Is there consensus on child violence exposure measures? A study of six recommended instruments.

Background: International research has established that children and adolescents are at high risk for being exposed to violence. A systematic review published in 2023 recommended six child and adolescent self-report violence against children (VAC) measures, based on their psychometric properties, in a systematic COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) review. However, the degree of overlap and heterogeneity was not part of the analysis.Objective: To compare the six measures with respect to item overlap and differences concerning specification of exposure dimensions.Method: A content analysis of the original 174 items resulted in a reduction to 38 unique items. These items were organized visually in a co-occurrence circle using an adapted version of Fried's R code. Furthermore, a pairwise comparison of event lists was performed using the Jaccard index.Results: There was a modest overlap among the six measures. Only one item was present in all six measures, only two items were present in four measures, and 78% of the items were present in just one or two measures. The overall overlap between the six measures was 25%.Conclusions: The lack of overlap among measures reflects a heterogeneity of definitions and purposes. It also impedes progress in research, as comparisons between various studies are difficult to make in a valid and reliable way. The lack of consensus also delays efficient political initiatives, because solid, consensual knowledge about the prevalence of VAC does not exist.

Violence against children (VAC) is a high political and professional priority. A recent systematic review recommended six self-report measures based on their psychometric qualities.The VAC items were very diverse. A content analysis reduced the original 174 items to 38 unique items. A Jaccard index showed an overlap of 25%.The lack of consensus in definitions and applied measures impedes progress in research and delays important political, prophylactic initiatives.

School Violence Exposure as an Adverse Childhood Experience: Protocol for a Nationwide Study of Secondary Public Schools.

BACKGROUND: Poor mental health and adverse childhood experiences (ACEs) predict extensive adverse outcomes in youth, including increases in long-term risk for chronic disease and injury, impaired emotional development, and poor academic outcomes. Exposure to school violence, specifically intentional gun violence, is an increasingly prevalent ACE. The anticipation of school shootings has led to the implementation of school safety and security interventions that may increase anxiety, depression, and other indicators of poor mental well-being among students and staff alike. Despite this, the association between exposure to existing school safety interventions and early adolescent student mental health outcomes, while accounting for one's history of ACEs, has not been previously investigated. OBJECTIVE: The study protocol described here aims to determine whether there is a significant difference in the prevalence of mental health outcomes, perceived school safety, and academic engagement between adolescent students (grades 6-12) at schools who have experienced a school shooting and those who have not; whether existing interventions to promote school safety and security are associated with poor mental health outcomes among students and school staff; and what the strength of the association between school safety interventions and mental health outcomes among students and teachers is in schools that have experienced a school shooting versus schools that have never experienced a school shooting. METHODS: This observational study will collect cross-sectional survey data from a nationwide sample of students, teachers, and principals at 12 secondary public schools across the United States. The participants come from 6 randomly selected exposure schools that have either experienced a recent (<2 years ago) intentional school shooting or have experienced an intentional school shooting less recently (>2 years ago). Data from these schools are being directly compared with 6 secondary schools that have never experienced a school shooting. RESULTS: Institutional review board approval for this research project was obtained and the study subsequently began its recruitment and data collection phase in January 2024. Data collection is currently ongoing and the expected completion date is January 2025. The analytic plan is designed to determine if the strength of the association between school safety interventions and mental health outcomes differs among students and school staff in schools with varying levels of school violence exposure. Analyses will be used to evaluate the role of ACEs on the relationships among exposure to an intentional school shooting, exposure to school safety strategies, and student outcomes (ie, mental health and well-being, perceptions of school safety, and educational outcomes). CONCLUSIONS: The results from this study promise to generate meaningful and novel findings on the extent to which having a prior history of ACEs moderates the relationships among exposure to intentional school gun violence, school safety strategies, and student outcomes (ie, mental health and well-being, and perceptions of school safety). TRIAL REGISTRATION: ClinicalTrials.gov NCT06153316; https://clinicaltrials.gov/study/NCT06153316. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56249.

Levels of Nursing Students' Exposure to Colleague Violence and Affecting Factors: A Multicenter Cross-Sectional Study.

BACKGROUND: Colleague violence experiences of students negatively affect their vocational education in the short term and their desire to stay in the profession in the long term. This study aims to determine the levels of colleague violence experienced by nursing students and the affecting factors in Türkiye. METHODS: This study was conducted with second-, third-, and fourth-year nursing students (N = 703) from three state universities in three different provinces in Turkey. The data were collected using the "Student Information Form" and "The Scale of Exposure to Colleague Violence" with an online questionnaire. Descriptive statistics, the Independent Samples t-test, and the ANOVA test were employed for data analysis. RESULTS: students' total mean score on the scale was 46.72 ± 21.30. The "exposure to verbal/psychological violence" and "effect of violence on physical and mental health" subscales were 21.62 ± 10.09 and 25.10 ± 12.02, respectively. The most common reaction to the violence they were exposed to was "remain silent" (34.7%). CONCLUSIONS: nursing students were exposed to moderate levels of verbal/psychological colleague violence, and students' physical and mental health were moderately affected by this violence. Most students remained silent as a response to colleague violence. This study contributed to the emergence of factors that affect and are related to colleagues' violence. The results highlighted the need for programs that educate people about colleague violence and what should be done.

Exposure to community violence and parenting behaviors: A meta-analytic review.

This meta-analysis examines the association between exposure to community violence and parenting behaviors (i.e., positive parenting, harsh/neglectful parenting, parent-child relationship quality, and behavior control). A systematic search yielded 437 articles that measured community violence exposure before or at the time of parenting, assessed parenting, and were available in English. There were 342 effect sizes across parenting constructs: positive (k = 101; 68 studies), harsh/neglectful (k = 95; 60 studies), relationship quality (k = 68; 41 studies), and behavior control (k = 78; 51 studies), from 160 reports representing 147 distinct studies. Results of the three-level meta-analyses found small but significant effects between community violence and positive parenting (r = -.059, 95% CI [-.086, -.032]; 95% PI [-.268, .151]), harsh/neglectful parenting (r = .133, 95% CI [.100, .166]; 95% PI [-.107, .372]), parent-child relationship quality (r = -.106, 95% CI [-.145, -.067]; 95% PI [-.394, .182]), and behavior control (r = -.047, 95% CI [-.089, -.005]; 95% PI [-.331, .237]). The association between exposure to community violence and harsh/neglectful parenting and behavior control was moderated by the type of exposure to community violence, informant or source of community violence and parenting data, child age, sex, and race/ethnicity. Given the substantial degree of heterogeneity in overall effect sizes, implications for policy and intervention are tentatively considered while emphasizing that more empirical research on the association between community violence and parenting is essential for advancing the field. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Four-Wave Cross-Lagged Study of Exposure to Violent Contexts, Cognitive Distortions, and School Bullying during Adolescence.

School bullying represents a widespread expression of violence in the peer context. Guided by the social-ecological model, this study investigated the longitudinal and transactional pathways linking domestic and neighborhood/community violence exposure (through direct victimization and witnessing), self-serving cognitive distortions (CDs), and school bullying perpetration. Furthermore, consistent with the previous literature, we tested the cognitive desensitization process that could develop in response to chronically violent contexts. Two four-wave cross-lagged panel mediation models were tested in a sample of 778 high school students (28.1% males; Mage [Time 1; T1] = 14.20, SD = 0.58). The results showed differential effects of multiple contexts and forms of violence exposure, with domestic violence victimization and community violence witnessing being associated with self-serving CDs and bullying perpetration over time. Moreover, significant associations between CDs and bullying perpetration over time were found, with bidirectional effects for each of these longitudinal patterns. Finally, self-serving CDs significantly mediated the relationships between both domestic violence victimization and community violence witnessing and school bullying perpetration. These findings highlight the need to consider school bullying as a social phenomenon stemming from a complex and bidirectional interplay between individuals and the environments they inhabit, confirming a basic postulate that "violence breeds violence".

Neighborhood Racial Composition and Unequal Exposure to Violent Crime in Everyday Contexts.

Exposure to violence is a critical aspect of contemporary racial inequality in the United States. While extensive research has examined variations in violent crime rates across neighborhoods, less attention has been given to understanding individuals' everyday exposure to violent crimes. This study investigates patterns of exposure to violent crimes among neighborhood residents using cell phone mobility data and violent crime reports from Chicago. The analysis reveals a positive association between the proportion of Black residents in a neighborhood and the level of exposure to violent crimes experienced by residents. Controlling for a neighborhood's level of residential disadvantage and other neighborhood characteristics did not substantially diminish the relationship between racial composition and exposure to violent crimes in everyday life. Even after controlling for violence within residents' neighborhoods, individuals residing in Black neighborhoods continue to experience significantly higher levels of violence in their day-to-day contexts compared to those living in White neighborhoods. This suggests that racial segregation in everyday exposures, rather than residential segregation, plays a central role in racial inequality in exposure to violence. Additionally, the analysis suggests that neighborhoods with more Hispanic and Asian residents are exposed to less and more violent crime, respectively, compared to neighborhoods with more White residents. However, this is only observed when not adjusting for the volume of visits points of interest receive; otherwise, the finding is reversed. This study offers valuable insights into potentially novel sources of racial disparities in exposure to violent crimes in everyday contexts, highlighting the need for further investigation.

Mindless to Mindful Parenting? Videofeedback-Enhanced Psychotherapy for Violence-Exposed Mothers and Their Young Children.

This article presents a frequent dilemma of treatment-seeking mothers suffering from complex posttraumatic stress disorder (PTSD) that is related to exposure to maltreatment and other forms of interpersonal violence. Namely, that complex PTSD symptoms, including dissociative states in mothers that are triggered by normative child emotion dysregulation, aggression, and distress during early childhood, hinder the development of a productive psychotherapeutic process in more traditional psychodynamic psychotherapies for mothers and children. The article thus presents clinician-assisted videofeedback exposure (CAVE) that characterizes a recently manualized brief psychotherapy for this population, called CAVE-approach therapy (CAVEAT). CAVEAT can be used on its own or to preface a deeper process using child-parent psychotherapy or other non-videofeedback-enhanced psychodynamic models. A clinical illustration is provided.

Parenting practices as a buffer in the relationship between exposure to community violence and bullying in Mexican adolescents.

Multiple studies have shown that adolescents exposed to community violence are likely to engage in bullying behaviors. However, we still need to understand which variables can help reduce the influence of community violence exposure (CVE) on bullying. To investigate this question, a study was conducted with a sample of 568 Mexican adolescents, comprising 276 (48.6%) males and 292 (51.4%) females aged 12 to 16 years old (M age = 13.7 years, SD = 0.82). The study examined how parental support (PS) and parental induction to justice sensitivity (JS) can moderate the relationship between CVE and bullying. The study used structural equation modeling with latent variables. The results showed that CVE was positively associated with bullying, whereas PS and the induction to perpetrator JS were negatively associated. The moderation analysis suggests that the relationship between CVE and bullying was weaker among adolescents who received high PS. On the other hand, low and high parental induction to JS had the same moderating effect. Based on the findings, parental practices are critical when developing preventive programs to reduce the harmful effects of CVE on bullying behavior.

The link between exposure to violence and psychological distress among middle-aged Muslims in Israel: the role of gender.

Introduction: To date, it is still unclear if exposure to violence affects psychological distress in middle-aged adults and if the effects are gender specific. This age group is of special interest as it is at the onset of the aging process and is often overlooked or understudied in scholarly research. Specifically, targeted research on middle-aged Muslims living in Israel, a unique population exposed to increasing violence, is lacking. Methods: We examined the relationship between exposure to violence and psychological distress in a cohort of 363 middle-aged adults (223 women) from three Muslim villages in northern Israel, collecting data on violence exposure (Screen for Adolescent Violence Exposure (SAVE) questionnaire), psychological distress (Kessler 6 Psychological Distress questionnaire), and other demographic characteristics including education level and socioeconomic status. We used this data to answer two questions: (1) is exposure to violence a predictor of psychological distress in middle-aged Muslims, and (2) does the relationship between exposure and distress differ between men and women? Results: We revealed a positive link between exposure to violence and psychological distress (ß = 0.145, p = 0.017) when controlling for gender, age, education level, and socioeconomic level. Discussion: Despite previous evidence of gender-based differences in this interplay in younger cohorts, we did not find a significant interaction between gender and the violence exposure-psychological distress interplay. Our findings are some of the first to focus on middle-aged individuals and show that both men and women exhibit connections between exposure to violence and psychological distress when considering covariates. This research provides insights that can be used when planning community-wide interventions and treatment schemes to support healthy aging.

Childhood exposure to domestic violence: can global estimates on the scale of exposure be obtained using existing measures?

Purpose: Childhood exposure to domestic violence and abuse (DVA) can lead to major short- and long-term effects on the victim. Despite this, there is no accepted measure for children's experiences, with most existing measures being validated only in high income countries and not in low- and middle- income countries. As a result, international statistics are not comparable. This paper seeks to critically appraise existing measures and discuss whether any are fit-for-purpose on a global scale. Method: The COSMIN PROMs approach was followed to critically appraise and compare the appropriateness of measures. A comprehensive literature search was undertaken in seven journal databases for measures mentioned in formally peer-reviewed articles exploring childhood exposure to DVA. Results: A literature search resulted in the identification of 10 measures and, following criteria to only keep original measures and remove modifications, four measures which have been validated cross-culturally are discussed in detail in line with the COSMIN PROMs criterion: The Child Exposure to Domestic Violence Scale, Children's Perception of Interparental Conflict Scale, Juvenile Victimization Questionnaire and The Violence Exposure Scale for Children. Strengths and limitations of each are discussed, along with any validations undertaken not in the country of origin. Conclusion: Despite childhood exposure to DVA being an urgent research priority worldwide, the current measures to explore the extent of the issue are not validated cross-culturally, leading to concerns about comparisons across different population groups. The development and implementation of interventions to reduce the levels and effects of exposure relies heavily on cross-cultural comparisons, which may indicate different strategies are needed in different contexts. The lack of these validated comparisons is constraining advances, and the paper advocates for further efforts to be made in this regard.

Violence Exposure and Disability in Colombian Female Survivors of Intimate Partner Violence: the Mediating Role of Depressive Symptoms.

BACKGROUND: Violence is an important public health problem and one of the main causes of deaths worldwide. The mental health consequences of surviving intimate partner violence (IPV) include depression, anxiety and post-traumatic stress disorder. Previous studies have identified that there is a relationship between depression and level of disability in female survivors of IPV. Estimating the direct, indirect or total effect of an exposure on an outcome makes it possible to identify mediating effects between a group of variables. Detecting mediation effects is useful for identifying casual pathways that generate a final outcome and provides a rationale for designing interventions to target the mediator, which in turn positively affects the outcome. The objective was to identify the mediating role of depressive symptoms on the relationship between IPV and disability. METHODS: This was a cross-sectional study of 94 women over the age of 18 who were survivors of IPV by men. They were recruited from two public hospitals in Cali and Tuluá in southwest Colombia. An analysis of casual relationships was performed using structural equation modelling that was made up of: four exogenous observed variables (age, current relationship status [in a relationship or single], level of schooling, and history of an impairment), intermediate endogenous variables (violence and depressive symptoms), and the main endogenous variable (disability). The analyses were carried out in Stata14.2. RESULTS: The direct effect of IPV severity on the level of disability was not statistically significant (ß=0.09; P=0.63). However, the indirect effect of IPV severity on disability mediated by depressive symptoms was (ß=0.39; P<0.01). The total effect of IPV severity on the level of disability was even greater (ß=0.48; P=0.01). CONCLUSIONS: This study found a complete mediating role of depressive symptoms on the relationship between the severity of IPV and the level of disability for the female participants in this study. The results of this research contribute to defining strategies to prevent and address intimate partner violence, depressive symptoms and disability in this population.

Nursing students' exposure to violence in clinical practice and violence management competence levels.

INTRODUCTION: The violence nursing students experience in the clinic may affect their attitudes towards the profession. AIM: This study was conducted to determine nursing students' exposure to violence during their clinical practice and their violence management competence levels. DESIGN: This was a two-centred, descriptive, and correlational study. PARTICIPANTS: A total of 512 nursing students from two universities in Türkiye participated in this study. METHODS: The study data was collected between March and April 2023 with the Student Information Form, Violence Exposure Form, and Management of Workplace Violence Competence Scale for Nursing Students. Institutional permission and ethics committee approval were obtained before starting the study (Date: 05/01/2023, No: 50). Descriptive statistics, Mann-Whitney U test, Kruskal Wallis test and linear regression analysis were used to evaluate the data. Statistical significance was accepted as p < 0.05. RESULTS: It was determined that 17.4 % (n = 89) of the participant students felt competent in managing violence, and 94.3 % (n= 483) were concerned about being exposed to violence at various levels. In these results, 20.5 % (n = 105) of them were exposed to violence during clinical practice, 60.9 % (n = 64) of whom experienced verbal violence and 52.3 % (n = 55) psychological violence. The total mean score from the violence management competence scale was 103.29 ± 16.64. No statistically significant difference was found between the scale total and subscale scores according to gender (p > 0.05). The scale total scores of fourth-grade students with a good perceived academic success and who received training on coping with violence were statistically significantly higher (p˂0.05). The regression model created between the scale score and students' perceived academic success and receiving white code training (Training on the use of the alarm system that will enable security guards to reach the scene as soon as possible in cases where healthcare workers are exposed to all kinds of violence.) was statistically significant (F = 23.108, p < 0.001). CONCLUSION: Some of the students participating in the study experienced violence in clinical practices. Their violence management competence levels were good. It can be said that academic success, coping with violence, and white code training are useful in increasing competence levels.

The impact of acute violent videogame exposure on neurocognitive markers of empathic concern.

Research examining the purported association between violent gaming and aggression remains controversial due to concerns related to methodology, unclear neurocognitive mechanisms, and the failure to adequately consider the role of individual differences in susceptibility. To help address these concerns, we used fMRI and an emotional empathy task to examine whether acute and cumulative violent gaming exposure were associated with abnormalities in emotional empathy as a function of trait-empathy. Emotional empathy was targeted given its involvement in regulating not only aggression, but also other important social functions such as compassion and prosocial behaviour. We hypothesized that violent gaming exposure increases the risk of aberrant social behaviour by altering the aversive value of distress cues. Contrary to expectations, neither behavioural ratings nor empathy-related brain activity varied as a function of violent gaming exposure. Notably, however, activation patterns in somatosensory and motor cortices reflected an interaction between violent gaming exposure and trait empathy. Thus, our results are inconsistent with a straightforward relationship between violent gaming exposure and reduced empathy. Furthermore, they highlight the importance of considering both individual differences in susceptibility and other aspects of cognition related to social functioning to best inform public concern regarding safe gaming practices.

Firearm Violence Exposure and Functional Disability among Black Men and Women in the United States.

This study investigates the relationship between firearm violence exposure and functional health among Black adults in the United States (US). We examined associations between different forms of firearm violence exposure (direct, indirect, and community) and functional health with particular attention to differences across sex groups. We used survey data from a nationally representative sample of 3015 Black adult Americans to analyze associations between types of firearm violence exposure and four aspects of functional disability including: the ability to concentrate, walk/use stairs, dress/bathe, and run errands among males and females. The findings indicate notable disparities in exposure and health outcomes based on the exposure type and cumulative exposure to violence. Among males, functional disability was associated most closely with community violence exposure, while direct threats of firearm violence were most consequential for functional health among females. High cumulative exposure to firearm violence was linked to significant risks to functional health, particularly among females. The results shed light on sex differences in the repercussions of firearm violence exposure and emphasize its implications for daily functioning and health. This study contributes to the understanding of the multifaceted impacts of firearm violence on functional well-being and highlights the need for inclusive and culturally sensitive healing approaches based in community settings. There is a critical need for heightened awareness and strategies to enhance the well-being of those disproportionately affected by firearm violence in the US.

Patterns of intimate partner violence exposure across the first 10 years of life and children's emotional-behavioural outcomes at 10 years.

BACKGROUND: Childhood exposure to intimate partner violence (IPV) is associated with emotional-behavioural problems. However, little is known about children's emotional-behavioural outcomes following exposure to different long-term patterns of IPV. OBJECTIVE: The current study aimed to investigate the emotional-behavioural functioning of children at 10 years of age following exposure to different patterns of IPV across the first 10 years of life. PARTICIPANTS AND SETTING: Data for this study was drawn from the Mothers' and Young People's Study- a longitudinal study of 1507 first time mothers and their first born child. METHODS: Women were recruited during pregnancy from six public hospitals in Victoria, Australia. Data was collected during pregnancy, and at one, four and ten years postpartum. Four patterns of IPV exposure were previously identified: (a) minimal IPV exposure; (b) early IPV; (c) Increasing IPV; and (d) persistent IPV. Logistic regression was used to assess associations between IPV exposure and emotional-behavioural outcomes. RESULTS: Exposure to early, increasing, or persistent IPV was associated with increased odds of experiencing emotional-behavioural difficulties (OR 2.15-2.97). Children exposed to a persistent pattern of IPV experienced over 6 times the odds of conduct problems (OR = 6.15 CI = 2.3-16.44). CONCLUSIONS: Children exposed to early, increasing, or persistent IPV experienced increased odds of emotional-behavioural problems at age 10, regardless of the duration or type of violence they were exposed to. However, children exposed to persistent IPV across childhood appeared to experience the highest odds of emotional-behavioural difficulties.

Violence Exposure and Trauma Screener for Youth (VETSY).

BACKGROUND: Youth exposed to violence are at serious risk for physical, emotional, behavioral, and mental distress. Reliable and prompt detection is necessary to mitigate the psychological consequences of youth violence exposure and trauma. OBJECTIVE: To describe the initial creation of the VETSY screener and its construct validity and potential use. METHODS: From 2014 through 2022 we surveyed 20,532 at-risk youth aged 8-18 years from a diverse metropolitan community participating in the Defending Childhood Initiative (DCI). Youth completed a 17-item self-report screener. An Exploratory Factor Analysis (EFA) was used to determine the reliability and variable grouping for this brief screener. Violence exposure, violent behaviors, and trauma symptoms were assessed. Responses were evaluated based on youth demographics. A potential cutoff score meriting further assessment and intervention was established. RESULTS: Sixty-seven percent of youth reported at least one type of violence exposure within the last year, 55 % reported perpetrating at least one type of violent behavior, and 68 % of youth reported at least one trauma symptom. An Exploratory Factor Analysis (EFA) with a geomin (oblique) rotation was applied and yielded a three-factor model with high loadings and acceptable fit for violence exposure, violent behaviors, and trauma symptoms. Additional analyses showed the screener structure was the same across sex, race and age groups. CONCLUSIONS: The use of the brief screener to quickly and reliably assess violence exposure, violent behaviors, and trauma symptoms among youth provides an opportunity for mental health providers to detect and refer at-risk youth for additional assessment and treatment.

Understanding adverse childhood experiences and the call for trauma-informed healthcare system in Turkey: a review.

Over the past four decades, research has underscored the significance of approaching and preventing trauma from a systemic standpoint. Trauma-informed care (TIC) methodologies offer a structure for healthcare practices, striving to convert organizations into trauma-informed systems that employ trauma-specific interventions. This review employs epidemiological and household data from Turkey to underscore the importance of integrating trauma-informed care as a means of prevention and intervention. Through a desk review, the study examines the role of adverse childhood experiences (ACEs), delving into their origin from family dynamics, migration, violence, exposure to violence, juvenile delinquency, and child maltreatment. The research highlights innovative healthcare approaches that leverage data to address complex patient health issues while considering mental health needs. In contemporary times, healthcare organizations acknowledge the value of a data-driven approach to make informed clinical decisions, enhance treatment procedures, and improve overall healthcare outcomes. The reviewed research and empirical data furnish proof of the importance of effective and efficient treatment methods that prioritize trauma prevention and treatment, integrating the role of ACEs. This paper seeks to contribute to discussions on transforming the healthcare system to meet the healthcare needs of Turkish households, all the while taking into account the evolving sociopolitical factors that shape Turkey's population characteristics.

Spatial spillovers of violent conflict amplify the impacts of climate variability on malaria risk in sub-Saharan Africa.

Africa carries a disproportionately high share of the global malaria burden, accounting for 94% of malaria cases and deaths worldwide in 2019. It is also a politically unstable region and the most vulnerable continent to climate change in recent decades. Knowledge about the modifying impacts of violent conflict on climate-malaria relationships remains limited. Here, we quantify the associations between violent conflict, climate variability, and malaria risk in sub-Saharan Africa using health surveys from 128,326 individuals, historical climate data, and 17,429 recorded violent conflicts from 2006 to 2017. We observe that spatial spillovers of violent conflict (SSVCs) have spatially distant effects on malaria risk. Malaria risk induced by SSVCs within 50 to 100 km from the households gradually increases from 0.1% (not significant, P>0.05) to 6.5% (95% CI: 0 to 13.0%). SSVCs significantly promote malaria risk within the average 20.1 to 26.9 °C range. At the 12-mo mean temperature of 22.5 °C, conflict deaths have the largest impact on malaria risk, with an approximately 5.8% increase (95% CI: 1.0 to 11.0%). Additionally, a pronounced association between SSVCs and malaria risk exists in the regions with 9.2 wet days per month. The results reveal that SSVCs increase population exposure to harsh environments, amplifying the effect of warm temperature and persistent precipitation on malaria transmission. Violent conflict therefore poses a substantial barrier to mosquito control and malaria elimination efforts in sub-Saharan Africa. Our findings support effective targeting of treatment programs and vector control activities in conflict-affected regions with a high malaria risk.

The long-term association between exposure to wartime bombing earlier in life and post-traumatic stress later in life among today's older Vietnamese population.

This analysis examines the relationship between exposure to American wartime bombardments earlier in life and later-life PTSD among current surviving Vietnamese aged 59+. It also assesses whether the relationship varies by military status during the war - formal military, informal military, or civilian - and whether associations are explained by exposure to violence and malevolent conditions. Data link survey responses from the 2018 Vietnam Health and Aging Study to provincial-wide level bombing intensity using U.S. Department of Defense records from the Theater History of Operations Vietnam database. PTSD measured using nine items from the PTSD Checklist. Analyses employ multivariate logistic quantile regression. Findings examined for a sample of 2290 Vietnamese survivors and a subsample of 736 Vietnamese that moved at least once during wartime. Results show a robust and significant positive association between province-wide bombing intensity and later-life PTSD scores. Interaction effects indicate civilians have overall lower levels of PTSD than those that were in the formal or informal military, but the association between bombing and PTSD is stronger among civilians. Much of the association is a function of exposure to violence and less is a function of exposure to malevolent conditions. Findings confirm earlier studies that have shown severe deleterious impacts of war trauma, and arial bombardments particularly, on long-term psychological health, while extending extant literature to civilian populations living in Vietnam during intense aerial bombing episodes.

Cash Transfers and After-School Programs: A Randomized Controlled Trial for Young Men at Risk of Violence Exposure in Wilmington, Delaware.

We conducted a randomized controlled trial to determine whether an after-school program paired with a cash transfer (a conditional cash transfer) or a cash transfer alone (an unconditional cash transfer) can help improve health and economic outcomes for young men between the ages of 14 and 17 whose parents have low incomes and who live in neighborhoods with high crime rates. We find that receiving the cash transfer alone was associated with an increase in healthy behaviors (one of our primary outcome composite measures) and that the cash transfer paired with after-school programming was associated with an improvement in the financial health of participants (one of our secondary outcome composite measures). We find no differences in spending on alcohol, marijuana, cigarettes, or other drugs between either the treatment group and the control group. Neither the cash transfer alone nor the programming plus cash transfer had statistically significant effects on our other primary composite measures (physical and mental health or school attendance and disciplinary actions), or our other secondary composite measures (criminal justice engagement or social supports) but in most cases, confidence intervals were too large to rule out meaningful effects. Results suggest that cash transfers hold promise to improve the health of youth without any indication of any adverse effects.