Longitudinal Patterns of Electronic Teen Dating Violence Among Middle School Students.

We investigated rates and developmental trends of electronic teen dating violence (TDV) perpetration and victimization overall and by gender. Data were collected from a single cohort of seventh-grade students from four schools using paper-and-pencil surveys administered at 6-month intervals (N = 795). Data were analyzed with descriptive statistics and longitudinal growth models to estimate change over time in TDV. Overall, 32% of youth reported electronic TDV perpetration, and 51% reported electronic TDV victimization. Victimization was more prevalent for boys (42%) than for girls (31%) at baseline only (t = 2.55, p < .05). Perpetration did not differ at any wave. Perpetration and victimization each decreased significantly from the beginning of seventh grade to the end of eighth grade, ß = -.129 (.058), p < .05, for perpetration, and ß = -.138 (.048), p < .01, for victimization. Gender moderated the decrease in reported victimization, with simple slopes indicating girls showed almost no change in victimization, ß = .006 (.066), ns, whereas boys decreased significantly over the 2 years, ß = -.292 (.069), p < .001. Although moderation by gender of change in perpetration was not conventionally significant, the simple slopes revealed that girls again showed a nonsignificant change in TDV across seventh and eighth grades, ß = -.067 (.078), ns, whereas boys showed a significant decline in reported electronic TDV perpetration, ß = -.197 (.083), p < .05. The high prevalence of electronic TDV underscore the need for addressing these behaviors within TDV prevention interventions.

Implementers' Perspectives on Fidelity of Implementation.

Fidelity of implementation is an essential factor in realizing outcomes of evidence-based interventions. Yet perspectives vary on the degree to which fidelity is necessary or desirable, implementers may receive limited guidance on fidelity, and research on implementers' understanding and operationalization of fidelity is lacking. We conducted key informant interviews with 20 individuals who implemented an evidence-based teen dating violence prevention curriculum in seven sites. Interviews addressed how implementers defined fidelity and the adaptations they made in implementing the curriculum. Although all implementers reported delivering the curriculum with fidelity, their definitions of fidelity varied. Most defined fidelity in terms of adherence to the published curriculum, although definitions sometimes allowed modifications of pedagogy or adding or subtracting materials. A smaller group of implementers defined fidelity in terms of their perceptions of the curriculum's core messages. All implementers described variations from the published curriculum, which were frequently inconsistent with their own definitions of fidelity. Implementers committed to the value of implementation with fidelity may need support in its definition and application. Developers can support implementers by communicating program theory in terms that implementers will understand, clarifying expectations for fidelity and allowable adaptations, and codifying lessons learned from previous implementation.

Evaluation of the Start Strong initiative: preventing teen dating violence and promoting healthy relationships among middle school students.

PURPOSE: This study reports on an independent evaluation of Start Strong: Building Healthy Teen Relationships, a multicomponent initiative targeting 11- to 14-year-olds. "Start Strong" was designed to focus on the developmental needs of middle school students and to enhance skills and attitudes consistent with promotion of healthy relationships and reduction of teen dating violence (TDV). METHODS: The quasi-experimental evaluation design included data collection from four Start Strong schools and four comparison schools. Student surveys were collected at four waves of data at the beginning and the end of grades 7 and 8. Multilevel models used repeated observations nested within students who were, in turn, nested within schools to determine whether participation in Start Strong enhanced healthy skills and relationships and decreased TDV-related attitudes and behaviors. RESULTS: Short-term effects from waves 1 to 2 were statistically significant for increased parent-child communication and boy/girlfriend relationship satisfaction and support and decreased gender stereotypes and attitudes supporting TDV. Findings for acceptance of TDV and gender stereotypes persisted longitudinally. CONCLUSIONS: Results are promising and illustrate that a multicomponent, community-based initiative reduced risk factors predictive of TDV. Start Strong is innovative in its focus on early adolescence, which is a critical period in the transition to dating. The results inform future intervention efforts and underscore the need for further study of middle school students.

A latent transition model of the effects of a teen dating violence prevention initiative.

PURPOSE: Patterns of physical and psychological teen dating violence (TDV) perpetration, victimization, and related behaviors were examined with data from the evaluation of the Start Strong: Building Healthy Teen Relationships initiative, a dating violence primary prevention program targeting middle school students. METHODS: Latent class and latent transition models were used to estimate distinct patterns of TDV and related behaviors of bullying and sexual harassment in seventh grade students at baseline and to estimate transition probabilities from one pattern of behavior to another at the 1-year follow-up. Intervention effects were estimated by conditioning transitions on exposure to Start Strong. RESULTS: Latent class analyses suggested four classes best captured patterns of these interrelated behaviors. Classes were characterized by elevated perpetration and victimization on most behaviors (the multiproblem class), bullying perpetration/victimization and sexual harassment victimization (the bully-harassment victimization class), bullying perpetration/victimization and psychological TDV victimization (bully-psychological victimization), and experience of bully victimization (bully victimization). Latent transition models indicated greater stability of class membership in the comparison group. Intervention students were less likely to transition to the most problematic pattern and more likely to transition to the least problem class. CONCLUSIONS: Although Start Strong has not been found to significantly change TDV, alternative evaluation models may find important differences. Latent transition analysis models suggest positive intervention impact, especially for the transitions at the most and the least positive end of the spectrum.

Dating violence, bullying, and sexual harassment: longitudinal profiles and transitions over time.

Although there is growing recognition of the problem of dating violence, little is known about how it unfolds among young adolescents who are just beginning to date. This study examined classes (subgroups) and transitions between classes over three time points based on dating violence, bullying, and sexual harassment perpetration and victimization experienced by youth. The sample was ethnically diverse, consisting of 795 seventh-grade students from schools that were part of a multi-site, longitudinal evaluation of a dating violence initiative (50 % female; 27 % White, 32 % African American, 25 % Latino, 16 % other or multiple races). Results from latent transition analyses revealed five classes of students with distinct behavioral profiles: multi-problem (victimization and perpetration), bullying and sexual harassment (victimization and perpetration), bullying (victimization and perpetration) and sexual harassment (victimization only), bullying (victimization and perpetration), and a least problem group. The majority of classes were characterized by reports of both perpetration and victimization for at least one behavior. Girls were more likely to be in the less problematic classes. Class membership was fairly stable across the three time points. When students transitioned to a different class, the shift was most often from a more problematic to a less problematic class, particularly for girls. The findings support understanding dating violence within a dynamic, developmental process that recognizes related behaviors within and across individuals. Overall, the findings highlight the utility of person-oriented approaches to enhance our understanding of longitudinal profiles and transitions over time for dating violence and related behaviors.

Interpersonal conflict and referrals to counseling among married soldiers following return from deployment.

Deployment represents a significant potential strain on military families. The impact of postdeployment stresses may be increased if family coping resources are diminished by returning service members' physical injuries, mental health issues, or substance abuse. This article examines the health and mental health correlates of self-reported concerns regarding interpersonal conflict among married soldiers following return from deployment and the likelihood that soldiers acknowledging such concerns are referred to counseling services. Among 20,166 married Army soldiers completing Post-Deployment Health Reassessments, 18% reported having experienced serious interpersonal conflict with their spouse, family members, close friends, or coworkers. Results indicate that interpersonal conflict was more common among those who reported health problems, depression, post-traumatic stress disorder, and alcohol abuse. Among soldiers reporting interpersonal conflict and not already receiving services, 11% were referred to service. Findings support the need to communicate with soldiers and their spouses about the availability of services following return from deployment and to continue efforts to reduce stigma associated with seeking treatment.

Public health efforts to build a surveillance system for child maltreatment mortality: lessons learned for stakeholder engagement.

CONTEXT: Reducing the number of largely preventable and tragic deaths due to child maltreatment (CM) requires an understanding of the magnitude of and risk factors for fatal CM and targeted research, policy, and prevention efforts. Public health surveillance offers an opportunity to improve our understanding of the problem of CM. In 2006, the Centers for Disease Control and Prevention (CDC) funded state public health agencies in California, Michigan, and Oregon to implement a model approach for routine and sustainable CM surveillance and evaluated the experience of those efforts. OBJECTIVE: We describe the experiences of 3 state health agencies in building collaborations and partnerships with multiple stakeholders for CM surveillance. DESIGN: Qualitative, structured key informant interviews were carried out during site visits as part of an evaluation of a CDC-funded project to implement a model approach to CM surveillance. PARTICIPANTS: Key informants included system stakeholders from state health agencies, law enforcement, child protective services, the medical community, and child welfare advocacy groups in the 3 funded states. RESULTS: Factors that facilitated stakeholder engagement for CM surveillance included the following: streamlining and coordinating the work of Child Death Review Teams (CDRTs); demonstrating the value of surveillance to non-public health partners; codifying relationships with participating agencies; and securing the commitment of decision-makers. Legislative mandates were helpful in bringing key stakeholders together, but it was not sufficient to ensure sustained engagement. CONCLUSIONS: The engagement process yielded multiple benefits for the stakeholders including a deeper appreciation of the complexity of defining CM; a greater understanding of risk factors for CM; and enhanced guidance for prevention and control efforts. States considering or currently undertaking CM surveillance can glean useful insights from the experiences of these 3 states and apply them to their own efforts to engage stakeholders.

Substance use by soldiers who abuse their spouses.

Data on 7,424 soldier spouse abuse offenders were analyzed to determine the prevalence of substance use during abusive incidents, and to examine differences between substance-using and non-substance-using offenders. Results showed that 25% of all offenders used substances during abusive incidents, with males and non-Hispanic Whites being more likely to hav e used substances. Substance-using offenders were more likely to perpetrate physical spouse abuse and more severe spouse abuse. These findings underscore the importance of educating military personnel (including commanders) about links between substance use and domestic violence, and of coordinating preventive and therapeutic substance abuse and violence-related interventions.

The impact of child maltreatment and intimate partner violence surveillance initiatives.

Child maltreatment (CM) and intimate partner violence (IPV) take a tremendous toll on communities around the world. Despite the impact of CM and IPV, data on their incidence are drawn from disparate sources of varying quality. To improve data resources in these areas, the Centers for Disease Control and Prevention's (CDC) Division of Violence Prevention funded state-based IPV and CM surveillance activities in nine states between 1994 and 2005. This article describes reported outcomes of these surveillance programmes; assesses factors affecting their sustainability; and provides recommendations for similar programmes through document review and interviews with state representatives. Findings indicate that states achieved outcomes with these surveillance initiatives; however, states noted concerns with sustaining systems because of a lack of resources and ineffective collaborations. Highlighted in this article are several lessons that other countries can learn from the experiences of these states in testing CM and IPV surveillance systems.

Behavioral predictors of weight regain after bariatric surgery.

BACKGROUND: After bariatric surgery, a lifelong threat of weight regain remains. Behavior influences are believed to play a modulating role in this problem. Accordingly, we sought to identify these predictors in patients with extreme obesity after Roux-en-Y gastric bypass (RYGB). METHODS: In a large tertiary hospital with an established bariatric program, including a multidisciplinary outpatient center specializing in bariatric medicine, with two bariatric surgeons, we mailed a survey to 1,117 patients after RYGB. Of these, 203 (24.8%) were completed, returned, and suitable for analysis. Respondents were excluded if they were less than 1 year after RYGB. Baseline demographic history, preoperative Beck Depression Inventory (BDI), and Brief Symptom Inventory-18 scores were abstracted from the subjects' medical records; pre- and postoperative well-being scores were compared. RESULTS: Of the study population, mean age was 50.6 +/- 9.8 years, 147 (85%) were female, and 42 (18%) were male. Preoperative weight was 134.1 +/- 23.6 kg (295 +/- 52 lb) and 170.0 +/- 29.1 kg (374.0 +/- 64.0 lb) for females and males, respectively, p < 0.0001. The mean follow-up after bariatric surgery was 28.1 +/- 18.9 months. Overall, the mean pre- versus postoperative well-being scores improved from 3.7 to 4.2, on a five-point Likert scale, p = 0.001. A total of 160 of the 203 respondents (79%) reported some weight regain from the nadir. Of those who reported weight regain, 30 (15%) experienced significant regain defined as an increase of > or =15% from the nadir. Independent predictors of significant weight regain were increased food urges (odds ratios (OR) = 5.10, 95% CI 1.83-14.29, p = 0.002), severely decreased postoperative well-being (OR = 21.5, 95% CI 2.50-183.10, p < 0.0001), and concerns over alcohol or drug use (OR = 12.74, 95% CI 1.73-93.80, p = 0.01). Higher BDI scores were associated with lesser risk of significant weight regain (OR = 0.94 for each unit increase, 95% CI 0.91- 0.98, p = 0.001). Subjects who engaged in self-monitoring were less likely to regain any weight following bariatric surgery (OR = 0.54, 95% CI 0.30-0.98, p = 0.01). Although the frequency of postoperative follow-up visits was inversely related to weight regain, this variable was not statistically significant in the multivariate model. CONCLUSIONS: Predictors of significant postoperative weight regain after bariatric surgery include indicators of baseline increased food urges, decreased well-being, and concerns over addictive behaviors. Postoperative self-monitoring behaviors are strongly associated with freedom from regain. These data suggest that weight regain can be anticipated, in part, during the preoperative evaluation and potentially reduced with self-monitoring strategies after RYGB.

Male soldier family violence offenders: spouse and child offenders compared to child offenders.

Army data from 2000 to 2004 were used to compare two groups of married, male, Army soldier, first-time family violence offenders: 760 dual offenders (whose initial incident included both child maltreatment and spouse abuse) and 2,209 single offenders (whose initial incident included only child maltreatment). The majority (81%) of dual offenders perpetrated physical spouse abuse; however, dual offenders were less likely than single offenders to perpetrate physical child abuse (16% vs. 42%) or sexual child abuse (1% vs. 11%), but they were more likely to perpetrate emotional child abuse (45% vs. 12%). These findings may be, at least in part, explained in light of the Army Family Advocacy Program policy, which considers spouse offenders as also being emotional child abuse offenders since children may be traumatized by exposure to spouse abuse.

Empowerment evaluation with programs designed to prevent first-time male perpetration of sexual violence.

This special issue captures several threads in the ongoing evolution of sexual violence prevention. The articles that follow examine an empowerment evaluation process with four promising programs dedicated to preventing first-time male perpetration of sexual violence, as well as evaluation findings. Both the evaluation approach and the programs examined shed light on how sexual violence prevention can continue to be improved in the future.

Factors contributing to the effectiveness of four school-based sexual violence interventions.

This study extends past research by examining factors associated with changes in attitudes, knowledge, and intended behaviors related to sexual assault. This study included 1,182 participants from four unique multiple-session school-based sexual violence interventions. Implementation and participant factors examined include single- versus mixed-gender groups, group setting versus classroom lecture setting, and participant gender. Participants completed self-administered, paper-and-pencil pre- and postsurveys. A significant desired overall effect was found on participants' reports of positive attitudes, beliefs, and behavior regarding sexual harassment and personal boundaries and positive dating relationship norms (from pretest to posttest). There were steeper increases over time in both measures, with larger mixed-gender/single-gender differences among boys than among girls. Differences in the impact of participating in mixed- versus single-gender groups depended on classroom versus small group settings. The implications of these findings are discussed for sexual assault prevention programs.

Empowering programs with evaluation technical assistance: outcomes and lessons learned.

Although empowerment evaluation has gained widespread currency, few reports have described its outcomes. This article combines perspectives of participants and technical assistance providers to describe the process and outcomes of the Evaluation Assistance for Sexual Violence Programs project. Participating programs reported substantial enhancements in evaluation capacity, resources devoted to evaluation, and the extent and sophistication of their evaluation practice, as well as numerous examples of the application of evaluation findings to program improvement. Experiences from evaluation technical assistance providers identified aspects of the process that were particularly useful in achieving these outcomes, including investing in collaborative relationships, maximizing participation among program staff, tailoring the content and form of technical assistance to program preferences, and combining structured learning with program-specific technical assistance.

Occurrence of maltreatment in active duty military and nonmilitary families in the State of Texas.

This study compared the occurrence of child maltreatment in military and nonmilitary populations. Data came from the National Child Abuse and Neglect Data System. All cases of child maltreatment substantiated from January 1, 2000 through December 31, 2002, in the state of Texas were analyzed. The rate of occurrence of substantiated maltreatment was lower for children in military families compared with children in nonmilitary families (5.05 vs. 7.89 per 1000 person-years). A greater proportion of caretakers of children in nonmilitary families compared with military families reportedly had financial problems (18.7% vs. 5.2%) and received public assistance (28.2% vs. 8.9%). The rate of occurrence of substantiated child maltreatment appears to be lower in military than nonmilitary families. The proportion of families with financial problems and public assistance is lower in military than nonmilitary families, suggesting that these factors may increase stress in families and the risk of maltreatment.

Child maltreatment and substance abuse among U.S. Army soldiers.

Although substance abuse has consistently been linked to child maltreatment, no study to date has described the extent of substance abuse among child maltreatment offenders within the military. Analysis of U.S. Army data on all substantiated incidents of parental child maltreatment committed between 2000 and 2004 by active duty soldiers found that 13% of offenders were noted to have been abusing alcohol or illicit drugs at the time of their child maltreatment incident. The odds of substance abuse were increased for offenders who committed child neglect or emotional abuse, but were reduced for child physical abuse. The odds of offender substance abuse nearly tripled in child maltreatment incidents that also involved co-occurring spouse abuse. Findings include a lack of association between offender substance abuse and child maltreatment recurrence, possibly because of the increased likelihood of removal of offenders from the home when either substance abuse or spouse abuse were documented.

Child maltreatment in enlisted soldiers' families during combat-related deployments.

CONTEXT: Parental stress is believed to play a critical role in child maltreatment, and deployment is often stressful for military families. OBJECTIVE: To examine the association between combat-related deployment and rates of child maltreatment in families of enlisted soldiers in the US Army who had 1 or more substantiated reports of child maltreatment. DESIGN AND SETTING: Descriptive case series of substantiated incidents of parental child maltreatment in 1771 families of enlisted US Army soldiers who experienced at least 1 combat deployment between September 2001 and December 2004. MAIN OUTCOME MEASURES: Conditional Poisson regression models were used to estimate rate ratios (RRs) that compare rates of substantiated child maltreatment incidents during periods of deployment and nondeployment. RESULTS: A total of 1858 parents in 1771 different families maltreated their children. In these families, the overall rate of child maltreatment was higher during the times when the soldier-parents were deployed compared with the times when they were not deployed (942 incidents and 713 626 days at risk during deployments vs 2392 incidents and 2.6 million days at risk during nondeployment; RR, 1.42 [95% confidence interval {CI}, 1.31-1.54]). During deployment, the rates of moderate or severe maltreatment also were elevated (638 incidents and 447 647 days at risk during deployments vs 1421 incidents and 1.6 million days at risk during nondeployment; RR, 1.61 [95% CI, 1.45-1.77]). The rates of child neglect were nearly twice as great during deployment (761 incidents and 470 657 days at risk during deployments vs 1407 incidents and 1.6 million days at risk during nondeployment; RR, 1.95 [95% CI, 1.77-2.14]); however, the rate of physical abuse was less during deployments (97 incidents and 80 033 days at risk during deployments vs 451 incidents and 318 326 days at risk during nondeployment; RR, 0.76 [95% CI, 0.58-0.93]). Among female civilian spouses, the rate of maltreatment during deployment was more than 3 times greater (783 incidents and 382 480 days at risk during deployments vs 832 incidents and 1.2 million days at risk during nondeployment; RR, 3.33 [95% CI, 2.98-3.67]), the rate of child neglect was almost 4 times greater (666 incidents and 303 555 days at risk during deployments vs 605 incidents and 967 362 days at risk during nondeployment; RR, 3.88 [95% CI, 3.43-4.34]), and the rate of physical abuse was nearly twice as great (73 incidents and 18 316 days at risk during deployments vs 141 incidents and 61 105 days at risk during nondeployment; RR, 1.91 [95% CI, 1.33-2.49]). CONCLUSIONS: Among families of enlisted soldiers in the US Army with substantiated reports of child maltreatment, rates of maltreatment are greater when the soldiers are on combat-related deployments. Enhanced support services may be needed for military families during periods of increased stress.

Effect of deployment on the occurrence of child maltreatment in military and nonmilitary families.

War has a profound emotional impact on military personnel and their families, but little is known about how deployment-related stress impacts the occurrence of child maltreatment in military families. This time-series analysis of Texas child maltreatment data from 2000 to 2003 examined changes in the occurrence of child maltreatment in military and nonmilitary families over time and the impact of recent deployment increases. The rate of occurrence of substantiated maltreatment in military families was twice as high in the period after October 2002 (the 1-year anniversary of the September 11th attacks) compared with the period prior to that date (rate ratio = 2.15, 95% confidence interval: 1.85, 2.50). Among military personnel with at least one dependent, the rate of child maltreatment in military families increased by approximately 30% for each 1% increase in the percentage of active duty personnel departing to (rate ratio = 1.28, 95% confidence interval: 1.20, 1.37) or returning from (rate ratio = 1.31, 95% confidence interval: 1.16, 1.48) operation-related deployment. These findings indicate that both departures to and returns from operational deployment impose stresses on military families and likely increase the rate of child maltreatment. Intervention programs should be implemented to mitigate family dysfunction in times of potential stress.

Family violence in the military: a review of the literature.

Family violence, including both child maltreatment and spouse abuse, is a public health concern in both military and civilian populations. However, there is limited knowledge concerning violence in military families relative to civilian families. This literature review critically reviews studies that examine child maltreatment and spouse abuse among military families and compares family violence in military versus nonmilitary populations. Physical abuse and neglect compose the majority of the reported and substantiated cases of child maltreatment in military families, followed by sexual abuse and emotional abuse. On the other hand, physical abuse represents more than 90% of all substantiated cases of spouse abuse in military families, followed by emotional abuse, neglect, and sexual abuse. Mixed results were found when comparing military and nonmilitary families in terms of child maltreatment and spouse abuse, in part because of a lack of consistency in policies and practices between military and civilian agencies.