Effects of Exposure to Community Violence and Family Violence on School Functioning Problems among Urban Youth: The Potential Mediating Role of Posttraumatic Stress Symptoms

The link between exposure to violence and psychological distress among middle-aged Muslims in Israel: the role of gender

Introduction

To date, it is still unclear if exposure to violence affects psychological distress in middle-aged adults and if the effects are gender specific. This age group is of special interest as it is at the onset of the aging process and is often overlooked or understudied in scholarly research. Specifically, targeted research on middle-aged Muslims living in Israel, a unique population exposed to increasing violence, is lacking.

Methods

We examined the relationship between exposure to violence and psychological distress in a cohort of 363 middle-aged adults (223 women) from three Muslim villages in northern Israel, collecting data on violence exposure (Screen for Adolescent Violence Exposure (SAVE) questionnaire), psychological distress (Kessler 6 Psychological Distress questionnaire), and other demographic characteristics including education level and socioeconomic status. We used this data to answer two questions: (1) is exposure to violence a predictor of psychological distress in middle-aged Muslims, and (2) does the relationship between exposure and distress differ between men and women?

Results

We revealed a positive link between exposure to violence and psychological distress (β = 0.145, p = 0.017) when controlling for gender, age, education level, and socioeconomic level.

Discussion

Despite previous evidence of gender-based differences in this interplay in younger cohorts, we did not find a significant interaction between gender and the violence exposure-psychological distress interplay. Our findings are some of the first to focus on middle-aged individuals and show that both men and women exhibit connections between exposure to violence and psychological distress when considering covariates. This research provides insights that can be used when planning community-wide interventions and treatment schemes to support healthy aging.

Academic Achievement After Violence Exposure: The Indirect Effects of School Attachment and Motivation to Succeed

Disparities in educational outcomes for students living in communities burdened with high rates of violence are striking as they are at an increased risk for misbehavior, low GPA, poor school attendance, and decreased standardized test scores. However, limited research identifies the role that schools play in exacerbating exposure to violence to inform changes that aid in mitigating violence exposure. As such, this study utilizes the Pathways to Desistance Study to explore the mediating roles of school attachment and motivation to succeed on students' academic outcomes after exposure to community violence. Using a serial mediation model, findings indicate that school attachment and motivation to succeed mediate the relationship between exposure to violence and grades. Implications for adapting school programs and policies as well as providing teacher training to increase school attachment and motivation are discussed.

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

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

Community Violence Exposure and School Functioning in Youth: Cross-Country and Gender Perspectives

Background: Many children and adolescents experience violent events which can be associated with negative consequences for their development, mental health, school, and social functioning. However, findings between settings and on the role of gender have been inconsistent. This study aimed to investigate cross-country and gender differences in the relationship between community violence exposure (CVE) and school functioning in a sample of youths from three countries. Methods: A self-report survey was conducted among school students (12-17 years old) in Belgium (Antwerp, N = 4,743), Russia (Arkhangelsk, N = 2,823), and the US (New Haven, N = 4,101). Students were recruited from within classes that were randomly selected from within schools that had themselves been randomly selected (excepting New Haven, where all students were included). CVE was assessed with the Screening Survey of Exposure to Community Violence. School functioning was assessed with four measures: the Perceived Teacher Support scale, Negative Classroom Environment scale, and Academic Motivation and Perception of Safety at School scales. Multivariate Analyses of Covariance were performed to assess differences in the levels of school-related problem behaviors in boys and girls, who reported different degrees of CVE. Results: Participants in all three countries reported a relatively high prevalence of violence exposure (36.2% in Belgium, 39.3% in Russia and 45.2% in the US who witnessed violence), with a higher proportion of girls than boys witnessing violent events (varied from 37.4 to 51.6% between the countries), whereas boys reported more episodes of victimization by violence than girls (varied from 32.3 to 49.9% between the countries). Youths who experienced increased CVE (from no exposure to witnessing to victimization) reported an increase in all school functioning problems in all of the countries and this association was not gender-specific. Conclusions: Our findings suggest that regardless of differences in the level of CVE by country and gender, violence exposure is negatively associated with school functioning across countries. Nonetheless, even though reactions to community violence among adolescents may be expressed in a similar fashion, cross-country differences in social support systems should also be taken into account in order to provide culturally sensitive treatment modalities.

From Exposure to Violence between Mother and Her Intimate Partner to Suicidality Experienced by Urban Adolescents in Chicago's Southside

Although the relationship between exposure to intimate partner violence and youths’ psychological and other wellbeing has been widely studied, there is limited research about how youths’ exposure to violence between mother and her intimate partner may be related to youth psychological wellbeing. The study used a sample of urban adolescents in Chicago Southbound to examine whether youths’ exposure to verbal conflict between mother and her intimate partner is related to their suicidality and whether youth depression and aggression may be in between such a linkage. Our findings indicated that one-third of the youth had suicidal thoughts or suicidal/self-hurting attempts. Youths’ exposure to verbal conflict between mother and her intimate partner was associated with their depressive and aggressive symptoms, and depressive symptoms subsequently were linked to suicidality. The findings also showed that youth depressive symptoms and aggressive symptoms were positively correlated, which may influence their associations with suicidality. We concluded that youth exposure to parental intimate partner violence, even comparatively mild forms such as a verbal conflict between mother and her intimate partner, may increase their risk of suicidality by worsening psychological wellbeing. The findings highlight the importance of tackling youth suicidality risks while accounting for their exposure to intimate partner violence including verbal conflicts between parents.

The Role of Trauma-Informed Training in Helping Los Angeles Teachers Manage the Effects of Student Exposure to Violence and Trauma

Exposure to trauma, such as community violence, has far-reaching effects on childrens' learning and behavior. While schools are a critical place to provide positive and safe spaces for students, teachers have self-reported a lack of knowledge on how to work effectively with traumatized students. In response to this, there has been an increase in teacher training on trauma-related topics. However, it is unclear how training impacts teachers' trauma knowledge and difficulty responding to traumatized students in the classroom. As such, this exploratory study used a survey (N = 94) with Los Angeles teachers to assess whether training on violence and trauma is related to trauma knowledge and reported difficulty responding to traumatized students. Regression analyses indicate that total training increased teachers' trauma knowledge, which was found to mediate teachers' difficulty responding to traumatized students. Findings from this study support the need for a focus on trauma-informed training within the education context.

Mindfulness and Posttraumatic Stress Disorder Symptom Severity in Urban African-American High School Students

OBJECTIVES

The aim of the current study was to examine the relations among mindfulness, posttraumatic stress disorder (PTSD) symptom severity, and stressful life events (SLEs) in African-American urban adolescents. Another aim was to examine mindfulness as a moderator of the relation between SLEs and PTSD symptom severity in this population.

METHOD

Eighty-eight African-American high school students from a low-income urban community completed measures of demographics, PTSD symptom severity, SLEs, and mindfulness.

RESULTS

Mindfulness was significantly negatively related to PTSD symptom severity, r(86) = -.70, p < .001, 95% CI [-.58, -79], and SLEs were significantly positively related to PTSD symptom severity, r(86) = .29, p = .003, 95% CI [.09, .47]. Mindfulness was an independent predictor of PTSD symptom severity after accounting for SLEs, B = -1.16, t(84) = -9.06, p < .001, 95% CI [-1.41, -0.90], and SLEs were an independent predictor of PTSD symptom severity after accounting for mindfulness, B = 0.49, t(84) = 2.92, p = .004, 95% CI [0.16, 0.82]. Mindfulness did not moderate the relation between SLEs and PTSD symptom severity, B = -.003, t(84) = -0.15, p = .89, 95% CI [-.04, .03].

IMPLICATIONS

This study has implications for both mindfulness as a potential protective factor against PTSD symptom severity and SLEs as a potential risk factor for increased PTSD symptom severity in African-American urban adolescents.

Prescribed medication use among elementary teachers: Prevalence and associated factors

The aims of the study were to assess the prevalence and analyze the associated factors of medication use among teachers. A cross-sectional study was carried out, involving 530 teachers from Londrina city, Paraná, Brazil. The dependent variable was prescribed medication use and the independent variables were sociodemographic, work-related, lifestyle, health disorders, and chronic diseases, all assessed through questionnaires. Prevalence of medication use was 59.1%. Chronic disease was associated with all medications analyzed. Variables positively associated with medication use according to health disorder type were: Cardiometabolic (Length of employment, overweight, not current tobacco use, and TV viewing); Psychological (Length of employment, common mental disorders, current tobacco use, and disability); Orthopedic (Length of employment, health insurance, overweight, musculoskeletal pain, low job support, and disability); Respiratory (TV viewing and problems related to dust or chalk powder); and Gastrointestinal (common mental disorders and physical activity [negative association]). Support for access, the appropriate use of medicines, and a reduction in medication use should consider work-related, lifestyle, and health disorders, as well as chronic diseases.

The Longitudinal Relation Between Community Violence Exposure and Academic Engagement During Adolescence: Exploring Families' Protective Role

Few published studies have examined the interaction between community violence exposure, academic engagement, and parental involvement, despite theory suggesting that these three domains of development are interrelated during adolescence. This study had two related objectives: (a) to assess the temporal ordering of the relation between community violence exposure and academic engagement over the course of mid-adolescence and (b) to examine whether the pattern of these relations varies by level of parental involvement. The study sample included 273 ethnic minority males (33.4% Latino and 65.6% African American) and their caregivers living in impoverished urban neighborhoods. The present study drew on data collected through in-home surveys on violence exposure, school experiences, and family functioning at three time points during mid-adolescence. Cross-lagged model results suggest that at Time 1 (M age = 13.5), community violence exposure predicted lower academic engagement at Time 2 (M age = 14.8). Between Time 2 and Time 3 (M age = 15.8), it was academic engagement that predicted lower community violence. Parental involvement moderated these relations such that academic engagement at Time 2 only reduced the risk of violence exposure at Time 3 in the presence of families with high levels of involvement relative to others in the sample. Findings suggest that practitioners might seek to promote positive school experiences as youth move into high school to reduce risk of violence exposure. Results also indicate the importance of designing interventions that target both positive family and school functioning.

What are the long-term consequences of youth exposure to firearm injury, and how do we prevent them? A scoping review

The long-term consequences of exposure to firearm injury-including suicide, assault, and mass shootings-on children's mental and physical health is unknown. Using PRISMA-ScR guidelines, we conducted a scoping review of four databases (PubMed, Scopus, PsychINFO, and CJ abstract) between January 1, 1985 and April 2, 2018 for articles describing long-term outcomes of child or adolescent firearm injury exposure (n = 3582). Among included studies (n = 31), most used retrospective cohorts or cross-sectional studies to describe the correlation between firearm injury and post-traumatic stress. A disproportionate number of studies examined the effect of mass shootings, although few of these studies were conducted in the United States and none described the impact of social media. Despite methodologic limitations, youth firearm injury exposure is clearly linked to high rates of post-traumatic stress symptoms and high rates of future injury. Evidence is lacking on best practices for prevention of mental health and behavioral sequelae among youth exposed to firearm injury. Future research should use rigorous methods to identify prevalence, correlates, and intervention strategies for these at-risk youth.

Patterns of Caregiver Factors Predicting Participation in Trauma-Focused Cognitive Behavioral Therapy

This study examined patterns of caregiver factors associated with Trauma- Focused Cognitive Behavioral Therapy (TF-CBT) utilization among trauma-exposed youth. This study included 41 caregivers (caregiver age M = 36.1, SD = 9.88; 93% African American) of youth referred for TF-CBT, following a substantiated forensic assessment of youth trauma exposure. Prior to enrolling in TF-CBT, caregivers reported on measures for parenting stress, attitudes towards treatment, functional impairment, caregiver mental health diagnosis, and caregiver trauma experiences. Classification and regression tree methodology were used to address study aims. Predictors of enrollment and completion included: attitudes towards treatment, caregiver trauma experiences, and parenting stress. Several caregiver factors predicting youth service utilization were identified. Findings suggest screening for caregivers' attitudes towards therapy, parenting stress, and trauma history is warranted to guide providers in offering caregiver-youth dyads appropriate resources at intake that can lead to increased engagement in treatment services.

Trauma-informed schools: Child disaster exposure, community violence and somatic symptoms

BACKGROUND

Given the increasing prevalence of natural disasters, trauma-informed school settings should include efficient methods for assessing child health and mental health in post-disaster environments. To develop such methods, factors that contribute to children's vulnerability and key signs of distress reactions after disasters need to be understood. To address these issues, we evaluated pre-disaster community violence exposure as a vulnerability factor for children's post-disaster reactions and somatic symptoms as a key post-disaster outcome.

METHODS

We evaluated 426 children exposed to Hurricane Katrina at two timepoints (3-7 months and 13-17 months post-disaster). Structural equation models evaluated community violence exposure, hurricane exposure, and posttraumatic stress and somatic symptoms.

RESULTS

Community violence exposure was associated with increased levels of posttraumatic stress symptoms among disaster-impacted youth, and did not moderate the relationship between disaster exposure and posttraumatic stress symptoms. Posttraumatic stress symptoms were associated with somatic symptoms in the short-term recovery period (3-7 months), but not associated with somatic symptoms during the longer-term recovery period (13-17 months).

LIMITATIONS

This study did not include school-level factors, and somatic symptoms were based on parent reports. The study did not include parent functioning information or distinguish between whether somatic symptoms were medical or functional in nature.

CONCLUSIONS

Post-disaster school-based screeners may need to incorporate questions related to children's past exposure to community violence and their somatic symptoms to provide trauma-informed care for children.

Association Between Socioeconomic Status and Tumor Grade Among Black Men with Prostate Cancer

BACKGROUND

Prostate cancer affects black men disproportionately. Black men have an increased incidence of prostate cancer diagnoses at earlier ages and higher grade as indicated by Gleason score, compared to other races. This study investigates the impact of socioeconomic status (SES) on prostate cancer tumor grade among black men.

METHODS

Black men with a prostate cancer diagnosis during 1973-2011 were examined using individual-level data from the SEER NLMS database. Logistic regression model estimated the likelihood of receiving a diagnosis of high versus low grade prostate cancer based on self-reported SES status at the time of diagnosis.

RESULTS

Men who completed high school only were statistically significantly more likely to have a higher prostate cancer grade than those with a bachelor's degree or higher. However, there was no dose-response effect across educational strata. Retirees were 30% less likely to have higher grade tumors compared to those who were employed.

CONCLUSIONS

SES differences among black men did not fully explain the high grade of prostate cancer. Further research is needed on the biology of the disease and to assess access to medical care and prostate health education, discrimination, stress exposures, and social norms that might contribute to the aggressiveness of prostate cancer among black men.

Mental Health and School Functioning for Girls in the Child Welfare System: the Mediating Role of Future Orientation and School Engagement

This study investigated the association between mental health problems and academic and behavioral school functioning for adolescent girls in the child welfare system and determined whether school engagement and future orientation meditated the relationship. Participants were 231 girls aged between 12 and 19 who had been involved with the child welfare system. Results indicated that 39% of girls reported depressive symptoms in the clinical range and 54% reported posttraumatic symptoms in the clinical range. The most common school functioning problems reported were failing a class (41%) and physical fights with other students (35%). Participants reported a mean number of 1.7 school functioning problems. Higher levels of depression and PTSD were significantly associated with more school functioning problems. School engagement fully mediated the relationship between depression and school functioning and between PTSD and school functioning, both models controlling for age, race, and placement stability. Future orientation was not significantly associated with school functioning problems at the bivariate level. Findings suggest that school engagement is a potentially modifiable target for interventions aiming to ameliorate the negative influence of mental health problems on school functioning for adolescent girls with histories of abuse or neglect.