OBJECTIVES:Intergenerational games offer a potential channel to impact parent-youth sexual health communication. The "Secret of Seven Stones" (SSS) is an 18-level online adventure game and parent website designed to engage parents and youth (11-14 years) in conversations about healthy dating relationships and sexual behavior and to provide sexual health skills training to youth. Study hypotheses were that SSS exposure would increase sexual health parent-child communication, increase youth intentions to delay sexual debut, and reduce youth exposure to situations that promote sexual activity. MATERIALS AND METHODS:SSS was evaluated in the homes of parent-youth dyads randomly assigned to intervention (n = 40) and comparison (n = 45) conditions. Online surveys were used to collect baseline and three-month follow-up data on dyadic sexual health communication, determinants for communication and youth sexual behavior, and game usability ratings. RESULTS:Dyads comprised parents (n = 83, 47% white, 93% female, 44.4 ± 5.8 years) and youth (n = 83, 42% white, 54% male, 12.9 ± 1.1 years, and 96% sexually inexperienced). Frequency of parent-youth sexual health communication and youth communication self-efficacy increased in those playing SSS compared with those in the comparison group (P < 0.01). Youth perceived parent-youth communication as more open and demonstrated significant improvement in condom and human immunodeficiency virus/sexually transmitted infection knowledge and perceptions of parents' beliefs about sex (<0.001). Usability ratings were higher on ease, credibility, and helpfulness (all >78%) but lower on duration and appeal (<56%). CONCLUSION:This study demonstrated the utility of an in-home intergenerational sexual health education game to impact parent-youth communication by short-term follow-up. Further investigation of longer-term behavioral impact is indicated.

Intimate partner violence (IPV) has been linked to substantial physical, social, and mental health concerns across the lifespan. Health impacts of IPV are linked to economic and housing instability. Emergency shelter is primarily focused on the safety and stabilization of the most vulnerable IPV survivors. Despite frequent use of shelter interventions, little is known about the health service experiences of IPV survivors in shelters, including the extent to which these services are perceived as helpful. To address these gaps, we surveyed 214 IPV shelter residents in a Southern state. We asked socioecological and economic questions, and health conditions including food insecurity, physical health status, mental health (e.g., post-traumatic stress disorder [PTSD], depression, somatic symptoms). We asked participants about seven IPV shelter health services use and perceived helpfulness. We used bivariate and regression analysis to examine study queries. In our racially and ethnically diverse sample of mostly (95%) women, over 40% self-report a disability. Over 63% of participants met criteria for probable PTSD, 43.9% met criteria for probable depression, and 40.2% reported severe somatic symptoms. Over 59% reported very low food security. Both food insecurity and PTSD were associated with economic, sexual and physical IPV before shelter. Participants used an average of five health services in shelter, with advocacy being perceived as most helpful. Participants with poor health and/or depression were less likely to find key health services helpful. This study demonstrated the ongoing need for health services for survivors of IPV residing in emergency shelter environments. While most services are perceived as helpful, substantial gaps prevent holistically addressing survivor health concerns.

Despite prevalent use, surprisingly little research has examined how intimate partner violence (IPV) shelter stays relate to violence experiences, including risk for homicide. To address this gap, we surveyed shelter residents to investigate (a) IPV types reported before and during a shelter stay and the differences by sociodemographic factors known to influence shelter stays; (b) extent of IPV homicide risk and significant associations; and (c) empowerment related to safety and risk for IPV homicide. We administered an online survey to IPV shelter residents (N = 241) in 19 programs in Texas. We assessed multiple forms of IPV, IPV homicide risk, and safety. Over 51% of IPV shelter residents had previously been denied shelter. Since arriving at the shelter, 22% of the residents experienced IPV. Over half of the sample (57%) were at high risk for IPV homicide. Chi square tests associate with IPV homicide risks based on disability status and lifetime shelter stays. Logistic regression identified previous shelter denials were associated with high risk for IPV homicide. Shelter stays are protective against IPV; however, the high rate of shelter denials, especially among those at high risk for homicide, indicates that we are not meeting the need of this precarious population. Innovative economic strategies and enhanced prevention are needed.

Human papillomavirus (HPV) can cause six cancer types but can be prevented with timely vaccination in early adolescence. However, despite the wide availability of the HPV vaccine, uptake remains suboptimal among US adolescents. School nurses are invaluable resources to students and their families regarding adolescent immunization needs. As part of the All for Them vaccination program, we assessed the impact of the continued nurse education (CNE) intervention on school nurses’ HPV vaccine communication with parents. Seventy-two school nurses and nurse administrators in Texas participated in the study. Using a single-arm study design, we measured participants’ potential barriers to and self-efficacy for recommending the HPV vaccine, and knowledge about HPV and the vaccine. Data were collected between November 2021 and May 2023. We evaluated differences in survey responses using paired t-test and McNemar-Bowker chi-square test. Participants’ uncertainty about HPV vaccine efficacy was significantly reduced at follow-up (P < .001). More participants indicated that their HPV knowledge (P = .003) and understanding of the recommended dosing schedule for the vaccine (P = .003) were not barriers at all at follow-up. Participants’ confidence to communicate with parents about HPV vaccination significantly increased across six self-efficacy variables at follow-up (P < .001). The CNE intervention appeared to improve nurses’ HPV and HPV vaccine-related knowledge and increased their self-efficacy to communicate about HPV vaccination with parents, while lessening their perceived barriers to do so. The CNE can be a key resource to support school nurses’ professional practice, facilitating their high-quality HPV vaccine recommendations to adolescents and parents.

Teen dating violence (TDV) is a prevalent public health problem with significant consequences for mental, physical, and social well-being. School-based programs have demonstrated modest but reliable effects on TDV-related outcomes; however, skills introduced in early adolescence may be less applicable as youth age. This project was embedded within a larger randomized controlled trial conducted in spring 2018, in which students were randomized to receive either the Fourth R relationship–based intervention or a standard school health education curriculum. Five years after the intervention, a subset of adolescents originally assigned to the Fourth R condition (n = 666) were randomized to receive an 8-week text message booster focused on healthy relationships, safety, and help-seeking. Engagement metrics (e.g., enrollment, opt-outs, interactive responses) were automatically recorded via Mobile Commons, the secure platform used to deliver all messages. Of the 666 youth randomized to the booster, 283 enrolled (42.5

Community organizations strive to help survivors of intimate partner violence (IPV), stalking, sexual assault and human trafficking address health and safety needs. Hotline, offered by local agencies, is the first line of support for survivors to address needs. Increasingly, hotline is offered in digital formats (chat and text) to meet the emergent needs of survivors. Despite the growing use of digital hotline, little is known about short-term health and safety changes associated with use. Partnering with 2 local agencies in a Southern state, we recruited first-time digital hotline participants to an online baseline and follow-up (6 weeks later) assessment (n = 237) to examine changes in health (e.g. physical health, depression, PTSD) and safety (tools related to safety, perception of safety). Descriptive statistics, paired sample t-tests, chi-square, and regression modeling were used for data analysis. At 6 weeks post-digital hotline use, depression and PTSD symptoms had significantly decreased, and hope and feelings of safety had significantly increased. No changes were observed for physical health. Repeated hotline use after baseline was associated with revictimization, sustained health needs, and reduced perception of internal tools related to safety. Longer-term and expanded study are needed of digital hotline to further examine potential impacts, however these findings suggest that hotline is not merely a conduit to other services, but a potentially impactful intervention into itself.

INTRODUCTION:Firearm access and associated risk behaviors (i.e., firearm storage and carriage) are established factors that increase the risk of firearm-related injuries. While extant research has demonstrated associations between singular substance use and these risks, little is known regarding the impact of polysubstance use on these outcomes. The present study aims to investigate the relationships between polysubstance use in adolescence and four specific firearm-related risks manifesting in emerging adulthood. METHODS:Ten years of annual data from a cohort of 1,042 adolescents initially aged 13-18 years were analyzed to identify polysubstance use trajectories and their associations with firearm-related behaviors in emerging adulthood. Using group-based multi-trajectory modeling, polysubstance use patterns from adolescence to emerging adulthood were identified. Associations between membership in these trajectory groups and four firearm-related risk factors in emerging adulthood-firearm access, improper storage of firearms and ammunition, and frequent carriage-were assessed using multivariable logistic regression. RESULTS:Five distinct polysubstance risk trajectories were identified. The highest rates of firearm access were observed among Chronic Illicit and Non-Illicit Polysubstance Users. The greatest prevalence of improper firearm storage was exhibited by Alcohol Ascenders and Chronic Non-Illicit Users. Additionally, significantly higher odds of engaging in frequent firearm carrying were found for all polysubstance use groups compared to Mild Alcohol Users, with the exception of Chronic Illicit Users. No significant associations were observed for improper ammunition storage across groups. CONCLUSION:This study is among the first to identify specific associations between firearm-related risk behaviors and distinct polysubstance use trajectories. The findings provide novel insights for developing targeted interventions to mitigate firearm risks in polysubstance-using individuals transitioning from adolescence to young adulthood.

PURPOSE:Intimate partner violence (IPV) victimization and traumatic brain injury (TBI) are common correlates of mental health problems in adolescence. However, research has yet to investigate whether IPV victimization is related to developmental changes in mental health, as well as the contributing role that TBI may play in conditioning this association. We address this gap by analyzing longitudinal data with well-validated measures of mental health from an ethnically diverse sample of adolescents. METHODS:Prospective data from the Dating it Safe sample (n = 699) were used to measure IPV victimization, depression, post-traumatic stress, binge drinking, and TBI from 2015 to 2021. We used latent growth curve models to evaluate both cross-sectional and longitudinal associations between victimization, starting levels, and rates of change. Interaction terms were used to assess whether TBI conditions pathways between victimization, starting levels, and changes. RESULTS:IPV victimization was associated with higher levels of depression, post-traumatic stress, and binge drinking in late adolescence. All associations were stronger for participants with a history of TBI due specifically to being hit by another person or shaken violently. Participants who experienced IPV with a history of TBI due to physical violence demonstrated more rapid increases in post-traumatic stress from late adolescence to young adulthood (β = 0.21; 95% confidence interval = 0.10-0.33; p = .008). DISCUSSION:Findings highlight the synergistic relationship between IPV victimization and TBI for mental health sequelae. Research and practice should seek to develop effective assessments and interventions for people who experience IPV and have a history of TBI.

Despite the potential for negative health consequences, scant recent literature has focused on sexual harassment among older adolescent populations. In assessing the prevalence, predictors, and outcomes of this persistent public health problem, we begin to address this gap in knowledge. As part of an ongoing longitudinal study, we administered the Sexual Experiences Questionnaire to 1,124 older adolescents (17 and 18) and conducted multilevel logistic regression analyses to examine the link between demographic, environmental, and health factors and sexual harassment. 20

Despite accumulating research on help-seeking among violence victims, little is known about help-seeking among youth who use violence. In a racially and ethnically diverse sample of early adolescents (N = 2,676; 50.3% female; Mage = 12.67), participants self-reported physical bullying, physical fighting, physical dating violence perpetration, and help-seeking intentions over the past year. T-test and one-way analysis of variance examined help-seeking by sex and race, respectively. Prevalence and comparisons of help-seeking across youth with and without any violence were examined. Youth who used any physical peer violence (n = 965) reported lower help-seeking intentions than their peers, and among violent youth, males reported higher help-seeking intentions than females. Overall, peers and caregivers were rated the most likely sources of support for adolescent personal problems. Findings underscore the need for universal violence prevention to equip youth, caregivers, and community members with help-seeking psychoeducation.

Background: We sought to better understand the impact of exposure to active shooter drills (ASDs) on students' perceived stress, including those with disabilities and prior experiences with trauma. Methods: We used data from a longitudinal study of ethnically diverse students (n = 2,033; 53.5% female) originally recruited in 2018 and followed annually thereafter. In addition to self-reporting on their perceived stress with ASDs, participants responded to questions about adverse childhood experiences, anxiety, suicidal ideation, and disability. Results: Female students and those with a disability, probable anxiety, and suicidal ideation were more likely to be anxious after an ASD. Conclusion: While necessary given the increasing reality of school shootings in the United States, our results indicate that active shooter drills should be implemented with concern for vulnerable groups, including distressed students and those with a history of traumatic experiences or who have a disability.

Adolescence is a critical stage for sexual development that coincides with the onset of dating relationships and the debut of sexual behavior, and teen dating violence (TDV) is prevalent in many of these relationships. While cross-sectional studies have shown that TDV victimization is linked to sexual risk behavior (SRB), the pathway between these variables is not well-understood. To address this knowledge gap, we explore the mediating role of self-efficacy to refuse sex in the longitudinal relationship between physical TDV victimization and subsequent SRB among adolescents. Self-report data from 3 longitudinal studies were harmonized to create a sample of primarily racial and ethnic minority adolescents (N=4,620; 51.4% Hispanic, 38.5% Black, and 58% female) from 44 schools in the southwest U.S. Participants' physical TDV victimization at baseline (7th and 8th grade), self-efficacy to refuse sex at 12-month follow-up, and various SRB at 24-month follow-up was tested using mediation models with bias corrected bootstrapped confidence intervals. All regression models controlled for age, race, parental education, SRB, and intervention status at baseline. Physical TDV victimization at baseline was associated with refusal self-efficacy at 12 months and SRB (e.g., frequency of vaginal and oral sex, lifetime number of vaginal sex partners, and number of vaginal sex partners in the past three months without condom use) at 24 months. Refusal self-efficacy mediated the link between physical TDV victimization and increased risk of SRB for females and males, to a lesser extent. Adolescent victims of physical TDV report diminished self-efficacy to refuse sex, predisposing them to engage in sexual risk behaviors, including condomless sex. Loss of self-efficacy to refuse sex following physical TDV victimization may increase SRB and attendant risk of teen pregnancy and sexually transmitted infection. Findings reveal that there are persistent consequences associated with reduced self-efficacy that could potentially carry on into adulthood. Violence prevention programs and sex education targeting young adolescents should promote self-efficacy strategies to reduce SRB and other harmful sexual outcomes.

Background Sexual harassment (SH) and sexual assault (SA) are serious public health problems among US service members. Few SH and SA prevention interventions have been developed exclusively for the military. Code of Respect (X-CoRe) is an innovative web-based, multilevel, SA and SH intervention designed exclusively for the active-duty Air Force. The program’s goal is to increase Airmen’s knowledge and skills to build and maintain respectful relationships, ultimately reducing SH and SA and enhancing Airmen’s overall well-being and mission readiness. Objective This pilot study aimed to assess the short-term psychosocial impact (eg, knowledge, attitudes, and self-efficacy) of the web-based component of X-CoRe on a sample of junior enlisted and midlevel Airmen. Methods Airmen from a military installation located in the Northeastern United States were recruited to complete the 10 web-based modules in X-CoRe (9/15, 60% male; 7/15, 54% aged 30-35 years). Participants were given pretests and posttests to measure short-term psychosocial outcomes associated with SH and SA. Descriptive statistics and paired 2-tailed t tests were conducted to assess differences from preintervention to postintervention time points. Results After completing X-CoRe, participants had a significantly greater understanding of active consent (P=.04), confidence in their healthy relationship skills (P=.045), and confidence to intervene as bystanders (P=.01). Although not statistically significant (P>.05), mean scores in attitudes about SH, couple violence, and cyberbullying; perceptions of sexual misconduct as part of military life; and relationship skills self-efficacy with a romantic partner and friend also improved. Conclusions The findings from this study demonstrate X-CoRe’s effectiveness in improving critical determinants of SH and SA, making it a promising intervention for SH and SA prevention. More rigorous research is needed to determine X-CoRe’s impact on SH and SA victimization and the long-term impact on associated psychosocial determinants.

Purpose: While cross-sectional studies have shown that teen dating violence (TDV) victimization is linked to sexual risk behavior (SRB), the pathway between these variables is not wellunderstood. To address this knowledge gap, we explore the mediating role of self-efficacy to refuse sex in the longitudinal relationship between physical TDV victimization and subsequent SRB among adolescents. Methods: Self -report data from three prior longitudinal studies were harmonized to create a single aggregated sample of primarily racial and ethnic minority adolescents (N 1/4 4,620; 51.4% Hispanic, 38.5% Black, and 58% female) from 44 schools in the southwest U.S. Participants' physical TDV victimization at baseline (seventh and eighth grade), self-efficacy to refuse sex at 12-month followup, and SRB at 24-month follow-up was tested using mediation models with bias corrected bootstrapped confidence intervals. All regression models controlled for age, race, parental education, SRB at baseline, and intervention status. Results: Physical TDV victimization at baseline was associated with refusal self-efficacy at 12 months and SRB (e.g., frequency of vaginal and oral sex, lifetime number of vaginal sex partners, and number of vaginal sex partners in the past three months without condom use) at 24 months. Refusal self-efficacy mediated the link between physical TDV victimization and increased risk of SRB for females and males, to a lesser extent. Discussion: Adolescent victims of physical TDV report diminished self-efficacy to refuse sex, predisposing them to engage in SRBs, including condomless sex. (c) 2023 Society for Adolescent Health and Medicine. All rights reserved.

Decades of inquiry on intimate partner violence show consistent results: violence is woefully common and psychologically and economically costly. Policy to prevent and effectively intervene upon such violence hinges upon comprehensive understanding of this phenomenon at a population level. The current study prospectively estimates the cumulative incidence of sexual and physical dating violence (DV) victimization/perpetration over a 12-year timeframe (2010–2021) using diverse participants assessed annually from age 15 to 26. Data are from Waves 1–13 of an ongoing longitudinal study. Since 2010 (except for 2018 and 2019), participants were assessed on past-year physical and sexual DV victimization and perpetration. Participants ( n = 1,042; 56% female; M age baseline = 15) were originally recruited from seven public high schools in southeast Texas. The sample consisted of Black/African American (30%), White (31%), Hispanic (31%), and Mixed/Other (8%) participants. Across 12 years of data collection, 27.3% experienced sexual DV victimization and 46.1% had experienced physical DV victimization by age 26. Further, 14.8% had perpetrated at least one act of sexual DV and 39.0% had perpetrated at least one act of physical DV against a partner by this age. A 12-year cumulative assessment of physical and sexual DV rendered prevalence estimates of both victimization and perpetration that exceeded commonly and consistently reported rates in the field, especially on studies that relied on lifetime or one-time specified retrospective reporting periods. These data suggest community youth are at continued and sustained risk for DV onset across the transition into emerging adulthood, necessitating early adolescent prevention and intervention efforts that endure through late adolescence, emerging adulthood, and beyond. From a research perspective, our findings point to the need for assessing DV on a repeated basis over multiple timepoints to better guage the full extent of this continued public health crisis.

Intimate partner violence (IPV), sexual assault, and stalking are consequential public health and safety issues with wide reaching impacts on emerging adults, including those on college campuses in the United States. In response to high rates of violence among college student populations, universities are developing campus-based advocacy (CBA) programs, which aim to support survivors of interpersonal violence through supportive connections, resource acquisition, and safety planning. However, little data exists related to their impact on key student-survivor outcomes. Thus, this study aims to understand (a) the approach CBA programs use to address safety and academic concerns of student-survivors, and (b) the initial outcomes of CBA programs on safety and academics among students engaged in CBA services at five universities in one Southwestern state. The project used a longitudinal mixed-methods approach, with data collection activities including qualitative interviews with student survivors (n = 29) and a longitudinal, web-based, quantitative survey with matched analyses of safety and academic outcome measures from 115 student survivors who participated in an initial survey and follow-up survey after 6 months. Findings demonstrate key pathways through which CBA programs support survivors and facilitate positive safety and academic outcomes. These pathways include education, supportive connection, and resource access. Analysis of longitudinal survivor data demonstrate substantial reductions in sexual violence, IPV, stalking, and school sabotage at 6-month follow-up compared to initial survey, as well as significant reductions in academic disengagement for student survivors. The findings of the study powerfully demonstrate the positive impact of CBA programs on survivor and campus outcomes. Furthermore, programs not only enhance individual survivor safety and academic outcomes but also support the overall climate and safety of hosting universities.

PURPOSE:Teen dating violence (TDV) is a global public health and safety issue causing health impacts to youth people. This study aimed to examine: (1) the impact of the pandemic on TDV victimisation rates and (2) socioecological factors associated with sustained risk for TDV victimisation during the first year of COVID-19. METHODS:Data are from an ongoing randomised controlled trial of a TDV prevention programme in Texas (n=2768). We conducted annual assessments in 2019-2021. We used regression modelling to assess demographic, individual, peer and family factors associated with TDV risks. RESULTS:TDV rates declined from 11.9% in 2019 to 5.2% in 2021. While demographic, peer and family/household factors were not associated with TDV victimisation during the pandemic, individual-level factors (ie, early sexual debut, substance use, acceptance of violence and prior TDV involvement) were related to COVID-era risks. Only early sexual debut was uniquely linked to TDV victimisation risk the first year of COVID-19. CONCLUSIONS:While TDV rates declined during the pandemic, previous victimisation, substance use and early sexual debut remained potent risks for relationship harm.

INTRODUCTION:The United States has the highest teen pregnancy rate and sexually transmitted infection rates among developed countries. One common approach that has been implemented to reduce these rates is abstinence-only-until-marriage programs that advocate for delaying sexual intercourse until marriage. These programs focus on changing adolescents' beliefs toward abstinence until marriage; however, it is unclear whether adolescents' beliefs about abstinence predict their sexual behavior, including sexual risk behavior (SRB). An alternative approach may be encouraging youth to delay their sexual debut until they reach the age of maturity, but not necessarily until marriage. METHODS:To address this question, we compare the longitudinal association between abstinence beliefs (i.e., abstaining completely until marriage) and beliefs about delayed sexual debut with subsequent SRB 24 months later. The harmonized data set included 4620 (58.2% female, Mage = 13.0, SDage = 0.93) participants from three randomized controlled trials attending 44 schools in the southern United States. Negative binomial regressions were employed to examine the association of abstinence until marriage beliefs and beliefs regarding delaying sex with SRB. RESULTS:We identified that beliefs supporting delaying sex until an age of maturity were associated with lower odds of engaging in SRB, such as having multiple sex partners and frequency of condomless sex, for both sexes. However, stronger abstinence beliefs had no significant associations with all SRB outcomes. CONCLUSIONS:Findings suggest prevention programming that focuses on encouraging youth to delay sex until an appropriate age of maturity may be more effective at preventing SRB and consequent negative sexual health outcomes.