harm (OR=3.1, 95% CI=1.9, 5.1, p≤0.001) remained significant, although attenuated.

CONCLUSIONS

Study findings that youth exposure to suicidal behavior is associated with negative emotional distress, and that it often co-occurs with other adversities and social risk factors, highlight the need to better understand the causal pathways among these risk factors to improve youth suicide prevention and response interventions.

Measurement Tools to Assess Relationship Abuse and Sexual Assault Prevention Program Effectiveness Among Youth

OBJECTIVE

This article describes the adaptation, development, and psychometric properties of survey instruments to assess outcomes of bystander-focused violence prevention efforts among high school students, including media literacy, rape myths, bystander readiness, bystander barriers and facilitators of bystander action, bystander intentions, perceptions of school personnel helping, perceptions of peer helping, and victim empathy.

METHOD

The study was based on data collected from 3,172 high school students across 25 schools in northern New England.

RESULTS

Overall, the measures demonstrated acceptable fit indices in multilevel exploratory and confirmatory factor analyses. Whereas most measures and subscales had adequate reliability, several measures had less than ideal internal consistency, likely because of the limited number of items.

CONCLUSION

Although additional measurement work is needed, these measures provide researchers and practitioners with foundational tools for basic research and program evaluation.

Characteristics of bias-based harassment incidents reported by a national sample of U.S. adolescents

Using a national sample of youth from the U.S., this paper examines incidents of bias-based harassment by peers that include language about victims' perceived sexual orientation, race/ethnicity, religion, weight or height, or intelligence. Telephone interviews were conducted with youth who were 10-20 years old (n = 791). One in six youth (17%) reported at least one experience with bias-based harassment in the past year. Bias language was a part of over half (52%) of all harassment incidents experienced by youth. Perpetrators of bias-based harassment were similar demographically to perpetrators of non-biased harassment. However, bias-based incidents were more likely to involve multiple perpetrators, longer timeframes and multiple harassment episodes. Even controlling for these related characteristics, the use of bias language in incidents of peer harassment resulted in significantly greater odds that youth felt sad as a result of the victimization, skipped school, avoided school activities, and lost friends, compared to non-biased harassment incidents.

From Poly-Victimization to Poly-Strengths: Understanding the Web of Violence Can Transform Research on Youth Violence and Illuminate the Path to Prevention and Resilience

For many years, an overly "siloed" approach has hampered efforts to understand violence and minimize the societal burden of violence and victimization. This article discusses the limitations of an overly specialized approach to youth violence research, which has focused too much on violence in particular contexts, such as the family or the school. Instead, a child-centered approach is needed that comprehensively assesses all exposures to violence. This concept of the total cumulative burden of violence is known as poly-victimization. The poly-victimization framework reveals that many youth are entangled in a web of violence, experiencing victimization in multiple settings by multiple perpetrators. This more accurate view of children's exposure to violence has many advantages for advancing our scientific understanding of violence. Perhaps somewhat surprisingly, this more comprehensive view also points to new insights for resilience and prevention. This includes recognizing a parallel concept, "poly-strengths," which captures the number of resources and assets children and their families can use to help insulate youth from violence (prevention) or assist in coping and promoting well-being after victimization (intervention). Reconceptualizing how resilience is defined and understood among youth populations can help alleviate the true societal burden of youth victimization.

Poly-Victimization and Peer Harassment Involvement in a Technological World

This article explores the ways poly-victimized youth (those experiencing multiple different types of victimization over the course of 1 year) use technology to interact with peers. Particular attention is given to the peer harassment victimization and perpetration experiences of poly-victimized youth compared with less victimized and non-victimized youth-both overall and through technology. Data were collected as part of the Technology Harassment Victimization (THV) study; a national survey of 791 youth, ages 10 to 20 across the United States. Study results document the heightened risks that poly-victimized youth experience when interacting with peers. Low and high poly-victimized youth were both at significantly greater risk of being dual victims and perpetrators of peer harassment when compared with non-victimized youth even after taking into account other potentially explanatory factors. This was not found to be the case for less victimized youth. This was true for high poly-victims and technology-involved harassment risk as well. There were indications that poly-victimized youth were interacting with peers in more intense and risky ways in general using new technology. The increase in attention to poly-victimization in recent years has importantly identified the detrimental role that experiencing different forms of victimization have on youth. This study not only adds to that literature but suggests that there is an opportunity to interrupt additional victimization by understanding how poly-victimized youth interact with peers before and during adolescence. Although preliminary, the differences in technology use by poly-victimized youth versus others suggest that more information is needed to understand how they are relating to peers in both positive and risky ways in this environment.

Exposure to Medication Overdose as an Adversity in Childhood

PURPOSE

To determine the prevalence of youth exposure to medication or pill overdose by someone close to them, as well as how common this is within the spectrum of major stressful events and child victimization experienced by youth.

DESIGN AND METHODS

Data were collected as part of the Third National Survey of Children's Exposure to Violence, a nationally representative telephone survey of youth, ages 2-17years (N=3738) conducted in 2013. The analytical subset for the current paper is youth ages 10-17years (n=1959).

RESULTS

Estimates indicate that approximately 1 in 12 youth (8%), ages 10-17 have been exposed to medication overdose by someone close to them in their lifetimes. Overdose exposure is related to recent trauma symptoms, alcohol and other substance use. However, these relationships appear to be largely driven by the co-existence of major stressful events these youth are experiencing. Alcohol use is the exception; exposure to medication overdose continues to be related to past year personal alcohol use even after adjusting for other lifetime stressful events.

CONCLUSIONS

Having a close family member or friend overdose on a medication is a common experience among U.S. youth and related to high rates of co-occurring stressful events.

PRACTICE IMPLICATIONS

Health care providers should be aware that youth exposure to medication overdoses likely indicates exposure to other recognized adversities. Youth with a caregiver who has had an overdose may require an urgent response including referral to crisis intervention through child and family services.

Echocardiographic Assessment of Left Ventricular Function in Healthy Horses and in Horses with Heart Disease Using Pulsed-Wave Tissue Doppler Imaging

Background

Assessment of left ventricular (LV) function by tissue Doppler imaging (TDI) is not well established in horses with heart disease.

Objectives

To describe the use of pulsed‐wave (PW) TDI for the assessment of LV function, establish reference intervals, investigate effects of mitral regurgitation (MR), aortic regurgitation (AR), and primary myocardial disease (MD), and provide proof of concept for the use of PW TDI in Warmblood horses with heart disease.

Animals

Thirty healthy horses, 38 horses with MR, 25 with AR, 8 with MD.

Methods

Echocardiograms were retrospectively analyzed. Reference intervals were calculated. PW TDI indices of healthy horses and horses with MR, AR, and MD were compared by one‐way ANOVA and Dunnett's test.

Results

A complete set of PW TDI variables could be obtained in 94 of 101 horses. Variables corresponding to isovolumic intervals were most difficult to measure. Valvular regurgitation influenced variables describing isovolumic contraction and ejection. Horses with MD had significantly shortened ET_m (−118.5 [−154.1 to −82.9] ms; mean difference [95% CI of difference of means]), increased PEP_m/ET_m (0.11 [0.05 to 0.17]), prolonged IMP_m (0.28 [0.18 to 0.37]), increased S₁ (8.9 [5.2 to 12.6] cm/s), and decreased E₁ (−2.6 [−4.7 to −0.5] cm/s), E_m (−14.2 [−19.9 to −8.5] cm/s), and E_m/A_m ratio (−1.6 [−2.6 to −0.6]).

Conclusions and Clinical Importance

Pulsed‐wave TDI might be useful for detection of LV dysfunction in horses with primary MD. The clinical value of TDI in horses with MR and AR remains uncertain.

A National Study of Lesbian, Gay, Bisexual (LGB), and Non-LGB Youth Sexual Behavior Online and In-Person

Online and in-person sexual behaviors of cisgender lesbian, gay, queer, bisexual, heterosexual, questioning, unsure, and youth of other sexual identities were examined using data from the Teen Health and Technology study. Data were collected online between August 2010 and January 2011 from 5,078 youth 13-18 years old. Results suggested that, depending on sexual identity, between 4-35 % of youth had sexual conversations and 2-24 % shared sexual photos with someone online in the past year. Among the 22 % of youth who had oral, vaginal, and/or anal sex, between 5-30 % met one of their two most recent sexual partners online. Inconsistent condom use was associated with increased odds of meeting one's most recent partner online for heterosexual adolescent men. For gay and queer adolescent men, having an older partner, a partner with a lifetime history of sexually transmitted infections (STI), and concurrent sex partners were each significantly associated with increased odds of having met one's most recent sex partner online. None of the examined characteristics significantly predicted meeting one's most recent sexual partner online versus in-person for heterosexual; bisexual; or gay, lesbian, and queer women. The Internet is not replacing in-person exploration and expression of one's sexuality and meeting sexual partners online appears to be uncommon in adolescence across sexual identities. Healthy sexuality programming that acknowledges some youth are meeting partners online is warranted, but this should not be a main focal point. Instead, inclusive STI prevention programming that provides skills to reduce risk when engaging in all types of sex is critical.