Suicide is a leading cause of death among adolescents and research on aggregated data conceals unique vulnerabilities across ethno-racial subpopulations. Adverse childhood experiences (ACEs) increase risk for suicide ideation (SI) and suicide attempts (SA), but these associations may vary across different ethno-racial groups and years. Data from the 2013–2022 Minnesota Student Survey were used to assess trends in past-year SI and SA (grades 8, 9, and 11, n = 421,709). We described frequencies of demographics and evaluated trends using the Mantel–Haenszel tests of linear associations stratified by 12 ethno-racial groups and sex. Using logistic regression models, we assessed how SI and SA outcomes varied across ethno-racial groups when adjusting for grade and ACEs. Overall, SI and SA increased among 8 th and 9 th grade female students. Female students more frequently reported SI (14.0–20.1

OBJECTIVE:Suicide screening guidelines based on findings from aggregated data conceal subpopulation vulnerabilities. Risk factors for a suicide attempt (SA), such as suicidal ideation (SI), may differ in frequency or be absent in certain ethnoracial youth subgroups. Thus, accurate identification of suicide risk remains a challenge, and guidelines are inconsistent. METHODS:This cross-sectional study used data from the 2019 and 2022 waves of the Minnesota Student Survey of eighth, ninth, and 11th graders. Students in 12 ethnoracially diverse groups self-reported their race and ethnicity, past-year SI and SA, and past 2-week symptoms of depression and anxiety. We used stratified chi-squared tests by sex and ethnoracial group for bivariate analyses. Logistic regression models adjusted for food insecurity, unstable housing, and mental health treatment, examined odds of SA. RESULTS:About 3.0% of male students attempted suicide in the past year. Of these youth, 35.9% denied depressive symptoms, 39.8% denied anxiety symptoms, and 14.8% denied SI, especially Somali (47.8%) and multiracial (26.3%) male students. Among the 7.3% of female students who attempted suicide during the preceding year, 25.4% denied depressive symptoms, 24.6% denied anxiety symptoms, and about 8.0% denied SI, especially Somali (29.7%) and Black (12.5%) female students. Students who reported depressive or anxiety symptoms, especially male students, had increased odds of SA. CONCLUSIONS:A higher proportion of males, certain Black subgroups, and multiracial students reported a past-year SA without endorsing symptoms of depression, anxiety, or SI. Future research should assess for whom screening tools work, mitigate screening limitations, and normalize minoritized experiences.

PurposeClinical firearm safety counseling can help prevent firearm injuries, yet many clinicians have not adopted this practice. We collected practical tips from physicians who do such counseling to help others interested in conducting such counseling while perhaps feeling insecure about how to implement it.DesignQualitative interview study.Setting/ParticipantsSixteen physicians who had made clinical firearm safety counseling part of their practice.MethodsAn interview guide included questions about how, when, and with whom participants were undertaking firearm safety counseling, motivations, experiences with the counseling, patient reactions, and barriers and facilitators. The interviews were analyzed using inductive thematic analysis.ResultsMost (11 out of 16) physicians were in primary care/family medicine or pediatrics; 54% worked in urban, 27% in rural/small town, and 20% in suburban settings. Three takeaways were reported by virtually every participant: firearm safety counseling is not difficult; almost all patients react positively, and occasional skeptical reactions are easily defused; and this counseling does not take much time. Participants kept conversations nonjudgmental and focused on safety, not on firearm ownership itself. Participants' strong convictions that it was their responsibility to address firearm safety helped them overcome barriers such as lack of time, training, and guidelines.ConclusionParticipants shared actionable ideas on how to facilitate firearm safety counseling, exemplifying ways to encourage firearm safety behaviors.

INTRODUCTION:High rates of suicidal ideation (SI), suicide attempts (SA), and repetitive nonsuicidal self-injury (NSSI) among some ethnoracially minoritized United States youth populations may be related to adverse childhood experiences (ACEs) with structural roots. METHODS:Using the 2013-2019 Minnesota Student Surveys, we assessed associations of student-reported structural ACEs (parental incarceration, housing instability, food insecurity, and foster care involvement) with SI, SA, and repetitive NSSI within the past 12 months using multilevel logistic regression stratified by ethnoracial group (American Indian/Alaskan Native [AIAN], Hmong, other Asian, Black Latino, other Latino, Somali, other Black/African American [AA], Native Hawaiian/Pacific Islander [NHPI], and multiracial), and adjusted for sex, grade, ACEs experienced within one's household, mental health treatment, and perceived safety. RESULTS:Structural ACEs were strongly associated with increasing SI, SA, and NSSI. At ≥2 structural ACEs, repetitive NSSI rates ranged from 7% to 29% (female), 8% to 20% (male); SA rates ranged from 13% to 35% (female), 10% to 22% (male); and SI rates ranged from 31% to 50% (female), 20% to 32% (male). Black Latino, NHPI, AIAN, and Black/AA students most often reported structural ACE exposures. CONCLUSION:Reducing structural ACEs may reduce SI, SA, and repetitive NSSI among ethnoracially minoritized youth populations. Disaggregating diverse youth groups revealed variations in these outcomes that remain hidden when subpopulations are aggregated.

OBJECTIVE : To use multiple perspectives to identify the key components of pediatric primary care conversations for motivating parents to utilize parenting programs. We aim to develop an actionable framework that primary care clinicians (PCCs) can follow for effective conversations with parents. METHODS : We conducted focus groups and interviews with researchers (n = 6) who have experience delivering parenting interventions through primary care, clinical personnel in federally qualified health centers (FQHCs) (n = 9), parents of 3-5year olds who receive services at a FQHC pediatric clinic (n = 6), and parent educators (n = 5). Groups and interviews were informed by nominal group technique, and researchers triangulated consolidated strategies across the groups. RESULTS : Key strategies for PCCs to motivate parents to utilize parenting programs followed three steps: 1) learning about a parent's questions and concerns, 2) sharing resources, and 3) following up. PCCs can learn about parents' needs by empathizing, listening and responding, and asking questions that acknowledge parents' expertise. When sharing resources, PCCs can motivate participation in parenting programs by explaining each resource and its benefits, providing options that support parents' autonomy, and framing resources as strengthening rather than correcting parents' existing strategies or skills. Finally, PCCs can continue to engage parents by scheduling follow-up conversations or designating a staff member to check -in with parents. We provide examples for each strategy. CONCLUSIONS : Findings provide guidance from multiple perspectives on strategies to motivate parents in pediatric primary care setting for utilizing parenting programs.

School resource officer (SRO) programs were expanded to improve school safety, but limited research has assessed factors impacting students' perspectives on and intended utilization of SROs. We analyzed the relationships of students' experiences with law enforcement and school discipline with views and intended use of SROs. We used multilevel logistic regression models based on the 2019 Minnesota Student Survey to estimate odds ratios of negative attitudes toward SROs. Among all students, 94.4% agreed having an SRO at school was a good idea, 62.1% said they would feel comfortable going to their SRO with a problem, and 68.1% that they would tell their SRO if they saw something unsafe. Among students with recent suspensions, a parent/guardian who was ever in prison, or attending alternative learning centers, there was still widespread support for SROs, albeit lower support for SROs. Furthermore, only about half of students with recent suspensions or impacted by parental incarceration stated they would utilize SROs. These findings highlight discrepancies in students' attitudes toward versus utilization of SROs, especially for those disproportionately impacted by law enforcement or school discipline. This is relevant, as having trusted adults to turn to with problems has been identified as a cornerstone of school safety. Students had overwhelmingly positive views of school resource officers (SROs) with 94% of students supporting the presence of SROs. However, fewer students stated they would feel comfortable going to their SRO if they had problems or needed help or if they knew about something unsafe or illegal (62% and 68%, respectively). While there is widespread support for SROs among students affected by law enforcement or school discipline, these individuals were significantly less likely to state that they supported the presence of SROs and intended to utilize SROs. Further research and interventions are necessary to optimize perspectives and utilization of SROs and/or assess adjuvants to SROs to promote feelings of school safety for all students, especially for students impacted by law enforcement or school discipline who are less likely to support and utilize SROs.

Restorative justice diversion aligns with youths' developmental needs more than traditional approaches. However, there is a research gap regarding its effectiveness among diverse youth, and when initiated by police. This study evaluated misdemeanor cases that occurred in Minneapolis between September 2014 and December 2018 finding that youth who participated in restorative justice diversion after arrest were less likely to experience re-arrest in the following year compared to those processed traditionally. Positive program impacts for Black and American Indian youth demonstrate RJ diversion can be effective with diverse youth while differences in rates of successful diversion by participating community agency highlight opportunities for further study. This study demonstrates the importance of continuing to understand and expand restorative justice diversion with youth.

Urban racial arrest disparities are well known. Emerging evidence suggests that rural policing shares similar patterns as urban policing in the USA, but without receiving the same public scrutiny, raising the risk of biased rural policing going unnoticed. We estimated adult and adolescent arrest rates and rate ratios (RR) by race, rural-urban status, and US region based on 2016 Uniform Crime Reporting Program arrest and US Census population counts using general estimating equation Poisson regression models with a 4-way interaction between race, region, age group, and urbanicity. With few exceptions, arrest rates were highest in small towns and rural areas, especially among Black and American Indian populations. Arrest rates differed between US regions with highest rates and racial disparities in the Midwest. For example, arrest rates among Black adults in the rural Midwest were 148.6 arrests [per 1000 population], 95

Adolescent suicidality is a significant public health concern in the US. Previous research based on aggregated data conceals potential unique vulnerabilities in diverse subpopulations, some of which experience disproportionate risk factors due to structural inequities, adversity, and racism. We aimed to describe and compare non-suicidal self-injury (NSSI) and suicide thoughts and behaviors (STBs), including time trends, among adolescents, stratified by sex and race and/or ethnicity We used cross-sectional data from the 2013, 2016, and 2019 waves of the Minnesota Student Survey (grades 8, 9, and 11, total N= 347,902). We described frequencies and used Chi-squared tests to compare proportions of students who reported having seriously considered attempting suicide, having attempted suicide, or purposely injuring themselves without wanting to die in the past 12 months, stratified by sex (female, male) and ethnoracial identity (American Indian/Alaska Native [AIAN], Asian, Black, Latino/a, multiracial, Native Hawaiian/Pacific Islander [NHPI], non-Hispanic [NH] White). NSSI and STBs were more frequent among girls than boys and varied by ethnoracial background, with highest suicidal ideation and NSSI rates among girls with AIAN, multiracial, and Latino/a backgrounds (e.g. 2019; AIAN: ideation 31.5% [27.8-35.1%], NSSI 40.8% [37.0-44.5%], and highest rates of suicide attempts among girls with AIAN, multiracial, Latino/a, or NHPI backgrounds (e.g. 2019; AIAN, 16.0% [13.1-18.8%]). Differences between ethnoracial groups in NSSI and STBs, stratified by sex, were significant (P<0.0001) in each survey year. Rates of suicidal ideation and NSSI increased across student groups between 2013 and 2019. With highest absolute rates in NSSI and STBs among girls, it was mostly male subgroups that saw significant (P<0.05) increases in STBs and NSSI in recent years (e.g. multiracial, ideation in 2019: 12.5% [11.3-13.7%] vs. in 2013: 9.7% [8.7-10.6%]; NSSI in 2019: 16.0% [14.7-17.3%] vs. in 2013: 12.9% [11.8-14.0%]; and Latino, ideation in 2019: 10.5% [9.6-11.3%] vs. in 2013: 8.1% [7.2-8.9%]; NSSI in 2019: 14.8% [13.8-15.8%] vs. in 2013: 12.7% [11.6-13.8%]). Our findings confirm that suicidality is an urgent and growing problem among adolescents, with alarmingly high rates of self-injurious thoughts and behaviors in some ethnoracial groups. Our findings add to recent research suggesting suicidal behaviors and underlying reasons may differ in populations of color compared with risk factors previously derived in primarily NH White populations, highlighting the need for in-depth studies of the correlates of suicidal behaviors with sufficient sample sizes of ethnoracial minoritized adolescents. Further, our findings emphasize the need for screening for NSSI and STBs, especially among ethnoracial subgroups who demonstrate high or increasing risk, to identify and intervene early with youth who demonstrate imminent or future risk of suicide.

Hispanic/Latina students face difficulties engaging in physical activity, but schools can help by integrating activity into accrue the school day and offering sport and activity-based extracurriculars. In this study, we examined physical activity (PA) and school-related factors among adolescent Hispanic/Latina students. Participants (N = 5,539) were eighth, ninth, and eleventh grade females identifying as Hispanic/Latina on the 2016 Minnesota Student Survey. We used descriptive statistics and a generalized linear model to examine relationships between school-related variables and days of >= 60 minutes of PA in the past week. Many participants engaged in no physical education (44%), sports (61%), PA lessons (84%), or after-school activities (76%). More days of physical education, sport, and PA lessons associated with higher PA levels (p < .001), as did more days of non-sport activities (p <= .01) and feeling safer going to/from school (p <= .05). Significant interactions demonstrated the effect of physical education on PA was strongest for eighth grade students. Hispanic/Latina students' PA and engagement in school activities are limited, and schools' practices and policies should intentionally support these adolescents' PA early and throughout their educational careers.

Background: We investigated the percentage of insufficiently active adolescents who became young adults meeting moderate to vigorous physical activity (MVPA) guidelines. We also explored adolescent psychosocial and environmental factors that predicted MVPA guideline adherence in young adulthood. Methods: Participants included N = 1001 adolescents (mean age =14.1 y) reporting < 7 hours per week of MVPA and followed (8 y later) into young adulthood through Project EAT. We examined mean weekly hours of MVPA, MVPA change between adolescence and young adulthood, and the proportion of participants meeting MVPA guidelines in young adulthood. With sex-stratified logistic regression, we tested 11 adolescent psychosocial and environmental factors predicting meeting MVPA guidelines in young adulthood. Results: Overall, 55% of insufficiently active adolescents became young adults meeting MVPA guidelines. On average, participants reported 3.0 hours per week of MVPA, which improved to 3.8 hours per week in young adulthood. Among female participants, higher MVPA in adolescence and stronger feelings of exercise compulsion predicted greater odds of meeting adult MVPA guidelines (odds ratioMVPA = 1.18; odds ratiocompulsion =1.13). Among female and male participants, perceived friend support for activity in adolescence predicted greater odds of meeting adult MVPA guidelines (odds ratiofemale = 1.12; odds ratiomale =1.26). Conclusions: Insufficiently active adolescents can later meet adult guidelines. Interventions that increase perceived friend support for activity may benefit individuals across development.

Via a school-based survey, we used a developmental assets framework to investigate associations of internal and social characteristics and weight-based bullying with sport and physical activity (PA) among female adolescents with high weight status ( n = 4,468; M age = 14.9 years, SD age = 1.3; body mass index ≥ 95th percentile). Participants reported ≥60 min of PA on approximately 3.0 days ( SD = 2.1) in the previous week. Over one-third played organized team sports, averaging 3.5 days ( SD = 1.5) per week. Weight-based bullying was common (46%) and unassociated with lower sport and PA. Results from t -tests and chi-squared tests demonstrated that adolescents who played sport (vs. those who did not) had higher internal developmental assets, better perceived health, and stronger perceptions of caring from parents, friends, and other community adults. Similarly, adolescents engaging in more PA reported higher developmental assets. In regression models adjusted for all variables and demographic characteristics, higher internal developmental assets, better perceived health, and stronger perceptions of caring from adults in the community were positively and significantly associated with increased odds of sport participation and higher PA. Findings suggest female adolescents with high weight status have internal and social assets related to their participation in PA and sport, despite experiencing weight-based bullying. Adults (e.g., coaches, parents, and healthcare professionals) should help female adolescents with high weight status participate in sport and PA and build developmental assets. Adults should also recognize the frequent weight-based bullying youth encounter and strive to mitigate it in sport and PA contexts.

White individuals in the United States (US) have historically had disproportionate access to firearms. The real-life availability of firearms, including those most lethal, may still be greater among White populations, manifesting in the number of victims in shootings. We compared the severity of US mass public shootings since Columbine by race and/or ethnicity of the perpetrator using The Violence Project Database of Mass Shooters, assessing fatalities (minimum four), total victims, type, and legal status of guns used. We used data visualization and Quasi-Poisson regression of victims minus four - accounting for truncation at 4 fatalities - to assess fatality and total victim rates comparing Non-Hispanic (NH) White with NH Black shooters, using winsorization to account for outlier bias from the 2017 Las Vegas shooting. In 104 total mass public shootings until summer 2021, NH White shooters had higher median fatalities (6 [IQR 5-9] versus 5 [IQR 4-6]) and total victims (9 [IQR 6-19] versus 7 [IQR 5-12]) per incident. Confidence intervals of NH Black versus NH White fatalities rate ratios (RR) ranged from 0.17-1.15, and of total victim RRs from 0.15-1.04. White shooters were overrepresented in mass public shootings with the most victims, typically involving legally owned assault rifles. To better understand the consequences when firearms are readily available, including assault rifles, we need a database of all US gun violence. Our assessment of total victims beyond fatalities emphasizes the large number of US gun violence survivors and the need to understand their experiences to capture the full impact of gun violence.

Most households with a smoker do not implement comprehensive smoke-free rules (smoke-free homes and cars), and secondhand smoke (SHS) exposure remains prevalent among children and low-socioeconomic status (SES) populations. This pilot project aimed to assess implementation feasibility and impact of an intervention designed to increase smoke-free rules among socioeconomically disadvantaged households with children. The pilot was implemented through Minnesota’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP). NBCCEDPs provide cancer prevention services to low-income individuals experiencing health disparities. We successfully utilized and adapted the Smoke-Free Homes Program (SFHP) to address comprehensive smoke-free rules among households with children. We used two recruitment methods: (a) direct mail (DM) and (b) opportunistic referral (OR) by patient navigators in the NBCCEDP call center. We used descriptive statistics to assess implementation outcomes and hierarchical logistic regression models (HLM) to assess change in smoke-free rules and SHS exposure over the study period. There was no comparison group, and HLM was used to examine within-person change. A total of 64 participants were recruited. Results showed 83% of participants were recruited through DM. OR had a high recruitment rate, and DM recruited more participants with a low response rate but higher retention rate. Among recruited participants with data (n = 47), smoke-free home rules increased by 50.4 percentage points during the study period (p < 0.001). Among recruited participants who had a vehicle (n = 38), smoke-free car rules increased by 37.6 percentage points (p < 0.01) and comprehensive smoke-free rules rose 40.9 percentage points (p < 0.01). Home SHS exposure declined, and within-person increase in smoke-free home rules was significantly related to less home SHS exposure (p < 0.05). It is feasible to adapt and implement the evidence-based SFHP intervention through a national cancer program, but the current pilot demonstrated recruitment is a challenge. DM produced a low response rate and therefore OR is the recommended recruitment route. Despite low recruitment rates, we conclude that the SFHP can successfully increase comprehensive smoke-free rules and reduce SHS exposure among socioeconomically disadvantaged households with children recruited through a NBCCEDP.

BACKGROUND:Social determinants of health play a fundamental role in a patient's health status. In recent years, health systems across the nation have implemented numerous strategies aimed at identifying and addressing the health-related social needs of the patients they serve. Despite the influx of peer-reviewed research highlighting outcomes of specific health-related social needs interventions, the spectrum of practices utilized by primary care clinics has not been established. OBJECTIVE:To determine the range of ways primary care clinics address health-related social needs after identification and initial contact with a frontline staff person is completed. DESIGN:We conducted 12 semi-structured, in-person interviews with staff from purposively sampled clinics. If the interview included more than one staff person, all participants were interviewed together. PARTICIPANTS:Twenty-one administrative staff and frontline clinic personnel with experience in 24 separate primary care clinics in the Minneapolis-St. Paul, Minnesota metropolitan area. APPROACH:Interviews focused on the range of health-related social needs processes utilized by clinics, including staff titles, referral procedures, and barriers to addressing needs. Interview recordings were transcribed and coded using thematic analysis. KEY RESULTS:Thematic analysis identified variation in four key areas involving how clinics address patients' health-related social needs after identification and initial contact by frontline staff: clinic personnel involved in addressing needs, clinic referral processes, "resource" and "success" definitions, and barriers to accessing community-based supports. CONCLUSIONS:This study describes the large variation in primary care clinic practices to address health-related social needs after they are identified. The results suggest challenges to standardization and real-world application of previously published studies. Our findings also highlight the opportunity for improved relationships between health systems and community-based agencies.

INTRODUCTIONTobacco 21 (T21) policies have shown promise in reducing cigarette use among adolescents. This study examined whether local T21 policies affected adolescent use of a variety of tobacco products and whether results differed by grade level.METHODSWe used repeated cross-sectional data from eighth, ninth, and eleventh-grade respondents to the 2016 (n = 107 981) and 2019 (n = 102 196) Minnesota Student Surveys. Generalized estimating equations modeled eight adolescent tobacco use outcomes in 2019 (past 30-day use of any tobacco, cigarettes, cigars, e-cigarettes, hookah, chewing tobacco, flavored tobacco, and multiple products) by T21 exposure, defined as respondents' attendance at a school within a jurisdiction with T21 policy implementation between the two surveys. Models controlled for demographic characteristics and product-specific baseline tobacco use at the school level in 2016 and were stratified by grade.RESULTSAfter adjusting for baseline tobacco use and other demographics, T21-exposed eighth and ninth-grade students had significantly lower odds of tobacco use than unexposed peers in five of eight models, i.e. any tobacco (aOR = 0.80, 95% CI: 0.74, 0.87), cigarettes (aOR = 0.81, 95% CI: 0.67, 0.99), e-cigarettes (aOR = 0.78, 95% CI: 0.71, 0.85), flavored tobacco (aOR = 0.79, CI: 0.70, 0.89), and dual/poly tobacco (aOR = 0.77, 95% CI: 0.65, 0.92). T21-exposed eleventh-grade students did not differ significantly in their odds of any tobacco use outcomes relative to their unexposed peers.CONCLUSIONST21 exposure is associated with lower odds of multiple forms of tobacco use, particularly among younger adolescent populations, supporting the implementation of T21 policies to reduce tobacco use in this population.

BACKGROUND: High adolescent gun-related mortality, gun violence, pro-gun policies, white supremacy, and the long-term socioeconomic and other effects of racial oppression are intricately linked in the United States. Racist prejudice depicts male individuals of color as more prone to criminality than white male individuals. We described long-term patterns of weapon carrying in US schools among non-Hispanic (NH) white, NH Black/African American, and Hispanic boys, hypothesizing that in contrast to racist stereotypes, boys of color did not bring weapons into schools more often than NH white boys in recent years. METHODS: We conducted a time series analysis using 1993-2019 Youth Risk Behavior Surveillance System data comparing boys' self-reported weapon carrying in a nationally representative sample of US high schools by race and/or ethnicity, age, and self-reported experience of safety and violence at school. RESULTS: Weapon carrying in schools has declined among all boys. Comparing all schools, we found no significant differences in weapon carrying (4%-5%) by race and/or ethnicity in 2017 and 2019. Boys who reported experiencing violence or feeling unsafe at school were at least twice as likely to bring a weapon into school, and such negative experiences were more common among boys of color (8%-12%) than among NH white boys (4%-5%). In schools perceived as safer, NH white boys have been more likely to bring weapons into schools than NH Black/African American or Hispanic boys in the past 20 years. CONCLUSIONS: Our findings contradict racist prejudice with regard to weapon carrying in schools, particularly in more favorable school environments. Making schools safer may reduce weapon carrying in schools where weapon carrying is most common.

Retrospective studies using adult self-report data have demonstrated that adverse childhood experiences (ACEs) increase risk of violence perpetration and victimization. However, research examining the associations between adolescent reports of ACE and school violence involvement is sparse. The present study examines the relationship between adolescent reported ACE and multiple types of on-campus violence (bringing a weapon to campus, being threatened with a weapon, bullying, fighting, vandalism) for boys and girls as well as the risk of membership in victim, perpetrator, and victim–perpetrator groups. The analytic sample was comprised of ninth graders who participated in the 2013 Minnesota Student Survey ( n ~ 37,000). Multinomial logistic regression models calculated the risk of membership for victim only, perpetrator only, and victim–perpetrator subgroups, relative to no violence involvement, for students with ACE as compared with those with no ACE. Separate logistic regression models assessed the association between cumulative ACE and school-based violence, adjusting for age, ethnicity, family structure, poverty status, internalizing symptoms, and school district size. Nearly 30% of students were exposed to at least one ACE. Students with ACE represent 19% of no violence, 38% of victim only, 40% of perpetrator only, and 63% of victim–perpetrator groups. There was a strong, graded relationship between ACE and the probability of school-based victimization: physical bullying for boys but not girls, being threatened with a weapon, and theft or property destruction ( ps < .001) and perpetration: bullying and bringing a weapon to campus ( ps < .001), with boys especially vulnerable to the negative effects of cumulative ACE. We recommend that schools systematically screen for ACE, particularly among younger adolescents involved in victimization and perpetration, and develop the infrastructure to increase access to trauma-informed intervention services. Future research priorities and implications are discussed.