Physical and Sexual Dating Violence and Nonmedical Use of Prescription Drugs

Outcomes Associated with Adolescent Dating and Sexual Violence Victimization: A Systematic Review of School-Based Literature

Dating and sexual violence (DSV) is a common occurrence among school aged youth and has been associated with numerous harmful long-term outcomes. The goal of this article is to better understand the range of outcomes associated with DSV during youth and adolescence. This systematic review consists of 28 school-based studies from 20 journals discussing outcomes of youth experiences of DSV. Results demonstrate significant associations between DSV victimization and mental health symptoms, substance use, sexual health, academic, and social outcomes. To better understand this issue, this article recommends that schools offer additional training for staff on recognizing DSV. Additionally, improved research is needed in this area including surveys that are inclusive of diverse student identities and include more comprehensive measures of DSV, and additional research on DSV explicitly focused on minoritized groups.

Adolescent Substance Use Disorder in Primary Care: Challenges in Treatment Referral Beyond Access Availability

OBJECTIVE

Fatal overdoses are the third leading cause of death in the pediatric population. Substance use disorders (SUD) screening is not routinely done in primary care practices. Early screening and intervention for adolescent SUD could mitigate future harm.

METHODS

We conducted a 3-month pilot adapting universal screening using the CRAFFT tool in patients aged 12 to 17 presenting to an urban and a rural primary care practice during well-child and acute/sick-child visits. We collaborated with our pediatric addiction service to ensure access availability for further assessment and treatment for all positively screened patients; this was broadly communicated to primary care providers.

RESULTS

There was a higher CRAFFT completion rate in the urban site (90%, vs 52.6% in our rural site). The majority of CRAFFT questionnaires were completed during acute/sick-child visits in both study sites. Moreover, we found a higher positive screen rate in our rural practice (14.6%, vs 2.4% in our urban practice). Only 27% of positively screened patients had substance use addressed by their providers. No pediatric addiction referrals were made.

CONCLUSIONS

Findings suggest provider-level barriers exist despite having adequate specialty referral sources and institutional encouragement. Future work is needed to explore these barriers.

Femicides and Victim's age-Associated Factors in Peru

Background. Femicides are an increasing social problem worldwide. In this study, we aim to describe the trend of femicides in the prepandemic decade and characterize the femicide victims and their perpetrators. Methods. We assessed the trend of femicides in Peru during 2010-2019 and performed a cross-sectional study to analyze the femicides reported in 2019 using open data. Results. We analyzed 166 femicides reported in 24/25 regions of Peru in 2019 and calculated a yearly incidence of 1.01 femicides per 100,000 women. This incidence level represents an increase of 38% compared to the mean annual incidence from 2010 to 2018 (0.74 femicides per 100,000 women). Most femicides occurred in urban areas (64%), through strangling/asphyxiation (25.9%), stabbing (23%), and shooting (16%). Most victims were mothers (61%) 30 years old or over (51%). Most perpetrators have had a partner history with their victims (69%), 30 years old or over (62%), employed (57%), and consumed enablers (51%). Our regression analysis observed that the victim's age was associated with the perpetrator's age and partner history. Conclusions. Femicides are endemic in Peru, and the main characteristics of the victims and their perpetrators offer opportunities for tackling this social problem in Peru and similar low- to middle-income countries.

Rates of Forced Sexual Experiences Among High School Students From 2001 to 2019

Public awareness of sexual assault and initiatives aimed at preventing sexual assault continue to increase over the years. However, whether rates of sexual assault have diminished because of such cultural shifts remains unclear. The purpose of this study was to assess if rates of sexual assault (i.e., forced sex) have changed over the past 18 years for adolescent girls and boys as well as potential differences across racial/ethnic identities. Using nationally representative data from the Youth Risk Behavioral Surveillance Survey from 2001 to 2019, we conducted logistic regressions to assess rates of experiences of forced sex by sex and by sex and racial/ethnic identity, while accounting for grade level. Participants included 135,837 high school students. From 2001 to 2019, rates of forced sex maintained for girls; however, there was a decrease over time for boys. For girls, there were inconsistent differences in rates of forced sex by racial/ethnic identities. However, boys who identified as Black, Hispanic, Multi-Racial, and Other Race/Ethnicity were at higher risk to report forced sex than their White peers, until 2015; only Other Race/Ethnicity was at higher risk in 2019. As girls and boys aged, the risk of forced sex increased. Despite prevention efforts, rates of forced sex did not decrease from 2001 to 2019 for adolescent girls disregarding race/ethnicity, and for racial/ethnic minority boys. That rates of forced sex continue to be high is problematic as experiencing sexual assault at an earlier age is associated with myriad consequences. Further, results suggest current prevention initiatives may be inadequate at addressing risk factors for forced sex, and more broadly, sexual assault. Moving forward, researchers and educators may want to re-evaluate the strategies used to address and measure sexual assault experiences.

Interpersonal Violence Among Heterosexual and Sexual Minority Youth: Descriptive Findings From the 2017 Youth Risk Behavior Surveillance System

Interpersonal violence is pervasive among youth in the United States. Sexual minority youth are disproportionately impacted. Utilizing data from the 2017 Youth Risk Behavior Surveillance System (YRBS, N = 12,868), this study describes the disparities in victimization among heterosexual and sexual minority youth. Sexual minority status was operationalized to include nonheterosexual identity (e.g., bisexual) and/or behavior (e.g., reporting same- and different-sex partners). Other predictors included sex (male/female), a sexuality*sex interaction term, age, and race/ethnicity. Outcomes included lifetime forced sexual intercourse and 12-month incidence of sexual violence, physical violence in relationships, sexual violence in relationships, in-school bullying, and cyberbullying. Approximately 15% (n = 1,974) of participants were classified as sexual minority youth and 48% (n = 6,213) self-identified as female. More than half (56%, n = 7,190) identified as racial and/or ethnic minorities. In bivariate logistic regression, sexual minority youth were significantly more likely to report all outcomes (p < .001). In multivariable logistic regression, sexual minority and female youth were significantly more likely to report all outcomes (p < .001). With the exception of physical violence in dating, sexuality*sex interaction terms were significant predictors for all outcomes (p < .001), indicating that the risks associated with sexual minority status are heightened for male youth. This study concludes with a call for more attention toward violence among and against sexual minority youth. Although some prevention and response efforts address the unique needs and experiences of these youth, particularly antibullying initiatives, efforts to address sexual and dating violence often emphasize heterosexual contexts and communities.

Social determinants of violence against women in Panama: results from population-based cross-sectional studies and a femicide registry

BACKGROUND

We aimed to investigate the prevalence of violence against women (VAW) in Panama and its association with social determinants of health (SDH) and to estimate the femicide rates from 2014 to 2017.

METHODS

Data were derived from three cross-sectional population-based studies. Logistic regression models were used to estimate the association between SDH and VAW, expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Age-standardized femicide rates were estimated using data from the Public Ministry.

RESULTS

Compared to the reference categories, women in the lowest quintile (Q) of income distribution (Q1: OR 4.0 [95% CI 1.4-11.7], Q2: OR 3.0 [95% CI 1.1-7.9]), divorced/separated women (OR 1.5 [95% CI 1.0-2.1]) and those in the age categories 25-33 y and 34-49 y (OR 1.9 [95% CI 1.2-3.1]) were more likely to have experienced violence in the past year. Indigenous ethnicity (OR 2.3 [95% CI 1.3-4.1]), age 15-19 y (OR 1.8 [95% CI 1.1-2.9]) and lowest education levels (very low: OR 4.7 [95% CI 1.4-15.5]; low: OR 4.5 [95% CI 1.4-14.6]) were associated with permissive attitudes towards violence. Indigenous (OR 2.7 [95% CI 1.3-6.1]), Afro-Panamanians (OR 3.1 [95% CI 1.3-7.6]) and education level (low: OR 2.5 [95% CI 1.2-4.9]; medium: OR 3.0 [95% CI 1.4-6.6]) were associated with physical/sexual intimate partner violence. Standardized adjusted femicide rates (×100 000) from 2015 to 2017 were 1.5, 0.9 and 0.8, respectively.

CONCLUSIONS

Our findings highlight the importance of prevention programmes.

Longitudinal Associations Between Sexual Victimization and Substance Misuse Among High School Youth in Colorado

There are consistently high rates of sexual victimization and substance misuse among youth in the United States. Although there is a known relation between sexual victimization and substance use, there is a gap in the research regarding the magnitude and temporality of these associations. This study examined whether latent classes of sexual victimization and help-seeking attitudes longitudinally predict intentions of future substance misuse 7-10 months later. Students from nine Colorado high schools (N = 533; M = age 16 years) completed surveys across two consecutive school semesters. Latent class analysis was used to identify classes of students who experienced at least one form of sexual victimization (e.g., sexual harassment, unwanted sexual contact) according to 13 sexual victimization items, and level of positive attitudes regarding help-seeking for sexual victimization. Classes were compared on demographic characteristics and for distal outcomes of likelihood of future substance misuse (cigarettes, alcohol, cannabis, prescription drugs, and electronic vaping products) using latent class regression, controlling for previous intentions to use. At Time 1, four classes of sexual victimization were identified with two main classes for comparison: low odds of experiencing sexual victimization (60.1% of sample) and high odds of endorsing all forms of sexual victimization (7.7% of sample). The high sexual victimization class had higher proportions of male and transgender students, compared to other classes. At Time 2 (7-10 months later), students in the high sexual victimization class reported a significantly greater likelihood of future cigarette (p = .017) and prescription drug misuse (p = .007) when compared to the low sexual victimization class. There was no evidence that having higher positive attitudes towards help-seeking resulted in lower intentions to use substances in the future. These findings highlight that addressing sexual violence in prevention programming may have crossover effects of reducing substance misuse and other forms of violence among youth.

Compulsive exercise and vaping among a sample of U.S. College students aged 18-26 years

PURPOSE

To determine the association between compulsive exercise and vaping among college students aged 18-26 years, and to characterize the type of vaping used among participants who report compulsive exercise.

METHODS

Cross-sectional, pooled data from two survey years (2018-2020; N = 2125) of the national (U.S.) Healthy Minds Study were analyzed. Compulsive exercise was measured based on number of occurrences in the past 28 days (analyzed continuously and among those who reported  ≥ 1 and ≥ 20 occurrences). Vaping was measured based on reported use in the past 30 days. Most recent type of vaping was assessed only among participants who reported vaping. Logistic regression analyses were conducted to estimate the associations between compulsive exercise and vaping, while adjusting for covariates.

RESULTS

For every additional occurrence of compulsive exercise reported by participants, their odds of also reporting vaping increased by 5% (95% CI 1.01-1.09). Participants who reported 20 or more occurrences of compulsive exercise in the past 28 days, a clinical threshold, had 3.71 (95% CI 1.28-10.76) higher odds of vaping in the past 30 days. Among participants who endorsed vaping, nicotine vaping was the most common recent type for those who reported any (76.2%) or 20 or more (50.2%) occurrences of compulsive exercise.

CONCLUSION

Compulsive exercise is associated with vaping in a national, U.S. sample of college students, with nicotine vaping being the most common type used. Screening for both compulsive exercise and vaping, particularly if either is reported, among college-age young adults is necessary to implement prevention and intervention strategies.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

Justice System Involvement Among Adolescents in the Emergency Department

OBJECTIVE

To assess justice system involvement among adolescents in the pediatric emergency department and identify associations with risk and protective factors.

STUDY DESIGN

We conducted a cross-sectional, computerized survey of adolescents to assess for personal, justice system involvement, and nonhousehold justice system involvement (ie, important people outside of household). We assessed sexual behaviors, violent behaviors, substance use, school suspension/expulsion, parental supportiveness, and participant mood (score <70 indicates psychological distress). We compared differences between groups using the χ2 tests, Fisher exact tests, t tests, and performed multivariable logistic regression analyses.

RESULTS

We enrolled 191 adolescents (mean age 16.1 years, 61% female). Most (68%) reported justice system involvement: personal (13%), household (42%), and nonhousehold (40%). Nearly one-half (47%) were sexually active and 50% reported school suspension/expulsion. The mean score for mood was 70.1 (SD 18); adolescents with justice system involvement had had lower mood scores (68 vs 74, P = .03) compared with those without justice system involvement. In a multivariable model, school expulsion/suspension was significantly associated with reporting any justice system involvement (OR 10.4; 95% CI 4.8-22.4).

CONCLUSIONS

We identified the pediatric emergency department as a novel location to reach adolescents at risk for poor health outcomes associated with justice system involvement. Future work should assess which health promotion interventions and supports are desired among these adolescents and families.

Using a theoretical approach to predict college students' non-medical use of prescription drugs - a survival analysis

This study assesses students' non-medical use of prescription drugs (NMUPD) from college entrance to graduation, and examines factors that predict NMUPD. Participants: The study was conducted between May 2011 and September 2015 with 338 students. Methods: Longitudinal cohort study design was used to examine NMUPD across time, and NMUPD-related attitudes and subjective norms. Five yearly interviews were conducted to collect data. Cox proportional hazards regression analysis was used to examine time to NMUPD. Results: Thirty-five percent of study participants reported NMUPD; the majority of those initiated non-medical use before their third year in college. Analyses indicated that more positive attitudes towards NMUPD (HR = 1.73, p < 0.001), increased subjective norms regarding NMUPD (HR = 1.01, p < 0.01), and gender (male) (HR= 1.89, p < 0.001) were significantly associated with sooner NMUPD. Conclusions: Findings suggest that NMUPD prevention efforts that target mutable factors such as attitudes and subjective norms should be implemented early during students' college careers.

Substance Use and Disparities in Teen Dating Violence Victimization by Sexual Identity Among High School Students

Sexual minority youth (SMY) report more substance use and experience more physical and sexual dating violence victimization than heterosexual youth; however, few studies have explored the relationship between substance use and disparities in teen dating violence and victimization (TDVV) using national-level estimates, and examined if these relationships vary by sexual minority subgroups. Data from the nationally representative 2015 and 2017 national Youth Risk Behavior Surveys were used to examine differences in TDVV and substance use by sexual identity, and to determine if substance use was associated with TDVV disparities between SMY and heterosexual high school students who dated 12 months prior to the survey (n = 18,704). Sex-stratified logistic regression models generated prevalence ratios adjusted for demographic characteristics and substance use behaviors to determine if substance use mediated the relationship between sexual identity and TDVV. Compared with their heterosexual peers, SMY experienced higher rates of TDVV and were more likely to report using most types of substances, although differences were more pronounced among female students compared with male students. Disparities in TDVV were reduced for male gay and bisexual students as well as for female bisexual students once substance use was entered into the model, suggesting that there is a relationship between substance use and some of gay and bisexual students' risk for experiences of TDVV. Comprehensive efforts for violence prevention among sexual minority students may benefit from incorporating substance use prevention, given its relationship to disparities in TDVV.

Sexual Violence Victimization of Youth and Health Risk Behaviors

INTRODUCTION

This study assesses associations between past-12-month sexual violence victimization and recent health risk behaviors using a nationally representative sample of male and female high school students. It is hypothesized that sexual violence victimization will be associated with most of the negative health behaviors for both sexes.

METHODS

Data from the 2017 National Youth Risk Behavior Survey, a school-based cross-sectional survey of students in Grades 9-12, were used to assess associations between sexual violence victimization and 29 health risk behaviors in sex-stratified logistic regression models. Effect modification was also examined through sex X sexual violence victimization interactions within unstratified models. All models controlled for race/ethnicity, grade, and sexual identity. Data were analyzed in 2018.

RESULTS

Students who experienced sexual violence victimization were significantly more likely to report many health risk behaviors and experiences, such as substance use, injury, negative sexual health behaviors, feelings of sadness or hopelessness, suicidality, poor academic performance, and cognitive difficulties, and these associations were often stronger among male students (significant adjusted prevalence ratios ranged from 1.63 to 14.40 for male and 1.24 to 6.67 for female students).

CONCLUSIONS

Past-year sexual violence victimization was significantly related to various health risk behaviors, suggesting that efforts to prevent sexual violence may also be associated with decreases in poor health. Integrating violence, substance use, sexual, and other health risk prevention efforts is warranted.

Heavy Drinking and Non-Medical Use of Prescription Drugs among University Students: A 9-Year Follow-Up

Purpose: Investigations suggest non-medical use of prescription drugs (NMUPD) is associated with heavy drinking and polydrug use among university students. Our aim is to determine the prevalence of NMUPD among university students and to analyze its association with alcohol, tobacco, and cannabis use, and to study the role of the age of drinking onset. Methods: Cohort study among university Spanish students (n = 1382). Heavy drinking (HED) and risky consumption (RC) were measured with the Alcohol Use Disorders Identification Test. Questions related to tobacco and cannabis consumption were also formulated. NMUPD refers to sedative, anxiety, or pain medication intake within the last 15 days without medical prescription. All variables were measured at 18, 20, and 27 years. Multilevel logistic regression for repeated measures was used to obtain adjusted OR (odds ratios). We analyzed the results from a gender perspective. Results: Prevalence of NMUPD were higher in students who already partook in NMUPD at the beginning of the study. NMUPD in women at 27 is 3 times higher than at 18, while in men it is twice. Among females, RC (OR = 1.43) and cannabis consumption (OR = 1.33) are risk factors for NMUPD, while later onset of alcohol use (OR = 0.66) constitutes a protective factor. No significant differences were found for males. Conclusions: NMUPD is prevalent among university students. RC and early onset of alcohol use were associated with higher prevalence of NMUPD in females. The prevalence of NMUPD increased with age in both sexes. Strategies for reducing risky drinking and delaying onset of drinking should be provided for university students. Pharmacists and parents should be alerted to the risk of NMUPD.

Prescription Opioid Misuse After a Recent Sexual Assault: A Randomized Clinical Trial of a Video Intervention

BACKGROUND AND OBJECTIVES

Prescription opioid (PO) misuse is increasing and is associated with overdose. Individuals who experienced a recent sexual assault are at risk for increased substance use, yet limited interventions target PO misuse after sexual assault. The current study examined the efficacy of video interventions on PO misuse after sexual assault.

METHODS

Adolescent girls and women (n = 154) were recruited in the context of a sexual assault medical forensic exam in the emergency department. Effects of a prevention of post-rape stress (PPRS) video and a pleasant imagery and relaxation instruction (PIRI) video were compared with treatment as usual (TAU) during a sexual assault medical forensic exam on PO misuse. Participants reported if they had used POs for non-medical purposes since the sexual assault at 1.5 month follow-up.

RESULTS

Results from a logistic regression analysis indicated that participants with a prior sexual assault were less likely to misuse prescription opioids 1.5 months after the assault in the PIRI condition compared with TAU. There were no main effects for video condition and no interactions for the PPRS condition on PO misuse.

DISCUSSION AND CONCLUSIONS

Providing the PIRI video, or teaching other types of mindfulness or relaxation exercises, may be warranted as a secondary prevention for individuals during the sexual assault medical forensic exam for those with a prior sexual assault history.

SCIENTIFIC SIGNIFICANCE

This research provides an initial examination of the impact of mindfulness skills recently after traumatic event exposure on PO misuse. (Am J Addict 2019;28:376-381).

Updates on adolescent dating and sexual violence prevention and intervention

PURPOSE OF REVIEW

Dating and sexual violence victimization are not uncommon in early adolescence and increase in prevalence throughout adolescence into young adulthood with profound health and social consequences. Greater attention to what works in prevention is needed to inform current policies and practices.

RECENT FINDINGS

Adolescent dating violence (ADV) and sexual violence victimization, including cyber dating abuse, are highly prevalent among adolescents. Studies have found sex category differences, with adolescent girls reporting more victimization than boys, particularly sexual violence. Sexual and gender minority youth also experience a higher prevalence of violence victimization than their heterosexual counterparts. Studies on risk factors include examinations of childhood adversities, exposure to sexually explicit material and substance use as well as the role of gender inequitable attitudes on violence perpetration. Recent prevention research includes examining the impact of bystander interventions and transforming gender norms.

SUMMARY

Recent ADV/ sexual violence research highlights both prevalence and modifiable risk and protective factors that may help reduce such violence. Practitioners caring for youth should consider ADV/ sexual violence when seeing patients (including those struggling with substance use and other behaviours that contribute to poor health) and not simply rely on screening tools to identify those suffering from ADV/ sexual violence.