Firearm carrying and adolescent suicide risk outcomes between 2015 and 2021 across nationally representative samples

INTRODUCTION

Firearms are the most frequent means of youth suicide for the 14-18-year-old age group, and adolescent firearm access confers substantial increases in the risk of suicidal behaviors. There have been significant increases in firearm purchases and firearm violence in the United States since the onset of the COVID-19 pandemic.

METHODS

This study uses four time points of nationally representative data from the Youth Risk Behavior Survey (YRBS) from 2015 to 2021 to examine the differential associations of reporting having carried a firearm and suicide-related outcomes, after controlling for relevant demographic factors. As a sensitivity analysis, we examined whether a similar risk pattern was seen for the probability of reporting depressed mood.

RESULTS

Results reveal significant increases in suicide-related outcomes among students who reported carrying a firearm and no significant increases among those who did not. Unlike the suicide-related outcomes, increases in depressed mood overtime were not limited to students who carried firearms, suggesting that the risk associated with firearms may be specific to suicide-related outcomes.

CONCLUSIONS

Carrying a firearm is associated with significant increases in the risk of suicidal ideation and behaviors among youth and this risk has increased between 2015 and 2021. Implications for youth suicide prevention and directions for future research are discussed.

The impact of HIV self-testing on risk behaviors among men who have sex with men: a mixed-methods study

Background

Men who have sex with men (MSM) have a high prevalence of HIV and a low rate of HIV testing in China. HIV self-testing (HIVST) presents a viable strategy for expanding HIV testing among MSM. However, the impact of HIVST on risk behaviors among MSM remains controversial. Our study sought to ascertain this impact.

Methods

From April 2021 to January 2022, a mixed-methods study was conducted in Qingdao City, employing both quantitative and qualitative methodologies. The quantitative component entailed a cohort study among MSM who had used HIVST. Generalized estimating equations fitting Poisson regressions were used to analyze the changes in risk behaviors of MSM in short time after HIVST (ST-HIVST) and longer time after HIVST (LT-HIVST) compared to before HIVST. Subsequently, we conducted in-depth interviews with 18 MSM who completed the follow-up to delve deeper into the impact of HIVST on MSM.

Results

A total of 410 MSM were recruited in the cohort, of whom 83 were lost to follow-up. Compared to before HIVST, there were no significant changes in risk behaviors in ST-HIVST (p > 0.05), while the proportion of recreational drugs abuse (20.7% vs. 33.3%), commercial sex (14.6% vs. 22.9%), and unprotected anal sex (95.9% vs. 98.5%) increased significantly in LT-HIVST (p < 0.05). Specific changes varied across demographic characteristics. According to qualitative interviews, MSM might have decreased risk perception and increased risk behaviors after HIVST.

Conclusion

The use of HIVST may promote MSM to engage in risk behaviors. In the future, customized HIVST promotion programs need to be developed to expand HIV testing among MSM and simultaneously control their risk behaviors.

Perceived Health Status and Medical Conditions Among US Active-Duty Service Members

Purpose

This paper investigates the association between self-reported perceived health status and doctor-informed medical conditions among US active duty service members (ADSM).

Methods

Data are from the 2018 Health-Related Behaviors Survey - a cross-sectional survey weighted to represent the US military (N = 17166). Perceived good health status was defined as having a response choice of "good", "very good", or "excellent" to the question: Would you say your overall physical health is ___? Medical conditions were based on self-reported presence of nine clinical conditions. Analysis included weighted prevalence and log-binomial regression models to explore relationships between ADSM characteristics with perceived good health status as well as concordance between perceived status and medical conditions.

Results

ADSM rated their health to be excellent (14.6%), very good (37.7%), good (36.2%), fair (9.7%) and poor (1.7%). About 88.5% perceived a good (to excellent) health status. Perceived good health status was negatively associated with the number of medical conditions present (adjusted odds ratio (aOR): ranging from 0.78 to 0.92) as well as several health behaviors (aOR): ranging from 0.86 to 0.98) and other sociodemographic factors. Among all ADSMs, 51% perceived good health in the absence of medical conditions, while 8% perceived poor health status in the presence of medical conditions. Concordance between perceived health status and medical conditions was significantly lower among ADSM who were older (aOR: 0.61; 95% CI: 0.54-0.69), with dependent children (aOR: 0.89; 95% CI: 0.84-0.95), or had been deployed (aOR: 0.89, 95% CI: 0.84-0.95).

Conclusion

The prevalence of perceived good health status among ADSMs was consistent with those documented in the general US population. The interrelationships between ADSM's perceptions, medical conditions and sociodemographic characteristics may have implications for their health literacy and utilization of health services. Study findings suggest that interventions promoting healthy behaviors, health literacy and treatment-seeking may influence perceived health status and mitigate medical conditions among ADSM, thus improving the US Military readiness, resilience and mission success.

Risk Behaviors among Migrant Adolescents in Italy

Adolescence is a critical period for engaging in health risk behaviors. Migrant adolescents may face unique challenges due to acculturation stress. This study aims to monitor substance use and problem gambling among migrant adolescents living in Italy. Data from the 2017/18 Health Behavior in School-Aged Children survey in Italy were analyzed. The 18,794 participants included 15-year-olds, categorized as native or migrants, with ethnic backgrounds from Western, Eastern European, or non-Western/non-European countries. Girls had higher smoking rates, while boys exhibited higher prevalence of alcohol-related risk behaviors, cannabis use, and gambling. Boys from Eastern European countries displayed a greater risk of drunkenness (OR: 1.58, 95% CI: 1.06-2.37), particularly in the first generation, while those from Western countries showed a higher risk of multiple substance use (OR: 1.44, 95% CI: 1.05-1.96). Girls from Eastern European and non-Western/non-European countries had a lower risk of alcohol consumption (OR: 0.50, 95% CI: 0.29-0.85; OR: 0.55, 95% CI: 0.33-0.91, respectively). Finally, boys, especially those from Eastern European and non-Western/non-European countries, had a significantly higher risk of problem gambling (OR: 1.83, 95% CI: 1.04-3.22; OR: 2.10, 95% CI: 1.29-3.42, respectively). This disparity was more pronounced in the first generation, possibly due to acculturation challenges and socio-economic factors. Risk behaviors in adolescents are influenced by complex interplays of gender, cultural factors, and migration generation. Preventive strategies should consider these factors to effectively address substance use and gambling in this heterogeneous population.

The 5Cs of Positive Youth Development and Risk Behaviors in a Sample of Spanish Emerging Adults: A Partial Mediation Analysis of Gender Differences

Positive Youth Development (PYD) emerged as a holistic and strength-based perspective that focuses on the fact that young people may have the internal and external resources for healthy and successful development through five dimensions (5Cs) that empower them: Perceived Competence, Confidence, Character, Connection, and Caring. The aim of this study was to examine the relationship between the overall PYD factor, the 5Cs, and risk behaviors, in addition to analyzing gender differences. This study showed the results of a cross-sectional study of 1044 emerging adults from 11 Spanish universities in 2021. Data collection was performed by applying an online self-report measure. The results showed that the Character was protective against substance abuse, mainly in women, while the connection was related to the participation of betting money and online betting in men. Caring was protective against money bets in the men's sample. However, controversial results were found regarding Perceived competence, which had a positive association with substance abuse, money bets, and drunk driving. It seems that high levels of Perceived competence, rather than objective competence, were associated with engagement in various risk behaviors. Concerning gender differences, men showed more risky behaviors than women. A partial mediation model pointed out that lower character and higher perceived competence in men partly explained the higher presence of risky behavior compared to women. These results underline the need to promote PYD within the university context to prevent risky behaviors by addressing gender differences and the separate role of the 5Cs.

Adolescent Sexting, Violence, and Sexual Behaviors: An Analysis of 2014 and 2016 Pennsylvania Youth Risk Behavior Survey Data

BACKGROUND

Sexting is common among adolescents and is associated with numerous health risk behaviors and negative psychosocial constructs. This study examined the relationships between high school students' experiences with sexual violence victimization, dating violence victimization, and engagement in risky sexual behaviors with experiences of receiving sexts.

METHODS

Cross-sectional data from the 2014 to 2016 data from Pennsylvania Youth Risk Behavior. Participants were selected using an independent 2-stage cluster sample design to produce a statewide population-based sample. The pencil and paper surveys were conducted in school. Participants included 6734 Pennsylvania high school students in grades 9-12.

RESULTS

Overall, 29.0% of Pennsylvania high school students had received a sext, which varied by sex, race/ethnicity, school grade, and sexual identity. Students who engaged in sexual risk behaviors, experienced dating violence, or experienced lifetime sexual violence outside of the dating context had a significantly higher prevalence of receiving a sext than students who did not engage in those behaviors or have those experiences.

CONCLUSIONS

Early screening and prevention efforts that include discussions about sexting behaviors may help prevent other negative outcomes, such as risky sexual behaviors and interpersonal violence. Addressing sexting in the education and health sectors may help to prevent other related harmful health and violence experiences during adolescence.

Risk behaviors and well-being among Egyptian and Roma adolescents in Albania during the COVID-19 pandemic: Vulnerability and resilience in a positive youth development perspective

Introduction

Egyptian and Roma communities represent two of the most deprived and stigmatized ethnic minorities in Albania. However, research investigating vulnerability and well-being in youth from these communities is scant. Even less is known among Egyptian and Roma adolescents who dropped-out of school. Within a Positive Youth Development framework, we investigated among Egyptian and Roma adolescents: (1) risk behaviors, well-being, and developmental assets (personal and contextual); (2) associations of developmental assets with risk behaviors and well-being; (3) specificities by ethnicity, gender, and education.

Methods

A total of 201 Egyptian and Roma adolescents (Mage = 16.63, SDage = 1.80; 47% girls; 53% school dropouts) completed a series of questionnaires in a community setting in August 2020 (first wave of the COVID-19 pandemic).

Results

Binomial, Poisson and linear regression models indicated that Egyptian and Roma adolescents reported similar and high levels of risk behaviors, with boys reporting overall more risk behaviors than girls. Low level of well-being and of personal and contextual assets were reported. Girls reported higher family assets, positive values and social competencies than boys. The situation of adolescents attending school was overall not better than that of youth who had dropped out. Higher positive identity was associated with higher well-being.

Discussion

Intervention and prevention efforts are urgently needed to support minority adolescents' development during and in the aftermath of the pandemic. They should address the structural factors which limit the availability of personal and contextual resources in minority youth's lives. Interventions aimed at building safer neighborhoods and providing safe access to schools for minority youth should be a priority and are essential to prevent the widening of inequalities during and after this health emergency.

Lifestyle Related Cancer Risk and Protective Behaviors Vary among a Convenient Sample of Physically Active, Young-to-Middle-Aged Adults 18-49

It is an assumption that physically active adults lead an overall healthy lifestyle. To examine this assumption, we administered a cross-sectional, web-based survey to a sample of young-to-middle-aged US adults between 18 and 49 who self-reported participation in at least one recreational sporting event in the past month. Logistic regressions were conducted to examine demographic characteristics associated with cancer risk and protective behaviors. Gender was represented equally (N = 938), and the average age was 32 years (SD: 8.4). Most participants reported >three days of moderate- to high-intensity physical activity (79%), but not meeting fruit and vegetable consumption guidelines (78%). Many reported current tobacco use (32%), binge drinking at least once in the past 30 days (62%), and suboptimal sun protection use (67%). Participation in lifestyle-related cancer risk and protective behaviors varied based on age, sex, education, routine doctor visits, perceived overall health, health-information-seeking behavior (how participants obtained health information), or team-based sport participation in regression models. Future interventions should be tailored to address varied cancer risk profiles among even physically active adults to encourage multiple healthy behavior changes.

Gambling participation among Connecticut adolescents from 2007 to 2019: Potential risk and protective factors

Background and aims

Gambling in adolescents is a public health concern. This study sought to examine patterns of gambling among Connecticut high-school students using seven representative samples covering a 12-year period.

Methods

Data were analyzed from N = 14,401 participants in cross-sectional surveys conducted every two years based on random sampling from schools in the state of Connecticut. Anonymous self-completed questionnaires included socio-demographic data, current substance use, social support, and traumatic experiences at school. Chi-square tests were used to compare socio-demographic characteristics between gambling and non-gambling groups. Logistic regressions were used to assess changes in the prevalence of gambling over time and effects of potential risk factors on the prevalence, adjusted for age, sex, and race.

Results

Overall, the prevalence of gambling largely decreased from 2007 to 2019, although the pattern was not linear. After steadily declining from 2007 to 2017, 2019 was associated with increased rates of gambling participation. Consistent statistical predictors of gambling were male gender, older age, alcohol and marijuana use, higher levels of traumatic experiences at school, depression, and low levels of social support.

Discussion and conclusion

Among adolescents, older males may be particularly vulnerable to gambling that relates importantly to substance use, trauma, affective concerns, and poor support. Although gambling participation appears to have declined, the recent increase in 2019 that coincides with increased sports gambling advertisements, media coverage and availability warrants further study. Our findings suggest the importance of developing school-based social support programs that may help reduce adolescent gambling.

A descriptive analysis of hospitalized adolescents facing chronic illnesses with different durations of disease

OBJECTIVES

To assess characteristics of hospitalized adolescents facing chronic diseases, correlating the perceptions of their illness, quality of life and the prevalence of risk behaviors, considering gender and the diseases' durations.

METHODS

The sample consisted of 61 adolescents, aged between 10 and 19 years, with chronic diseases, hospitalized at the University Hospital of the State University of Londrina. They answered a questionnaire and the scales World Health Organization Quality of Life (WHOQOL-BREF) and Illness Perception Questionnaire (IPQ). They were divided in groups, according to the durations of the disease: group 1 (up to 4 years) and group 2 (5 years or more).

RESULTS

Group 2 demonstrated higher leisure activity (p = 0.02) and more painful symptoms (p = 0.02). In WHOQOL-BREF, group 2 had a higher quality of life in the domain on environment (p = 0.02) and a higher total score (p = 0.04). Lower scores on the IPQ were associated with higher scores on the WHOQOL-BREF. Positive correlation was found between WHOQOL-BREF total score and years of disease, in which male presented higher scores.

CONCLUSIONS

These findings may alert to the need for more knowledge about the diseases and the importance of encouraging ways to improve quality of life and care to reduce risky behaviors.

Comparison of Contraception Method and Associated Risk Among US High School Students

Adolescent unintentional pregnancy and sexual transmitted infections (STIs) are at an alarming rating in the United States. The factors that contribute to high rates of unintentional pregnancy and STIs among adolescents are lack of contraception use and other risk behaviors. As such, this study sought to assess the relationship between type of contraception used during last sexual intercourse and risk behaviors among high school adolescents. Data for this study were derived from the 2019 Youth Risk Behavior Study (YRBS). A total of 13,677 participants completed the YRBS in 2019. Multiple logistic regression was used to estimate the association between contraceptive type (i.e., condom, oral birth control, withdrawal, no method) and risk behavior. Results found that those students who reported condom use were less likely to engage in certain substance use behaviors and sexual risk taking compared to those who used no contraceptive method, oral birth control, or withdrawal. The results seem to suggest that condom use and risk-taking behaviors are somewhat interconnected in that condom users were found to be more protective in their behaviors.

Parental Information Needs and Intervention Preferences for Preventing Multiple Lifestyle Risk Behaviors Among Adolescents: Cross-sectional Survey Among Parents

BACKGROUND

Parents play an influential role in the health behaviors of their children, such as physical activity, dietary intake, sleep, screen time, and substance use. However, further research is needed to inform the development of more effective and engaging parent-based interventions targeting adolescent risk behaviors.

OBJECTIVE

This study aimed to assess parents' knowledge about adolescent risk behaviors, barriers and facilitators to engaging in healthy behaviors, and preferences for a parent-based prevention intervention.

METHODS

An anonymous web-based survey was conducted from June 2022 to August 2022. Eligible participants were parents of children aged 11 to 18 years and were residing in Australia at the time of this study. The survey assessed the parents' perceived and actual knowledge about Australian health guidelines for youth, parent and adolescent engagement in health behaviors, parenting style and attitudes, barriers and facilitators to engaging in healthy behaviors, and delivery and component preferences for a parent-based preventive intervention. Descriptive statistics and logistic regressions were conducted to analyze the data.

RESULTS

A total of 179 eligible participants completed the survey. The mean age of the parents was 42.22 (SD 7.03) years, and 63.1% (101/160) were female. Parent-reported sleep duration was high for both parents (mean 8.31, SD 1.00 hours) and adolescents (mean 9.18, SD 0.94 hours). However, the proportion of parents who reported that their child met the national recommendations for physical activity (5/149, 3.4%), vegetable intake (7/126, 5.6%), and weekend recreational screen time (7/130, 5.4%) was very low. Overall, parents' perceived knowledge of health guidelines was moderate, ranging from 50.6% (80/158) for screen time to 72.8% (115/158) for sleep guidelines (for children aged 5-13 years). Actual knowledge was lowest for vegetable intake and physical activity, with only 44.2% (46/104) and 42% (31/74) of parents reporting correct guidelines for these behaviors, respectively. The key issues of concern reported by parents were excessive use of technology, mental health, e-cigarette use, and negative peer relationships. The top-rated delivery method for a parent-based intervention was via a website (53/129, 41.1%). The highest rated intervention component was opportunities for goal-setting (89/126, 70.7% rated very or extremely important), and other important program features were ease of use (89/122, 72.9%), paced learning (79/126, 62.7%), and appropriate program length (74/126, 58.8%).

CONCLUSIONS

The findings suggest that such interventions should be brief and web based and should aim to increase parental knowledge of health guidelines; provide opportunities for skill-building, such as goal-setting; and include effective behavior change techniques, such as motivational interviewing and social support. This study will inform the development of future parent-based preventive interventions to prevent multiple lifestyle risk behaviors among adolescents.

A Cross-Sectional Survey of Different Types of School Bullying before and during COVID-19 in Shantou City, China

BACKGROUND

Since the end of 2019, the COVID-19 pandemic has had serious wide-ranging effects on academic, occupational and other daily activities. Like other types of institutions, schools are facing unprecedented challenges. Students may face a variety of adverse consequences, including sleep disturbances and school bullying, if they are unable to adjust to the current learning and living environment. This study explored the effects of the COVID-19 pandemic on school bullying.

METHODS

A total of 5782 middle school students were enrolled in this multi-stage, cross-sectional study (3071 before and 2711 during the pandemic). The pre-pandemic group had a mean age of 14.9 ± 1.73, the pandemic group of 14.75 ± 1.47. Three models were set up using binary logistic regression to adjust for confounding variables (gender, school type, alcohol consumption, smoking, playing violent video games).

RESULTS

All types of bullying victimization and perpetration (physical, verbal, social and property bullying) were more common during the pandemic than before the pandemic. In terms of bullying victimization, property bullying victimization (crude odds ratio [OR]: 2.398, 95% CI: 2.014-2.854, p < 0.001; model 2 adjusted OR: 2.344, 95% CI: 1.966-2.795, p < 0.001; model 3 adjusted OR: 2.818, 95% CI: 2.292-3.464, p < 0.001) increased the most. In terms of bullying perpetration, verbal bullying perpetration (crude OR: 3.007, 95% CI: 2.448-3.693, p <0.001; model 2 adjusted OR: 2.954, 95% CI: 2.399-3.637, p < 0.001; model 3 adjusted OR:3.345, 95% CI: 2.703-4.139, p < 0.001) increased the most.

CONCLUSION

This study corroborate the significance of the pandemic on traditional school bullying and suggests that we should further consider other types of bullying and establish and improve the response and prevention mechanisms during public health emergencies such as the COVID-19 pandemic.

Chemsex Drug Use among a National Sample of Sexually Active Men who have Sex with Men, - American Men's Internet Survey, 2017-2020

Background: Chemsex is the intentional use of drugs to enhance sexual activity. Chemsex drug use among men who have sex with men (MSM) is associated with sexual behaviors that increase sexually transmitted infection (STI) risks and adverse mental health outcomes. However, published data are largely based on MSM recruited from STI clinics. There are limited data about use of chemsex drugs among national samples of MSM in the United States. Using data from the American Men's Internet Survey (AMIS), we assessed the prevalence and correlates of use of chemsex drugs among sexually active MSM in the United States. Methods: We used data from the 2017 to 2020 AMIS cycles to examine the prevalence of chemsex drug use in the past 12 months among MSM. We calculated prevalence ratios (PR) and 95% confidence intervals (CI) to compare chemsex drug use across demographic, behavioral, and mental health factors. Results: Of 30,294 MSM, 3,113 (10.3%) reported chemsex drug use in the past 12 months. Of the 3,113 MSM who reported chemsex drug use, 65.1% reported ecstasy use, 42.5% reported crystal methamphetamine use, and 21.7% reported GHB use. Factors associated with chemsex drug use included condomless anal sex (PR = 1.93, 95%=1.69-2.20), problem drinking (PR = 2.36, 95% = 2.13-2.61), bacterial STI test (1.84, 95% CI = 1.68-2.02) and probable serious mental illness (PR = 1.92, 95% = 1.76-2.09). Conclusion: Chemsex drug use is associated with behaviors that increase STI risk and mental distress among MSM. Health programs that serve MSM can consider screening for chemsex drug use and offering sexual and mental health promotion and risk reduction interventions when necessary.

Gender non-binary adolescents' somatic and mental health throughout 2020

Background

Non-binary gender adolescents are particularly vulnerable and more likely to be exposed to several socio-psychological difficulties and disorders. It is vital to discover and act on the vulnerabilities they encounter. The present study aims to describe the somatic and mental health, affect state, frequency of risk behaviors, victimization and negative psychosocial factors, as well as the personality profiles of non-binary adolescents. In this study the concept of gender non-binary is used and captured respondents who selected "neither of these" as their gender from the possible options (female/male/neither of these).

Materials and methods

Data was collected between September 2020 and February 2021 in Sweden, Morocco, Serbia, Vietnam, and the United States. The cross-sectional, retrospective study utilized the electronic version of the Mental and Somatic Health without borders (MeSHe) survey. From the over 5,000 responses of 15-19-year-old adolescents, 58 respondents identified as being non-binary, and built our study population. Their data was analyzed with descriptive statistic methods.

Results

Close to a fourth of adolescents identifying as non-binary reported the existence of at least one somatic disease. The most prevalent somatic disease was allergies. Almost one-third had suffered from pain either often or all the time in the past 12 months. The highest levels of perceived psychological distress were measured using obsessive-compulsive symptoms, depression, and interpersonal sensitivity. The average level of alcohol and drug use during the past 12 months was low. About 40% of non-binary adolescents reported having experienced physical abuse, and half of them experienced psychological abuse at some point in their lives. Seventeen percent reported living with adults with alcohol-use problems. Non-binary adolescents' personalities were found to be dominated by high scores in Openness, Neuroticism, and Agreeableness.

Conclusion

This study presents a detailed biopsychosocial picture of a multinational sample of non-binary adolescents. Our study suggests that awareness and support are required from all fields of society, including family, school, healthcare, and educational institutions, for cis-normative culture to progress toward a greater understanding of and respect for gender diversity.

Adverse Childhood Experiences and Health in Rural Areas of Riyadh Province in Saudi Arabia: A Cross-Sectional Study

Adverse childhood experiences (ACEs) and their consequences are a worldwide problem. ACEs are primary stressors that have a long-term impact on the body and mind during development. They are linked to a variety of chronic illnesses in adults. Information about ACEs and health and risk behaviors is scarce among rural populations. The study aimed to examine ACEs, chronic diseases, and risk behaviors, as well as to explore the relationship between them and number of sociodemographic factors among adults living in rural areas in Riyadh Province, Saudi Arabia. A cross-sectional design and a convenience sampling method were utilized to collect information. A self-reported questionnaire, including an ACEs questionnaire as well as direct health and risk behaviors questions, was used. In total, 68.2% of the respondents reported at least one ACE, and 34.2% reported four or more ACEs. Emotional and physical abuse were the most reported forms. Hypertension and chronic respiratory disease were the most reported chronic diseases. Depression and anxiety were associated with ACEs, indicating that those who reported four or more ACEs were more likely to develop depression and anxiety. ACEs contribute to many negative health outcomes; thus, identifying the prevalence of ACEs among the rural population is essential for future health-related actions. It is also important that chronic diseases and risk behaviors be specifically identified among the rural population in order to prioritize these actions. Future research should further investigate ACEs and other determinants of health among the rural population, taking into consideration the inclusion of more diverse people, such as older adults and those from other rural areas.

Association between Cooperative Attitude and High-Risk Behaviors on the Spread of COVID-19 Infection among Medical Students in Japan

The impact of high-risk behaviors on the spread of COVID-19 infection among young people is an important problem to address. This study analyzed the association between cooperativeness and high-risk behaviors. We conducted a cross-sectional study among fourth-year medical students at Tokyo Medical and Dental University. The students were asked about cooperative attitude in a hypothetical situation of performing a task together with an unfamiliar classmate, who did not cooperate to complete the task previously. The response items were as follows: "cooperate", "don't want to cooperate and do it alone (non-cooperative)", and "don't want to cooperate and let the partner do it alone (punishment)". Eating out and vaccine hesitancy were also treated as high-risk behaviors. Poisson regression was used to investigate the association between cooperative attitude and each high-risk behavior, adjusted for demographics. Of the 98 students, 23 (23.5%), 44 (44.9%), and 31 (31.6%) students chose "noncooperative", "cooperative", and "punishment", respectively. Cooperative-type students exhibited 2.77-fold (PR: 2.77, 95% CI: 1.03-7.46), and punishment-type students exhibited 3.16-fold greater risk of eating or drinking out (PR: 3.16, 95% CI: 1.14-8.75) compared with those of the noncooperative type. Among medical students, the "cooperative" type and "punishment" type comprised the high-risk group for eating out during the pandemic.

The Impact of a High School-Based Positive Youth Development Program on Sexual Health Outcomes: Results from a Randomized Controlled Trial

BACKGROUND

Although positive youth development (PYD) programs have demonstrated effectiveness in improving adolescent reproductive health outcomes, there is a lack of evidence on effective school-based interventions designed especially for high school settings. This study examined the efficacy of Peer Group Connection (PGC-HS), a school-based PYD program, in improving sexual health outcomes for high school participants.

METHODS

A total of 1523 ninth-grade students at 18 schools were randomly assigned to be offered PGC-HS or a classes-as-usual control condition during 2016 to 2017 and 2017 to 2018 school years. Impacts were assessed on three confirmatory and 6 exploratory outcomes via self-reported participant questionnaire data collected at the beginning of 10th grade.

RESULTS

Although the offer of PGC-HS had no statistically detectable effect on confirmatory behavioral outcomes (sexual initiation, frequency of sex, and number of sexual partners) at 10th grade follow-up, causal impact estimates indicate that PGC-HS participants were less likely than control participants to ever have had vaginal sex. PGC-HS participants also scored higher on decision-making skills and perceived connection to peer connectedness.

CONCLUSIONS

Results suggest that by building social and emotional skills and helping students form supportive peer relationships, PGC-HS may encourage students to make healthier choices and avoid risky behaviors during a critical period in high school, thus, reducing the risk of pregnancy.

Adverse Childhood Experiences: Mental Health Consequences and Risk Behaviors in Women and Men in Chile

Studies conducted worldwide indicate that adverse childhood experiences (ACEs) are among the most intense and frequent sources of stress, considerably influencing mental and physical health while also resulting in risk behaviors in adulthood.

METHODOLOGY

We used data from the Pilot National Survey of Adversity and Sexual Abuse in Childhood (2020), conducted by CUIDA UC, which comprises the Adverse Childhood Experiences International Questionnaire [ACE-IQ] (Adapted). The cross-sectional methodology used made it possible to directly calculate the prevalence of adverse childhood experiences in the population sampled, at a single point in time. We performed a bivariate and univariate descriptive analysis, a correlation analysis, and a multivariate analysis, all of which will be detailed in the section entitled "General Data Analysis Procedure".

RESULTS

We found equally high rates of adverse childhood experiences in men and women, with community violence exhibiting the highest prevalence. We found significant low- to moderate-sized associations between the multiple types of ACEs considered and mental health problems, substance use problems, criminal behaviors, and intrafamily violence (IFV), which differed between men and women. Significant correlations were detected between the ACE score and mental health, substance use, criminal behaviors, and IFV in both men and women. Importantly, ACEs were found to be predictors of all of these variables, with differences observed between men and women.

CONCLUSIONS

Nearly all participants reported having had at least one ACE and more than half reported had four or more ACEs. Those who had had four or more ACEs were more likely to report problems throughout their life. Having an ACE of any type was found to be a better predictor of mental health problems and IFV in men than in women and might be a stronger risk factor for substance use and criminal behaviors in women than in men.

Development and Validation of a Risk Prediction Tool to Identify People at Greater Risk of Having Hepatitis C among Drug Users

BACKGROUND

People who use drugs (PWUD) are among those with the highest risk for hepatitis C virus (HCV) infection. Highly effective direct-acting antiviral agents offer an opportunity to eliminate HCV. A simple tool for the prediction of HCV infection risk in PWUD is urgently needed. This study aimed to develop and validate a risk prediction tool to identify people at greater risk of having hepatitis C among PWUD that is applicable in resource-limited settings.

METHODS

We extracted data from national HIV/AIDS sentinel surveillance in PWUD (Zhejiang Province, 2016-2021) and developed and validated a risk score to improve HCV testing in PWUD. This risk score consists of seven risk factors identified using multivariable logistic regression modeling (2016-2020, exploratory group). We validated this score using surveillance data for 2021 (validation group). The accuracy of the model was determined using C-statistics.

RESULTS

We identified seven risk factors, including sex, age, marital status, educational attainment, and the use of heroin, morphine, and methamphetamine. In the exploratory group, the positive rates of detecting the HCV antibody in the low-risk (0-9 points), intermediate-risk (10-16 points), and high-risk (≥17 points) groups were 6.72%, 17.24%, and 38.02%, respectively (P_trend < 0.001). In the validation group, the positive rates in the low-, medium-, and high-risk groups were 4.46%, 12.23%, and 38.99%, respectively (P_trend < 0.001).

CONCLUSIONS

We developed and validated a drug-specific risk prediction tool for identifying PWUD at increased risk of HCV infection. This tool can complement and integrate the screening strategy for the purpose of early diagnosis and treatment.

Sexual Health and Communication Between Foster Youth and Their Caregivers

PURPOSE

Foster youth are at increased risk for negative sexual health outcomes and rarely receive the information or social/familial support needed to reduce risks. Foster and kinship caregivers report lacking the information and skills needed to effectively talk to youth in their care about sexual health. In a sample of caregivers from 2 large urban jurisdictions, our goals were to: 1) describe caregiver sexual health variables including communication and monitoring characteristics; and 2) assess associations between self-reported emotion regulation and caregiver-youth conflict and these variables.

METHODS

We administered surveys to foster and kinship caregivers in New York, New York and Los Angeles, California. Surveys assessed caregiver emotion regulation, caregiver-youth conflict, sexual/reproductive health knowledge, communication expectations and behaviors, and caregiver monitoring/youth disclosure. We generated descriptive statistics for all variables (aim 1) then performed multivariate regression analyses for aim 2.

RESULTS

Our sample included 127 foster and kinship caregivers who were primarily female (92%) and African American (55%). Most reported having >4 years of caregiving experience with foster youth (66%). On average, caregivers answered sexual health knowledge questions correctly 68% of the time. Caregiver-youth conflict was the only variable significantly associated with assessed sexual health variables; it was inversely associated with percent correct on the knowledge scale, outcomes expectations, number of topics discussed, and monitoring/disclosure.

CONCLUSION

Our study suggests that caregiver-youth conflict behaviors are related to sexual health knowledge, communication, and monitoring variables. Further prospective and longitudinal investigation is warranted to better characterize the complex relationship between these variables.

Family Violence, Personality Traits, and Risk Behaviors: Links to Dating Violence Victimization and Perpetration Among College Students

Though dating violence (DV) is prevalent on college campuses, few studies have examined a multitude of risk factors that may better explain this process. As such, we examined the role of family violence (i.e., childhood physical abuse, witnessing parental violence), personality traits (i.e., entitlement, antisocial personality [ASP] and borderline personality [BP]) and risk behaviors (i.e., risky sexual behaviors, heavy drinking, marijuana use, illicit drug use) on DV victimization and perpetration among 783 college students. Path analysis revealed that witnessing parental violence was linked to DV perpetration while experiencing more physical abuse was positively correlated with entitlement (females only), ASP traits, and BP traits. ASP traits (both males and females) and entitlement (females only) were directly associated with high-risk behaviors. Among females, entitlement was also indirectly associated with DV victimization and perpetration through sexual risk behaviors. Findings highlight the importance of histories of physical abuse and personality traits in understanding DV.

Risk behaviors as correlates of victimization of U.S.-born and foreign-born Asian, Black, and Latinx adolescents in the United States

The current study examines the association between risk behaviors and victimization and race-based victimization amongst U.S.-born and foreign-born Asian, Black, and Latinx adolescents. Data were derived from the U.S. subset of the 2009-2010 Health Behavior in School-aged Children study. Samples include 662 Asian, 2413 Black, and 3188 Latinx adolescents (M = 12.9, SD = 1.75, 48.6% female) in grades 5-10. Univariate analyses, t-test analyses, and multiple linear regression analyses were conducted. Aggressive behavior was associated with victimization for U.S.-born and foreign-born Asian, Black, and Latinx adolescents. Race-based aggressive behavior was correlated for U.S.-born and foreign-born Black and Latinx adolescents. Smoking was positively associated with victimization amongst foreign-born Asian adolescents. Alcohol use was correlated with victimization and race-based victimization amongst foreign-born Latinx adolescents. Marijuana use was related to victimization amongst U.S.-born Black adolescents. Physical fighting was shown to be positively correlated with race-based victimization for U.S.-born Latinx adolescents. Carrying a weapon was associated with victimization and race-based victimization for U.S.-born and foreign-born Latinx adolescents. It was also associated with victimization amongst U.S.-born Asian adolescents. Befriending deviant peers was negatively associated with U.S.-born and foreign-born Black adolescents and U.S.-born Latinx adolescents, but positively associated with U.S.-born Asian adolescents.

Associations Between Anabolic-Androgenic Steroid Use and Sexual Health Behaviors Among Adolescent Boys: Results From the 2019 Youth Risk Behavior Survey

The aim of this study was to determine the association between lifetime anabolic-androgenic steroid (AAS) use and seven indicators of sexual health behaviors among a nationally representative sample of adolescent boys in the United States. Multiple modified Poisson regression analyses were conducted to determine the associations between any lifetime AAS use and seven indicators of sexual health behaviors among 2,095 sexually active adolescent boys from the 2019 National Youth Risk Behavior Survey. Sexually active boys who reported lifetime AAS use were at greater risk of having sexual intercourse before the age of 13 years (adjusted risk ratio [aRR] = 2.73, 95% confidence interval [CI] = [1.44, 5.17]), reporting ≥4 sexual partners in their lifetime (aRR = 1.96, 95% CI = [1.34, 2.89]) and in the past 3 months (aRR = 6.77, 95% CI = [3.19, 14.37]), having been tested for HIV in their lifetime (aRR = 2.49, 95% CI = [1.13, 4.73]), and having been tested for any sexually transmitted infection in the past 12 months (aRR = 3.14, 95% CI = [1.63, 6.03]). These findings align with prior research among adult men and have implications for public health and health care prevention efforts to reduce the use of AAS, as well as support the engagement in safe sexual health behaviors among adolescent boys.

Matched and Fully Private? A New Self-Generated Identification Code for School-Based Cohort Studies to Increase Perceived Anonymity

Anonymous questionnaires are frequently used in research with adolescents in order to obtain sincere answers about sensitive topics. Most longitudinal studies include self-generated identification codes (SGICs) to match information. Typical elements include a combination of letters and digits from personal data. However, these data may make the participant feel that their answers are not truly anonymous, and some studies using these types of SGICs have been perceived as not entirely anonymous by some participants. Furthermore, data protection laws could place limits on research carried out with these codes. The objective of our article is to test an SGIC with a higher degree of anonymity. We conducted two studies. In Study 1, we tested the perceived anonymity of this new SGIC code. Adolescents aged 12 to 18 years (N = 601) completed an anonymous questionnaire about lifestyles and risk behaviors, which also included the SGIC. Adolescents with and without risk behaviors were compared regarding whether or not they answered to the SGIC questions. We did not find any differences to suggest that participants felt identifiable. In Study 2, we assessed the efficiency of the new SGIC. At baseline, 123 students from two high schools (eighth grade) filled in questionnaires consisting of the new SGIC and their full names. Two years later, these same students (then in the 10th grade) were invited to fill in the same information again (116 students responded to this second call). A total of 97 students were present in both waves. The SGIC showed a moderate performance, with good enough indices of recall and precision. Evidence suggests that the new SGIC is a suitable tool for the anonymous matching of adolescents in follow-ups of school cohorts.

Cat Ownership and Rural Residence Are Associated with Lyme Disease Prevalence in the Northeastern United States

Lyme disease (LD) is the most common vector-borne disease in the USA. Beyond its tick-borne nature, however, risk factors for LD are poorly understood. We used an online questionnaire to compare LD patients and non-LD counterparts and elucidate factors associated with LD. We investigated demographic, lifestyle, and household characteristics and use of prevention measures. Associations with LD were modeled using logistic regression, and average marginal effects were estimated. In total, 185 active or past LD patients and 139 non-patients participated. The majority of respondents were white (95%) and female (65%). Controlling for age, sex, and type of residential area, pet ownership was associated with an 11.1% (p = 0.038) increase in the probability of LD. This effect was limited to cat owners (OR: 2.143, p = 0.007; dog owners, OR: 1.398, p = 0.221). Living in rural areas was associated with a 36% (p = 0.001) increase in the probability of LD compared to living in an urban area. Participants who reported knowing someone with Lyme Disease were more likely to wear insect repellant and perform tick checks. This study suggests opportunities for improved LD prevention, including advising cat owners of their increased risk. Although patterns in adoption of LD prevention methods remain poorly understood, concern about LD risk does motivate their use.

Trends in HIV Prevalence and HIV-Related Risk Behaviors Among Male Students Who Have Sex With Men From 2016 to 2020 in Nanjing, China: Consecutive Cross-Sectional Surveys

Background

The growing HIV epidemic among student men who have sex with men (MSM) necessitates immediate attention from public health. In China, male students who have sex with men (SMSM) were also at an increasing risk of HIV transmission. The aim of this study was to investigate the trends in HIV prevalence, HIV-related risk behaviors, and HIV testing, as well as analyze the factors associated with HIV infection among SMSM in Nanjing.

Methods

Data were collected through face-to-face questionnaire interviews and laboratory testing in Nanjing. The participants were recruited among SMSM by snowball sampling and internet-recruited convenience sampling annually from 2016 to 2020. The self-report data primarily included demographics, HIV knowledge, HIV-related behaviors, and HIV testing, while the laboratory test results of HIV and syphilis were collected. Linear-by-linear chi-square test was used to analyze the trends of HIV/syphilis prevalence and its risk behaviors. The binary logistic regression model was used to explore the factors associated with HIV infection.

Results

During the 5 years from 2016 to 2020, a total of 775 SMSM were recruited in our survey (220, 112, 171, 142, and 120, respectively). The HIV prevalence was 5.2, 6.3, 5.3, 7.0, and 8.3%, without a significant increasing trend (P = 0.277). Syphilis prevalence fluctuated from 5.7% in 2016 to 4.2% in 2020, without a significant decreasing trend (P = 0.318). The proportion of consistent condom use in anal intercourse (48.5 to 56.2%, P < 0.05), and HIV testing in the past 12 months (51.0 to 59.2%, P < 0.05) were increasing. A remarkable growing trend has been reported in the percentage of MSM with more than one male sex partner (46.2 to 59.2%, P < 0.05). Multivariate analysis showed that HIV testing in the past 12 months was a protective factor against HIV infection. MSM who had unprotected anal intercourse (UAI) in the past 6 months, recreational drug use, and currently syphilis infection were risk factors for HIV infection.

Conclusions

We observed stable HIV/ syphilis prevalence, increasing consistent condom use, increasing HIV testing rate, and increasing multiple male sex partners dramatically among SMSM in China. The original comprehensive intervention measures should be continuously strengthened for the subgroup. To satisfy the current HIV prevention requirements, new biological interventions should be introduced and carried out as major components of combination prevention programs.

Risk Behaviors, Family Support, and Emotional Health among Adolescents during the COVID-19 Pandemic in Israel

We investigated the prevalence of risk behaviors among Israeli adolescents (tobacco smoking, alcohol consumption, drug use) during the COVID-19 pandemic. Associations between different risk behaviors were examined and so was whether specific characteristics could predict risk behaviors in adolescents. The study consisted of 1020 Israeli adolescents aged 15-18. Study subjects completed an online survey between the first and second lockdowns in Israel (April 2020 to September 2020). Participants reported the frequency at which they engaged in four different risky behaviors: general risky behavior, tobacco smoking, alcohol consumption (binge drinking), and cannabis use. The most prevalent risky behavior in the sample was binge drinking (33.8%). The four measured risky behaviors were significantly correlated. Among participants who had previously engaged in a risky behavior assessed, most did not change the behavior frequency during the pandemic. All independent variables (sociodemographic characteristics, family support, and emotional, health excluding friends' support, physical activity volume, and coronavirus restrictions) were significantly different between participants engaging vs. not engaging in risky behaviors. Our findings suggest that family support is one of the most influential factors in preventing risky behavior during the pandemic, and they emphasize the importance of family-based interventions with children and adolescents from elementary to high school.

Associations between State-Level High School HIV Education Policies and Adolescent HIV Risk Behaviors

BACKGROUND

School-based human immunodeficiency virus (HIV) education can reach most adolescents, but inconsistencies exist in state-level content policies. The purpose of this study was to evaluate the associations between state-level high school HIV education policies and adolescent HIV risk behaviors.

METHODS

This was a cross-sectional analysis of the 2019 Youth Risk Behavior Survey linked to the Guttmacher Institute Sex and HIV Education report. Logistic regression models examined the associations of state-level HIV education mandates and content policies with 3 HIV risk behaviors: (1) 4 or more lifetime sexual partners; (2) substance use before last sex; (3) condomless last sex.

RESULTS

Across 33 states, 128,986 high school students were included. Multivariable adjusted models demonstrated no associations between mandated HIV education and risk behaviors. Covering abstinence along with other safe sex options was associated with lower odds, whereas stressing abstinence was associated with higher odds of at least 4 lifetime sexual partners and condomless last sex. Discriminatory sexual orientation content was associated with increased condomless last sex; associations for all HIV risk behaviors were stronger among sexual minority youth.

CONCLUSIONS

Increased HIV risk behaviors associated with state policies stressing abstinence or requiring discriminatory sexual orientation content support the need for comprehensive and inclusive HIV education.

Understanding Relationships Between Fetal Health Locus of Control (FHLC) and Maternal Marijuana Use During Pregnancy

The objective of this study was to examine relationships between maternal perceptions of Fetal Health Locus of Control (FHLC) and perceived risk/benefit related to prenatal marijuana use with maternal marijuana use behaviors during pregnancy. The sample included women seeking prenatal care at The Ohio State University Wexner Medical Center (OSUWMC, Columbus OH) between 2010 and 2015, who participated in a follow-up study (2019-2020). Logistic regression models were run to estimate associations between maternal perceptions and prenatal marijuana use behaviors. Higher perceived benefit to mother (AOR = 1.53, 95% CI: 1.08-2.17) and lower perceived risk to children (AOR = 0.59, 95% CI: 0.45-0.78) were related to increased prenatal marijuana use, adjusted for confounders. In contrast, FHLC perceptions were not associated with maternal marijuana use; however, FHLC predicted women's perceptions of risk and benefit which in turn was associated with marijuana use during pregnancy. Understanding how maternal perceptions influence health-related risk behaviors during pregnancy is important because perceptions are feasible intervention targets.

Sex Differences in Injection Drug Risk Behaviors Among Hospitalized Persons

OBJECTIVES

As opioid use increases, it remains important to assess factors that contribute to injection drug risk behaviors, as sharing needles and other drug use equipment contributes to the spread of human immunodeficiency virus and hepatitis C virus. Such risks may differ by sex and injecting with others. The current study examined factors that contribute to increased injection drug risk separately for men and women.

METHODS

People who inject drugs were recruited at an academic safety-net hospital that reported recent injection drug use. Two main injection outcomes were assessed: (1) human immunodeficiency virus drug risk behaviors as assessed by the Risk Assessment Battery and (2) the number of times participants injected drugs with a needle used by someone else. For each outcome, different models for women and men were conducted to detect differences by sex.

RESULTS

Both men and women were more likely to inject with a needle used by someone else if they used drugs within a sexual relationship (incidence rate ratio (IRR) = 14.61, P < 0.01; IRR = 7.17, P < 0.05). Being employed was associated with lower risk assessment battery scores among men, and lower mean rates of using a needle used by someone else among women (IRR = 0.22, P < 0.05). Women with post-traumatic stress disorder (PTSD) and men with higher depression scores had higher rates of injecting with a needle used by someone else.

CONCLUSIONS

People who inject drugs who are in intimate relationships report higher injection drug risk behaviors. We found benefits to employment among both men and women. Identifying factors associated with increased injection risk behaviors can be useful for creating interventions tailored by sex.

Primary Care Associated With Follow Up Viral Load Testing in Patients Cured of Hepatitis C Infection With Direct Acting Antivirals at a Multidisciplinary Addiction Treatment Program: Insights From a Real-World Setting

OBJECTIVES

Treatment of hepatitis C virus infection (HCV) with direct acting antiviral therapy is encouraged regardless of substance use status. Patients with substance use disorder are at risk of HCV reinfection after cure. Follow up viral load testing (FUVL) with HCV RNA is recommended. We investigated factors associated with adoption of FUVL in real-world clinical settings.

METHODS

Medical records of all patients with SUD who achieved HCV cure with direct acting antivirals at a multidisciplinary addiction treatment program between 2014 and 2019 were reviewed as part of a quality improvement initiative. Demographic and clinical characteristics including SUD treatment, urine toxicology results, and medical service use were collected. Factors associated with FUVL were analyzed and the rate of HCV reinfection was determined.

RESULTS

Among 149 patients, 58.4% received FUVL. Receipt of FUVL was associated with engagement in ongoing primary medical care after cure (AOR 4.39, 95% CI [1.67, 11.49]). The HCV reinfection rate among those who received FUVL was 1.95 per 100 person-years of follow up (95% CI [0.64, 5.98]). There was no significant difference in the percentage of negative urine toxicology results before and after cure.

CONCLUSIONS

Over half of a cohort of patients with substance use disorder cured of HCV received FUVL. The relationship between FUVL and engagement in primary medical and substance use treatment highlights the importance of integrated systems in providing longitudinal care for patients cured of HCV. Standardized interventions that facilitate FUVL testing and management of infectious complications of SUD in addiction treatment settings are needed.

Factors Associated With Disordered Eating Behavior Among Adolescent Girls: Screening and Education

Introduction/Objectives:

An unhealthy relationship with food can lead to disordered eating in adolescence, highlighting the importance of screening. This study describes the frequency of disordered eating behavior among female adolescents, as well as associated characteristics and health behaviors.

Methods:

Data are from a multidimensional risk factor screening survey administered at a university medical center’s adolescent clinic from 2016 to 2018. The instrument was adapted from existing screening tools such as the Rapid Assessment for Adolescent Preventive Services (RAAPS), the American Medical Association’s Guidelines for Adolescent Preventive Services (GAPS), and the Youth Risk Behavior Survey (YRBS). Analysis was limited to self-reported responses provided by females aged 10 to 21 years (N = 915). Statistical analyses included chi-square tests and independent sample T-tests.

Results:

Of the N = 915 females who reported on disordered eating behavior, n = 57 (6.2%) had engaged in some form of disordered eating behavior within the past 12 months. Disordered eating was significantly associated (P < .001) with not consistently wearing a helmet while biking, having tried e-cigarettes, being bullied in the past 30 days, having an adverse childhood experience (ACE), and being African American (P = .005). Subgroup analysis of the relationship between disordered eating and bullying, by race, yielded significant findings: disordered eating was more highly associated with being bullied in the past 30 days among African American females (P = .038). The relationship between disordered eating and ACE was also significant (P < .001) among Caucasian girls when stratified by race.

Conclusions:

Adolescent risk behaviors often co-occur, and disordered eating behavior may be differentially observed by race. Findings highlight the importance of education and screening to prevent the development of disordered eating, and identify those who may be struggling. These results can be useful to community health education and in healthcare to develop and implement health promotion and eating disorder prevention strategies. Further studies are needed to assess additional factors that promote or protect against disordered eating to improve prevention.

Pre-Exposure Prophylaxis Perspectives, Sociodemographic Characteristics, and HIV Risk Profiles of Cisgender Women Seeking and Initiating PrEP in a US Demonstration Project

Little information is known about the cisgender women who seek and initiate pre-exposure prophylaxis (PrEP) for HIV prevention in the United States. Adherence Enhancement Guided by Individualized Texting and Drug Levels was a 48-week single-arm open-label demonstration study of daily oral tenofovir disoproxil fumaratel emtricitabine (TDF/FTC) in cisgender women ≥ 18 years old at risk for HIV. Participants were surveyed at screening and enrollment about sociodemographics, HIV risk perception and behaviors, and PrEP perspectives and aggregated into three risk groups according to HIV sexual risk behavior: being in a serodiscordant partnership (SD), engaging in sex work (SW), and having partners with unknown HIV status at risk for HIV (UP). One hundred sixty-seven women presented for screening with n = 31 screen failures. Of the 162 women completing enrollment, mean age was 40 (standard deviation 11), with 41% non-Hispanic Black, 22% non-Hispanic White, and 19% Latina. Compared with those who screened ineligible, enrolled participants were more likely to have heard of PrEP, had higher HIV risk perception, and reported higher perceived PrEP efficacy. Sixty-four women (47%) were categorized as SD, 21 (15%) as SW, and 51 (38%) as UP. The SW were more likely to report higher levels of drinking and drug use (p = 0.002) and history of intimate partner violence in the past year (p < 0.001) compared with SD and UP. Among cisgender women enrolled, there were significant differences between the three risk groups by demographics, HIV risk behavior, and PrEP perspectives, suggesting that interventions to successfully implement PrEP in US women may need to be tailored by HIV risk group. Clinical Trial Registration number: NCT02584140.

SARS-CoV-2: An Empirical Investigation of Rose's Population-based Logic

BACKGROUND

Geoffrey Rose's paper "Sick Individuals, Sick Populations" highlights the counterintuitive finding that the largest share of morbidity arises from populations engaging in low- to moderate-risk behavior. Scholars refer to this finding as the prevention paradox. We examine whether this logic applies to SARS-CoV-2 infected persons considered low to moderate risk.

METHODS

We conducted a population-representative survey and sero-surveillance study for SARS-CoV-2 among adults in Orange County, California. Participants answered questions about health behaviors and provided a finger-pin-prick sample from 10 July to 16 August 2020.

RESULTS

Of the 2979 adults, those reporting low- and moderate-risk behavior accounted for between 78% and 92% of SARS-CoV-2 infections. Asymptomatic individuals, as well as persons with low and moderate scores for self-reported likelihood of having had SARS-CoV-2, accounted for the majority of infections.

CONCLUSIONS

Our findings support Rose's logic, which encourages public health measures among persons who self-identify as unlikely to have SARS-CoV-2. See video abstract at, http://links.lww.com/EDE/B860.

Prevalence and Impact of Adverse Childhood Experiences on Chicago Public School Students in the Youth Risk Behavior Survey

BACKGROUND

Adverse Childhood Experiences (ACEs) can impair health and other outcomes. To obtain district-level data about the prevalence and impact of ACEs in Chicago Public Schools (CPS), we advocated for CPS to add a short ACE screener to the 2017 Youth Risk Behavior Survey (YRBS) and analyzed the results.

METHODS

Responses to the screener were scored zero, one, or two ACEs. Student scores for violence and victimization, substance use, sexual health risk, mental health, housing insecurity, physical health, grades, and multiple risk/high vulnerability (those students in the top 20% of affirmative responses) were correlated with ACE scores for categories and individual items.

RESULTS

Among 1883 student respondents (response rate 73%), there were 17.8% affirmative responses for experiencing physical abuse and 19.8% for witnessing domestic violence; 20% reported at least one ACE and 8% both. A significant dose-response was found for behaviors, experiences, and sleep by ACE scores.

CONCLUSIONS

ACEs were common among CPS high school students and associated with many negative behavior and health-related outcomes. Increased awareness of ACEs and their impact among all school personnel can inform and strengthen the development of safer, more supportive, and trauma-informed schools that help all students and families thrive.

The 2008 Financial Crisis and Changes in Lifestyle-Related Behaviors in Italy, Greece, Spain, and Portugal: A Systematic Review

Italy, Greece, Spain, and Portugal have all been strongly affected by the 2008 financial crisis, which has had a negative impact on health. We systematically evaluated the effects of the crisis on lifestyle and socioeconomic inequalities. We conducted a literature search using MEDLINE, Embase, the Cochrane Library, and health economics databases for studies reporting quantitative comparisons before and after (or during) the crisis on the following risk behaviors: alcohol consumption, smoking habit, healthy diet, physical activity, and psychotropic drugs and substance abuse, without setting any age restrictions. We selected 34 original articles published between 2011 and 2020. During/after the crisis, alcohol consumption and substance abuse decreased, while psychotropic drug use increased. We also observed a deterioration in healthy eating behavior, with a reduction in fruit and vegetable consumption. Smoking habit and physical activity showed a more complex, controversial trend. Socioeconomic inequalities were affected by the recession, and the negative effects on unhealthy lifestyle tended to be more pronounced among the disadvantaged. These results suggest the need to implement health policies and interventions aimed at monitoring risk behaviors, with special regard to disadvantaged people, and considering the potential additional impact of the COVID-19 pandemic.

The Longitudinal Association Between Exposure to Violence and Patterns of Health Risk Behaviors Among African American Youth

PURPOSE

We investigate whether exposure to violence (ETV) during adolescence and emerging adulthood predicts engagement in chronic disease-related health risk behaviors years later among African Americans.

DESIGN

A longitudinal study following youth from mid-adolescence (mean age = 14.8 years) to young adulthood (mean age = 32.0 years).

SETTING

Flint, Michigan.

SAMPLE

Four hundred forty-two African American (96.2%) and mixed African American and White (3.8%) participants.

MEASURES

Outcomes were diet, smoking, drinking, and physical inactivity. Covariates were ETV, sex, mother's educational attainment, and substance use by siblings, peers, and parents.

ANALYSIS

Latent profile analysis was conducted to identify distinct patterns of adult health risk behaviors and assess the association of youth ETV and identified patterns.

RESULTS

Four latent profiles were identified: high substance use (n = 46; 10.41%), high overall risk (n = 71; 16.06%), low overall risk (n = 140; 31.67%) and inactive (n = 185, 41.86%). Relative to the low overall risk profile, ETV was associated with being in the high overall risk profile (b = 0.37, p = 0.04), but not other profiles. Female gender and higher maternal education were associated with being in the inactive profile compared to the low overall risk profile. Peer alcohol and tobacco use were associated with being in the high substance use profile.

CONCLUSION

ETV during adolescence and emerging adulthood increased the risk of engagement in multiple health risk behaviors later in life.

Psychiatric hospitalization among youth at high risk for HIV

Youth at-risk for HIV are also at-risk for mental health disorders and psychiatric hospitalization. Understanding the association between engagement in HIV prevention, concurrent risk behaviors, and psychiatric hospitalization may lead to improvements in integrated prevention and mental health treatment efforts. Youth at-risk for HIV, aged 14-24 years old, predominantly Black/African American and Latinx (75%) were recruited through youth-serving clinics and community sites in Los Angeles (n = 839) and New Orleans (n = 647). We compared youth with and without histories of psychiatric hospitalization on engagement in HIV prevention, concurrent risk behaviors, and demographic characteristics. We examined predictors of hospitalization using multiple imputations for missing data. Hospitalized youth (30%) were more involved in HIV programs, but were less likely to use PrEP/PEP or condoms than non-hospitalized youth. The odds of hospitalization were higher for transgender/gender nonconforming youth relative to cisgender youth; the OR was increased after adjustment for concurrent risk behaviors. Hospitalization was associated with homelessness, trauma, incarceration, substance use, and involvement in substance abuse treatment programs. There is a continuing need to integrate the diagnosis and treatment of mental health disorders into HIV prevention programs to better address multiple challenges faced by vulnerable youth.

COVID-19 risk mitigation behaviors among rural and urban community-dwelling older adults in summer, 2020

PURPOSE

Risk mitigation behaviors are important for older adults, who experience increased mortality risk from COVID-19. We examined these reported behaviors among rural and urban community-dwelling adults aged 65 and older.

METHODS

We analyzed public use files from the National Health and Aging Trends Study, which fielded a COVID survey from June to October, 2020, restricted to community-dwelling adults (n = 2,982). Eight behaviors were studied: handwashing, avoid touching face, mask wearing, limiting shopping, avoiding restaurants or bars, limiting gatherings, avoiding contact with those outside the household, and distancing. Residence was defined as urban (metropolitan county) or rural (nonmetropolitan county). Difference testing used Chi Square tests, with an alpha level of P = .05. Multivariable logistic regression was used to calculate adjusted odds ratios.

RESULTS

Rural residents constituted 18.8% (± Standard Error 3.6%) of the study population. In bivariate comparisons, rural older adults were less likely to report 5 of 8 studied behaviors: keep 6-foot distance (rural: 88.3% ±1.0%, urban 93.2% ±.08%), limit gatherings (rural 87.5% ±1.8%; urban 91.6% ±0.8%), avoid restaurants/bars (rural 85.3% ±1.9%, urban 89.6% ±0.8%), avoid touching face (rural 83.1% ±2.3%, urban 88.6%, 0.8%), and avoid contact with those outside the household (rural 80.4% ±2.4%, urban 86.2% ±1.0%). After adjusting for demographic characteristics, only maintaining a 6-foot distance remained lower among rural older adults (AOR 0.58, 95% CI: 0.42-0.81).

CONCLUSIONS

Within older adults, reported compliance with recommended behaviors to limit the spread of COVID-19 was high. Nonetheless, consistent rural shortfalls were noted. Findings highlight the need for rural-specific messaging strategies for future public health emergencies.

Protester, Partygoer, or Simply Playing It Down? The Impact of Crowd Affiliations on LGBT Emerging Adults' Socioemotional and Academic Adjustment to College

Although peer crowd affiliations have been studied among emerging adults in college, this work has yet to focus in on LGBT-identifying students. Accordingly, the current study a) surveyed the peer crowd landscape using a sample of 234 LGBT students (M_age = 19.89, SD = 1.55; 70.51% female, 18.38% male, 11.11% other) at a small, private, liberal arts college in Southern California, and b) explored the relationships between self-reported peer crowd affiliations and LGBT students' adjustment (i.e., loneliness, belongingness, and academic-, alcohol-, drug-, and sex-risk behaviors). Results point to the existence of four underlying peer crowd dimensions among LGBT students: protester, nonvocal, social, and athletic. Furthermore, affiliation with these peer crowds was found to relate to students' self-reported loneliness and academic-, drug-, and sex-risk behaviors.

Could Road Safety Education (RSE) Help Parents Protect Children? Examining Their Driving Crashes with Children on Board

Recent evidence suggests that driving behavior and traffic safety outcomes of parents may be influenced by the extent to which they receive information and education on road safety, as well as the fact of driving with their children on board, which may increase their risk perception. However, there are no studies specifically addressing the case of crashes suffered while driving with children. Hence, this study aimed to describe the relationship between road safety education-related variables and parents' traffic safety outcomes while driving with children on board. For this cross-sectional study, data was retrieved from a sample composed of 165 Spanish parents-all of them licensed drivers-with a mean age of 45.3 years. Through binary logistic regression (logit) analysis, it was found that factors such as gender, having received road safety education (RSE), and having been sanctioned for the performance of risky driving behavior contribute to modulating the likelihood of suffering crashes while driving with children on board. Gender differences showed a riskier status for male parents. In this study, a set of risk factors explaining the involvement in traffic crashes when driving with children as passengers was identified among parents: gender, traffic sanctions, valuation, and exposure to road safety campaigns. Also, substantial limitations in the self-reported degree of received RSE were found, especially considering that risky driving behavior and traffic crash rates with children on board still have a high prevalence among parents.

Depressive Symptoms among Patients with Diabetes in Qatar: Frequency and Potential Determinants

Background: Diabetes is a highly prevalent chronic disease that is associated with major complications. Findings regarding risk of depression among patients with diabetes are controversial. This study aimed to determine the prevalence and determinants of depressive symptoms among Qatari patients with type 2 diabetes. Methods: This cross-sectional study was based on Qatar Biobank (QBB) data of 2448 Qatari adults with diabetes aged 21–60 years old. Data regarding age, gender, education, income, body mass index (BMI), medication use, glycated hemoglobin (HbA1c) were retrieved. Patients’ responses to the Patient Health Questionnaire-9 (PHQ-9) were also obtained. Data analyses was performed using STATA 16, and statistical significance was considered at a p-value of <0.05. Results: Of the 2448 participants, 15.4% (n = 378) had self-reported depressive symptoms. Depressive symptoms were frequent among females (69.6%), smokers (15.9%), and participants with a higher level of education (47.1%). Average age of participants who reported depressive symptoms was significantly less that among participants without depressive symptoms (44.8 vs. 52.9 years). Qatari women with diabetes seem to be at higher risk of depression when compared to men (OR = 1.819, 95% CI: 1.42–2.33); The odds of reporting depressive symptoms were 35% higher among patients with more advanced educational qualifications (OR = 1.351, 95% CI: 1.00, 1.82). Smokers were twice as likely to report depressive symptoms as their non-smoking counterparts. There was no significant relationship between depression and poor glycemic control, physical activity, BMI, or insulin use. Conclusions: In summary, the study results suggest that several sociodemographic factors, such as age, gender, and level of education were associated with the risk of depressive symptoms among Qataris with diabetes.

Digital Behavioral Phenotyping Detects Atypical Pattern of Facial Expression in Toddlers with Autism

Commonly used screening tools for autism spectrum disorder (ASD) generally rely on subjective caregiver questionnaires. While behavioral observation is more objective, it is also expensive, time-consuming, and requires significant expertise to perform. As such, there remains a critical need to develop feasible, scalable, and reliable tools that can characterize ASD risk behaviors. This study assessed the utility of a tablet-based behavioral assessment for eliciting and detecting one type of risk behavior, namely, patterns of facial expression, in 104 toddlers (ASD N = 22) and evaluated whether such patterns differentiated toddlers with and without ASD. The assessment consisted of the child sitting on his/her caregiver's lap and watching brief movies shown on a smart tablet while the embedded camera recorded the child's facial expressions. Computer vision analysis (CVA) automatically detected and tracked facial landmarks, which were used to estimate head position and facial expressions (Positive, Neutral, All Other). Using CVA, specific points throughout the movies were identified that reliably differentiate between children with and without ASD based on their patterns of facial movement and expressions (area under the curves for individual movies ranging from 0.62 to 0.73). During these instances, children with ASD more frequently displayed Neutral expressions compared to children without ASD, who had more All Other expressions. The frequency of All Other expressions was driven by non-ASD children more often displaying raised eyebrows and an open mouth, characteristic of engagement/interest. Preliminary results suggest computational coding of facial movements and expressions via a tablet-based assessment can detect differences in affective expression, one of the early, core features of ASD. LAY SUMMARY: This study tested the use of a tablet in the behavioral assessment of young children with autism. Children watched a series of developmentally appropriate movies and their facial expressions were recorded using the camera embedded in the tablet. Results suggest that computational assessments of facial expressions may be useful in early detection of symptoms of autism.

Association Between Substance Use Behaviors, Developmental Assets and Mental Health: A Glance at Latin American Young College Students

Positive Youth Development (PYD) is an approach that promotes resilience and focuses on youth strengths rather than their weaknesses as done by the traditional deficit-based perspective. Research in Europe and North America show that developmental assets are associated with school success, psychological well-being, and lower health risks among youth and young adults. However, not much research has been done on these associations in Latin American contexts. The purpose of this research study is to assess the association between substance use behaviors, such as drunkenness and the use of illicit drugs, and mental health, together with the mediating role of developmental assets representing youth strengths (e.g., social competence) and contextual resources (e.g., social support at home or school). Cross-national data was collected from Colombian (n = 210; 70.4% females) and Peruvian (n = 349; 66.5% females) 1st year university students. Results shed light on the protective role of developmental assets regarding substance use behaviors and mental well-being. Specifically, the results showed direct negative associations between developmental assets and substance use behaviors and positive associations of developmental assets with mental health indicators. Internal assets appear to be a stronger predictor of social, emotional, and psychological well-being compared to external assets. We did not find any statistical significance in the association of substance use behavior and mental health. We discuss implications regarding research, policy, and practice.

Being in the Closet. Correlates of Outness Among MSM in 13 European Cities

Data for MSM continue to show a high risk of acquiring HIV-STIs. Within this population, outness seems to have an impact on both risk-taking and on health seeking behaviors. The objective of this study was to assess the relationship between socio-demographic, behavioral characteristics, testing behaviors, and outness level among MSM using data from a multi-center bio-behavioral cross-sectional study carried out in 13 EU cities. A multilevel analysis was conducted to identify factors associated with being open ("out") versus not being open ("in"). A total of 4,901 MSM were enrolled in the study and were classified as "out" in 71% of the cases. MSM "out" were more likely to report HIV testing and being reached by HIV prevention programs compared to MSM who were "in." The results confirm the key role of outness in relation to different healthy and risky behavior, ranging from testing to party-drug use.

The utility of the International Classification of Functioning construct as a statistical tool - operationalizing mental health as an indicator of adolescent participation

BACKGROUND

The ICF provides a common scientific language for the study of health and functioning. Adolescent mental health, operationalized as engagement in life situations, is one aspect of functioning. Engagement as mental health has a bi-directional relation with environmental factors.

AIM

To test the statistical utility of the International Classification of Functioning (ICF) classification in coding adolescent mental health and mental health problems.

METHODS

Using data measuring mental health in a representative Swedish sample of 12-13-year-olds linking responses to the classification codes. The internal structure of the classification system constructs was tested using factor analysis.

RESULTS

A factorial solution could be found for most chapters indicating that the ICF framework and coding system could be used; however, the variance explained was quite low. Linking worked better at code-level, rather than chapter level. Items measuring risk behavior or risk factors are loaded in separate constructs.

CONCLUSIONS

When coding items for statistical purposes, code-level rather than chapter level is to be preferred. Also, participation in risk behavior loads in separate factors indicating that these behaviors are separate from other types of participation.Implications for rehabilitationConsidering some challenges with varying level of detail in the ICF-CY's chapters, the framework can be used to identify the content of mental health questionnaires to be used in rehabilitation.To provide more detailed information in rehabilitation addressing mental health, a code-level solution is more appropriate than a chapter level solution.Despite the use of same ICF-CY codes, negative participation, i.e., risk behavior, measures a different dimension than positive participation, is especially relevant in rehabilitation addressing mental health.

Leisure time activities and biomarkers of chronic stress: The mediating roles of alcohol consumption and smoking

AIMS

Previous research found an association between leisure time activities such as arts and cultural activities and self-reported health over the life course-a measure prone to response bias. This study tested the relationship between arts and cultural activities and allostatic load, a biomarker of chronic stress, and examined risky health behaviors, including alcohol consumption and smoking, as possible mediators.

METHODS

The sample consists of 8948 adults from the second wave of the United Kingdom Household Longitudinal Study, which is representative of the British population. The cross-sectional association between arts and cultural activities and allostatic load was tested with negative binomial models, and the mediation roles of alcohol consumption and smoking in the association was tested with the Karlson-Holm-Breen (KHB) decomposition method.

RESULTS

Frequent participation in arts, frequent attendance of cultural events, visits to museums or galleries, and visits to historical sites have negative associations with allostatic load. The associations are mediated by lower frequency of alcohol drinking and smoking.

CONCLUSIONS

Cultural capital may promote health by reducing the frequency of health risk behaviors such as drinking alcohol and smoking. Future research and public health policies should consider whether cultural capital acts as a social determinant of health to promote healthy leisure activities over the life course.

Adolescent Water Safety Behaviors, Skills, Training and Their Association with Risk-Taking Behaviors and Risk and Protective Factors

Background: Drowning remains the third leading cause of unintentional injury death for adolescents in the United States. Aims: This study described adolescent swimming lessons, behaviors (life jacket wear while boating) and comfort (swimming in deep water) and their association with protective and risk factors and risk-taking behaviors reported by Washington State students in Grades 8, 10, 12, primarily comprised of youth ages 13 to 18 years. Methods: This study used the 2014 Washington State Healthy Youth Survey (HYS), a publicly available dataset. Results: Most students reported having had swimming lessons, using life jackets, and comfort in deep water. Differences reflected racial, ethnic and socioeconomic disparities: being White or Caucasian, speaking English at home and higher maternal education. Lowest rates of comfort in deep water were among Hispanics or Latino/Latinas followed by Blacks or African Americans. Greater life jacket wear while boating was reported by females, those in lower grades and negatively associated with alcohol consumption, sexual activity and texting while driving. Having had swimming lessons was associated with fewer risk-taking behaviors. Conclusions: The HYS was useful to benchmark and identify factors associated with drowning risk among adolescents. It suggests a need to reframe approaches to promote water safety to adolescents and their families. Multivariate analysis of this data could identify the key determinants amongst the racial, ethnic, and socioeconomic disparities noted and provide stronger estimation of risk-taking and protective behaviors.

Sexual Risk Behaviors Associated with Sexually Transmitted Infections in a US Military Population Living with HIV After the Repeal of "Don't Ask, Don't Tell"

Risk behaviors associated with sexually transmitted infections (STIs) among people living with HIV (PLWH) have not been well characterized in the US military. We identified risk behaviors associated with a new STI in this population after the repeal of "Don't Ask, Don't Tell." US Military HIV Natural History Study participants who completed the risk behavior questionnaire (RBQ) between 2014 and 2017 and had at least 1 year of follow-up were included (n = 1589). Logistic regression identified behaviors associated with incident STI in the year following RBQ completion. Overall, 18.9% acquired an STI and 52.7% reported condom use at last sexual encounter. Compared with those with no new sex partners, participants with between one and four or five or more new partners were 1.71 [1.25-2.35] and 6.12 [3.47-10.79] times more likely to get an STI, respectively. Individuals reporting low or medium/high perceived risk of STI were 1.83 [1.23-2.72] and 2.65 [1.70-4.15] times more likely to acquire a new STI than those reporting no perceived risk, respectively. Participants who preferred not to answer about sexual preference, number of new partners, or perceived STI risk were also more likely to acquire a new STI. Our study illustrates that despite regular access to health care and accurate perceptions of risk, rates of STI among PLWH remain high in the US military setting, as in others. Given the potential individual and public health consequences of STI coinfection after HIV, more work is needed to assess interventions aimed at sexual behavior change for PLWH.