Objectives Using a national sample of Americans, this study estimated and compared patterns of depressive symptom trajectories stratified by military service. This study then examined associations between sociodemographic factors theorized to shape entry into military service and trajectory patterns. Method Data came from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study that followed participants from adolescence (1994-1995) through midlife (2016-2018). Latent growth mixture modeling was used to estimate depressive symptom trajectories among civilians (n=17,644) and participants who served in the military (n=1,266). Associations between trajectory membership and sociodemographic factors were tested with multinomial regression. Results Trajectories were best represented by 4-class linear models. “Low” was the largest class, representing 74.4% of civilians and 70.4% of those who served. The second largest class, “low then increasing,” was comprised of 13.6% of civilians and 19.6% of service members. The third smallest class, “high then decreasing” class, included 8.8% of civilians and 4.5% of service members. An “increasing” class emerged with high depressive symptoms by midlife, comprised of 3.2% of civilians and 5.5% of those who served. Gender and family structure had robust associations with trajectory membership. Discussion A larger percentage of those who served were in the “increasing” trajectory characterized by concerningly high depressive symptoms by midlife, underscoring the need for continued screening in depressive symptoms throughout the life course. Associations between family structure and gender on depressive symptoms support calls for conceptualizing family structure as a social determinant of health and continued investment in women’s health.

Suicide is a leading cause of death in the United States (U.S.), with firearms being the predominant method. This study examines the racial disparity and disproportionality of pediatric firearm suicide from 2014 to 2018 in 17 U.S. states. We used the National Violent Death Reporting System to quantify the burden of pediatric firearm suicide by race/ethnicity and gender and assessed themes among decedents aged 10 to 17 years. Racial disparity and disproportionality were measured using the Disparity Index and Disproportionality Representation Index, respectively. Decedents were primarily non-Hispanic White (NHW, 77.5%) and male (84.0%). NHW children died at a rate that was 1.3 times greater than expected based on their proportion in the general population and were 2.6 times more likely to die by firearm suicide than non-Hispanic Black (NHB) children. NHB children were less likely to disclose suicide intention, suggesting that this group may require more active screening intervention. Qualitative analysis revealed unsafe firearm storage as a common theme among these deaths. Differences in age with respect to social media use and precipitating factors such as bullying and arguments with parents were also identified as contributing factors. Results of this study support the expansion of interventions such as lethal means restriction counseling and implementation of safer firearm storage laws.

TikTok is the second most popular social media platform among American teenagers, suggesting it may be a way to reach young people with sexual violence-related messages. This qualitative content analysis focused on what TikTok users share about sexual violence. The content of the videos fell into two primary types of information, people sharing experiences of sexual violence (i.e., what happened, how they responded, impacts of experiences) and people sharing other information related to sexual violence (i.e., education, raising awareness). The study results demonstrate that people use TikTok as a platform to share their messages about sexual violence-related topics, underscoring the potential of this platform for prevention and recovery messages targeted toward individuals who directly or indirectly experience sexual violence.

Background Building therapeutic relationships and social presence are challenging in digital services and maybe even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations. Objective This study aims to categorize crisis counselors’ efforts to build rapport in written conversations by using deidentified conversation transcripts from the text and chat arms of the National Child Abuse Hotline. Using these categories, we identify the common characteristics of successful conversations. We defined success as conversations where help-seekers reported the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress, as reported by help-seekers. Methods The sample consisted of transcripts from 314 purposely selected conversations from of the 1153 text and chat conversations during July 2020. Hotline users answered a preconversation survey (ie, demographics) and a postconversation survey (ie, their perceptions of the conversation). We used qualitative content analysis to process the conversations. Results Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with less successful conversations, successful conversations tended to include fewer statements that attend to the emotional dynamics. There were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailor their comments to the situation. Conclusions Building therapeutic relationships and social presence are essential to digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates characteristics associated with successful conversations that could be adopted in other written help-seeking interventions.

Little is known about preservice depressive symptoms, their linkages to subsequent depressive symptoms, and the role of sociodemographic factors in shaping depressive symptoms of those who serve in the military. Using data from the National Longitudinal Study of Adolescent to Adult Health (n = 18,910), we modeled depressive symptom trajectories from baseline (Mage = 15.67) through midlife and compared differences in depressive symptoms between participants who did and did not enter military service. Those who served in the military went on to develop lower levels of depressive symptoms than civilians during their prime military service years, even after accounting for sociodemographic factors that shape pathways into military service. Differences in depressive symptoms by military affiliation were no longer significant by their mid-30s. Results provided a more complete account of depressive symptom patterns associated with military service by including data on individuals before and during military service.

Understanding the dynamics of counseling conversations is an important task, yet it is a challenging NLP problem regardless of the recent advance of Transformer-based pre-trained language models. This paper proposes a systematic approach to examine the efficacy of domain knowledge and large language models (LLMs) in better representing conversations between a crisis counselor and a help seeker. We empirically show that state-of-the-art language models such as Transformer-based models and GPT models fail to predict the conversation outcome. To provide richer context to conversations, we incorporate human-annotated domain knowledge and LLM-generated features; simple integration of domain knowledge and LLM features improves the model performance by approximately 15%. We argue that both domain knowledge and LLM-generated features can be exploited to better characterize counseling conversations when they are used as an additional context to conversations.

Abstract Injury is the leading cause of death and disability among children and adolescents. The injuries sustained by children and adolescents can be either unintentional or the result of violence. They can involve physical as well as emotional harm. Children sustain injuries in many environments, including the home, roadways, and workplaces. Each of these settings exposes children to a unique range of safety hazards. Effective strategies have been developed to prevent the occurrence and reduce the severity of injury in children and adolescents. Successful prevention of injuries requires simultaneous use of multiple interventions. This chapter examines how exposures in the physical and social environments influence risk of unintentional injury among children and adolescents. It reviews risk factors and causes of unintentional injuries in the home environment and on roadways. It also discusses environmental risk factors for firearm injury, violence, suicide, and violence.

Introduction This study investigated the intersectionality of adverse childhood experiences (ACEs) among subgroups of sex, race/ethnicity, and sexual orientation. Methods Using data from the Behavioral Risk Factor Surveillance Survey across 34 states (N=116,712) from 2009 to 2018, authors stratified subgroups of sex (male/female), race/ethnicity (White/Hispanic/Black/multiracial/other), and sexual orientation (heterosexual/bisexual/gay) to investigate the number of ACEs across groups. Analyses were conducted in 2022. Results Stratification resulted in 30 distinct subgroups (e.g., bisexual Black females, straight multiracial males) with significant post hoc differences per group. Generally, those identifying as sexual minority individuals had the highest number of ACEs (the top 14 of 30 subgroups), whereas seven of the top ten subgroups were female. Surprisingly, no clear patterns emerged by race/ethnicity, although the two largest groups (straight White females and straight White males) were 27th and 28th of 30, respectively. Conclusions Although studies have examined ACEs by individual demographic variables, less is known about the extent to which ACEs are present in stratified subgroups. Sexual minority subgroups (particularly female bisexual subgroups) trend toward a higher number of ACEs, whereas heterosexual subgroups (regardless of sex) comprised the lowest 6 groups with respect to ACEs. Implications include further examination of bisexual and female subgroups (including specific ACE domain investigations) to identify the vulnerable population.

Firearms are a leading cause of paediatric mortality in the United States. This study examines the contributing factors of racial disparity and disproportionality among paediatric firearm decedents aged 0–17 years. We used the National Violent Death Reporting System (NVDRS) to assess the individual and incident-level circumstances of paediatric firearm homicides from 2014 to 2018 in 17 US states. Among 1085 paediatric firearm homicides, non-Hispanic blacks (NHB) died at a rate three times greater than their proportion in the general population; they were nine times as likely to die by firearm homicide as non-Hispanic whites (NHW). NHW children were more often the victims of firearm homicide perpetrated by a parent/caregiver, and of homicide-suicides. Violence interruption programmes among NHB youth, and family-based interventions among NHW youth may be effective in preventing firearm homicide and homicide-suicide. Systematic investigations into firearm homicide perpetrators are necessary to better understand observed racial disparities.

Ecological approaches to shared decision-making (SDM) are underexplored in women's reproductive health.The purpose was to identify ecological factors important to women in contraceptive and prenatal care SDM.In this cross-sectional study, women (18-45 years) living in Indiana who had sought reproductive healthcare completed an online survey (N=432).Multiple linear regression was utilized to identify predictors of SDM.Furthermore, exploratory factor analysis, confirmatory factor analysis, and structural equation modeling were conducted to explore ecological factors associated with SDM in contraception and prenatal care.Healthcare professional type was associated with decreased contraceptive SDM scores, but not prenatal care SDM scores.Access, social support, and patienthealthcare professional relationship demonstrated good global fit in confirmatory factor analysis.Path coefficients suggested significant relationships between these ecological factors and contraceptive and prenatal care SDM scores.Additionally, the ecological factors demonstrated good global fit for contraceptive and prenatal care SDM.Social support had a significant, strong, and inverse relationship with both contraceptive and prenatal care SDM in the models.Findings further SDM work by moving beyond option discussion and toward increased attention to women's contexts and relationships.Taking a holistic approach to SDM and the patient experience ensures that women's multi-faceted needs, influences, and preferences are met across healthcare settings.

BACKGROUND:TikTok is a popular social media platform that allows users to create and share content through short videos. It has become a place for everyday users, especially Generation Z users, to share experiences about their reproductive health. Owing to its growing popularity and easy accessibility, TikTok can help raise awareness for reproductive health issues as well as help destigmatize these conversations.OBJECTIVE:We aimed to identify and understand the visual, audio, and written components of content that TikTok users create about their reproductive health experiences.METHODS:A sampling framework was implemented to narrow down the analytic data set. The top 6 videos from each targeted hashtag (eg, #BirthControl, #MyBodyMyChoice, and #LoveYourself) were extracted biweekly for 16 weeks (July-November 2020). During data collection, we noted video characteristics such as captioning, music, likes, and cited sources. Qualitative content analysis was performed on the extracted videos.RESULTS:The top videos in each hashtag were consistent over time; for example, only 11 videos appeared in the top 6 category for #BirthControl throughout the data collection. Most videos fell into 2 primary categories: personal experiences and informational content. Among the personal experiences, people shared stories (eg, intrauterine device removal experiences), crafts (eg, painting their pill case), or humor (eg, celebrations of the arrival of their period). Dancing and demonstrations were commonly used in informational content.CONCLUSIONS:TikTok is used to share messages on myriad reproductive health topics. Understanding users' exposure provides important insights into their beliefs and knowledge of sexual and reproductive health. The study findings can be used to generate valuable information for teenagers and young adults, their health care providers, and their communities. Producing health messages that are both meaningful and accessible will contribute to the cocreation of critical health information for professional and personal use.

Managing personal and professional responsibilities may be challenging during the postpartum period, as employees navigate new roles, responsibilities, and family dynamics.The purpose of this paper was to understand the work/life balance experiences of diverse stakeholders and identify opportunities to improve the work environment.We conducted a series of in-depth focus groups with faculty, staff, and graduate students (n = 22), and in-depth interviews with administrators (n = 10) at a research-intensive university in the United States.A six-phase thematic analysis approach was used to examine the experiences and perspectives of individuals with different roles.Three themes with subsequent subthemes emerged: 1) employee role shapes perspectives on campus policies and practices; 2) confusion about policies exacerbates return-to-work issues; and 3) coworkers and supervisors are the primary sources of postpartum support in this workplace.Employees in our study expressed strong desires for clear, consistent institutional policies to ensure employees' postpartum return-to-work experiences were not dependent on informal arrangements with coworkers and supervisors.Faculty, staff, and graduate student postpartum needs are shaped by individual, interpersonal, and community factors.Clear communication between individuals who make policy decisions and those who are subject to the policies may reduce employee issues during the postpartum period.

Statement of Purpose Extension Educators within Cooperative Extension Offices are a promising partner in extending the reach of injury and violence prevention programs to rural areas, but they have been underutilized for public health efforts. Cooperative Extension is a partnership of the US Department of Agriculture, land-grant universities, and local extension offices. Translating academic research into community-based health education is central to its mission. The purpose of this study is to inform future partnerships with Extension Educators by understanding their current practices, assessing partnership feasibility, and identifying potential barriers and facilitators. Methods/Approach We conducted qualitative interviews with 10 Extension Educators in rural Indiana counties. Guided by the Consolidated Framework for Implementation Research, the interviews focused on characteristics of individual, Extension Office, and community factors that may influence future partnerships and chosen interventions. Results Overall, Extension Educators were enthusiastic about many aspects of partnerships with injury and violence researchers, including access to evidence-based programs, partnerships with new areas of health, and opportunities to collaborate on funded projects. However, many viewed unintentional injury outcomes as a low priority in their communities. Conclusion Although Extension Educators are uniquely positioned to increase the reach of injury and violence prevention efforts to rural areas, partnership efforts may be challenged by limited awareness of the impact of these outcomes in their local communities. Significance Although many injury and violence outcomes disproportionately impact rural communities, Extension Educators were less enthusiastic about these health outcomes compared with chronic disease. Education about the impact of injuries and violence on community health may be a critical step to developing partnerships.

Background Fatal drug overdoses are predominantly attributed to opioids. Women of childbearing age are among those at greatest risk, underscoring the need to understand the overlapping risk of fatal poisoning in children. Methods A retrospective analysis of fatal poisonings among decedents aged 0-9 years captured in the National Violent Death Reporting System (NVDRS) from 2012 to 2017 was employed. Poisonings were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes for poisonings (T36-T50, Y10-Y19), toxic effects of substances (T51-T65), and assault (X85-X90). The frequency and types of drugs involved in poisonings were derived from toxicological analysis. Logistic regression was used to model the odds of fatal poisoning by decedent and perpetrator characteristics. Qualitative content analysis was used to contextualize the patterns of fatal poisonings. Findings 1850 violent deaths were identified; 7% (n = 122) were poisoning-related, and 50% of these were attributed to opioids. Next, benzodiazepines (8%), amphetamines (7%), and antidepressants (5%) were most prevalent. Among poisoning-related deaths, 25% involved homicide-suicide. No differences in deaths were observed according to child race/ethnicity, and the risk of fatal poisoning decreased 6% with each year of child age. Following qualitative analysis, three unique categories of fatal poisoning emerged: "intentional administration without documented benign intent", "intentional administration with benign intent", and "unclear administration". Conclusion The high proportion of fatal poisonings in children attributed to opioids in this study suggests a need for universal dissemination and training of naloxone in households comprised of children living with parents experiencing, or in recovery for substance misuse. Findings also indicate a needed emphasis on safe storage practices and education to parents about the risk of prescription drug toxicity in children.

Context Community paramedicine programs (i.e., non-emergency preventive care by emergency medical services personnel under the direction of a physician) offer a novel approach to improve the wellbeing of families with a heightened risk of adverse childhood experiences (ACEs). Community paramedics provide acute medical care and long-term support services that address the underlying causes of ACEs. Program To participate, women must have characteristics that increase the likelihood of maternal or infant morbidity and mortality. Throughout pregnancy and the 16 weeks following birth, community paramedics make regular in-home visits to provide clinical care directed by the physician. Community paramedics also provide services to meet the complex needs of mothers and infants. Nearly all mothers receive transportation assistance, abusive head trauma prevention education, home safety inspections, and guidance on coping, among others. Community paramedics often provide referrals to partner services, such as mental health and substance abuse services or doula services, and some unconventional services, such as connecting women with free or low-cost infant supplies. (e.g., diapers, formula) or assistance finding employment. Evaluation As a new program, we first conducted a process evaluation. We interviewed community stakeholders and mothers, which we analyzed using content analysis. Both groups are happy with the current program and believe it meets a significant need in the community. Several mothers discussed specific ways the program reduced violence in the home. Learning Objectives To explain how developers considered the community needs and matched program components to these needs. To define and summarize several challenges and strengths of the program.

Workplaces are critical in suicide prevention because work-related factors can be associated with suicide, and because workplaces can be effective suicide prevention sites. Understanding the circumstances associated with work-related suicides can advance worksite prevention efforts. Data from the United States Centers for Disease Control and Prevention, National Violent Death Reporting System from 2013 to 2017 were used to examine characteristics and circumstances associated with work compared with non-work suicides. Work-related suicides included those indicated as work-related on the death certificate or in which the death investigation mentioned a work problem or work crisis. Of the 84,389 suicides, 12.1% had some relation to the decedent’s work. Males, those aged 21–54, and with at least a college education, were most likely to have work-related suicides. The circumstances most strongly associated with work-related suicide were financial problems (Odds Ratio (OR) = 4.7; 95% Confidence Interval (CI) = 4.5–5.0), prior depressed mood (OR = 2.4; 95% CI = 2.3–2.5), and eviction/loss of home (OR = 1.6; 95% CI = 1.4–1.7). Suicides among healthcare practitioners and management occupations had the highest odds of being work-related. Workplace wellness programs can consider incorporating services, such as financial planning and mental health services, as potentially up-stream approaches to prevent work-related suicide.

Introduction: Rural crashes result in fatality rates twice as high as urban, after accounting for vehicle miles traveled, and those involving farm vehicles tend to be the most severe. Farm vehicle crash interventions have focused on the farm equipment (e.g., lighting and marking) or the farm vehicle operator (e.g., training), despite crashes being most frequently caused by other vehicle driver actions. Community-based campaigns focused on rural drivers have potential to influence driver behavior. The objective of this study was to describe the role, formation, and lessons learned from a community advisory board (CAB) in the development and dissemination of a community-based rural roadway safety campaign. Methods: The CAB provided campaign input through quarterly meetings and email. The campaign had three main CAB and crash data-informed messages: 1) Slow Down, 2) Leave More Space, and 3) Avoid Passing. The CAB led campaign activities to publicize the message, distribute swag, and organize event logistics. To evaluate CAB effectiveness and inform future community engagement efforts, we conducted in-depth, semi-structured telephone interviews with CAB members in July 2020. Interviews were transcribed, coded, and codes were categorized into five main themes. Results: Overall, CAB membership was described as an overwhelmingly positive experience in terms of the CAB structure, culture fostered among the group, responsibilities, and time commitment. Board members reported successful campaign implementation, gave positive feedback regarding the research team's engagement efforts, and provided valuable recommendations for future campaigns (e.g., adding social media components, expansion of CAB age and industry diversity, and increasing group bonding activities). Conclusions: Results from this study demonstrate the instrumental role and logistics involved in engagement of community advisors for the development and implementation of a rural roadway safety campaign. Steps and lessons from this study can be applied to other community-level injury and violence prevention topics, with a particular focus on rural communities.

Approximately one in three women experience sexual abuse, which can result in negative reproductive health consequences. A history of sexual abuse may negatively impact health care seeking and experience. The purposes of this article were to understand how women perceived their sexual abuse experiences and how these experiences integrated into their overall reproductive health, reproductive planning, and health care access. As part of a larger study about women’s reproductive health, researchers analyzed 16 in-depth interviews with women aged 18 years and older (range = 18–78) living in South Carolina (May–November 2016). A constant comparative method of data analysis was completed to explore women’s sexual abuse experiences as they related to reproductive health and health care experiences. HyperRESEARCH 3.7.3 assisted in data organization and management. Limited bodily agency impacted women’s ability to engage in family planning, particularly when partners utilized sexual coercion to maintain desired relationships and attain desired family size, regardless of women’s preferences. In addition, limited sexual violence and abuse discussion in health care contexts impacted women’s autonomy in reproductive health decision-making despite participants’ desire to engage in these discussions with providers. Participants expressed a desire for communication about their sexual abuse experiences; however, results indicated women had to navigate stigma within families and communities, which deterred disclosure and open discussion. Negative health outcomes and desire to discuss these experiences within the health care context highlighted a need for patient–provider communication about sexual abuse history as one aspect of gynecologic care. Findings from this study offer practical recommendations to guide communication about sexual abuse within reproductive health care experiences to empower women in their reproductive health choices. As these experiences may impact overall health and reproductive choices, provider-initiated conversations with adolescents and women may improve care and assist in prevention efforts, including the prevention of negative health outcomes.

Objectives This study identifies the ecological (ie, policy, environment, intrapersonal, and interpersonal) factors affecting the implementation of an Infant at Work program in a university setting. Methods Data were collected among faculty, staff, and graduate students at a large Midwestern university from February to July 2020 via focus group (FG) discussions with university employees (n = 22) and semistructured interviews with university administrators (n = 10). We used techniques from expanded grounded theory, allowing for a constant comparative approach to data contextualization and theme identification. Results Three themes emerged from the FG data: (i) program and policy scope, (ii) employee and employer benefits, and (iii) workplace concerns. Onsite daycares, flexible schedules and participation, and expanded childcare options were some of the programs and policies employees desired. However, barriers to implementing these types of programs include cost, safety, and structure of the work environment. Conclusions Findings offer practical recommendations and strategies to improve work/life balance among parents transitioning back to work in a university environment. Findings also provide insight into the feasibility of family-friendly workplace policies and environments. Additionally, findings provide a framework for other organizations to implement similar Infant at Work programs to improve employee work/life balance.

Technology has evolved and will continue to evolve in both ways we will anticipate or not. The internet and mobile technology have provided new ways in which adolescents participate in and disseminate their participation in risky behaviors. Youtube, Facebook, Instagram, and Tumbler have created online platforms for displaying high-risk behaviors and receiving attention for the behaviors. The attention the adolescent received can increase their willingness to participate in other risky behaviors and continue to seek fame (and in some instances money). The current chapter provides an overview of theories of adolescent risk behavior, recent online/social media display of high-risk behaviors, and ways in which practitioners can intervene to support the youth that minimizes the need to engage in these behaviors. While the chapter provides examples of recent social media challenges, new challenges will develop over time. We argue that what will remain constant is our understanding of why they engage in these high-risk activities and what contributes to their willingness to display these online.