Prevalence of Technology-Facilitated Abuse Among Sexual and Gender Minority Youths.

Importance: Digital communication and imaging technologies have created new opportunities for technology-facilitated abuse (TFA) and necessitate a better understanding of how and why the risk for TFA varies across different groups of youths. Objectives: To compare the prevalence of TFA among youths across 5 different sexual and gender identity groups, and to identify risk factors that may explain variations in TFA risk. Design, Setting, and Participants: A US nationally representative online survey was conducted among 2639 young adults recruited from the KnowledgePanel online panel from November 19 to December 29, 2021. Individuals aged 18 to 28 years were asked retrospectively about TFA and a variety of other youth experiences in childhood (aged <18 years). Main Outcomes and Measures: Participants were asked about their sexual and gender identities, 11 types of TFA occurring before the age of 18 years, and several potential risk factors. Prevalence rates of any TFA were compared across sexual and gender identity groups, and analyses were conducted to identify risk factors that help explain group differences. Weights were developed to compensate for gender, education, race and ethnicity, household income, census region, and metropolitan status disproportions. Results: Among the 2510 respondents (mean [SD] age, 24.8 [2.8] years) who provided gender and sexual identity information, 46.5% (95% CI, 41.9%-51.1%) were cisgender heterosexual females, 25.2% (95% CI, 21.6%-29.1%) were cisgender sexual minority females, 18.3% (95% CI, 14.4%-22.9%) were cisgender heterosexual males, 6.8% (95% CI, 4.6%-9.9%) were cisgender sexual minority males, and 3.3% (95% CI, 2.0%-5.4%) were gender minority individuals. The prevalence of TFA occurring before the age of 18 years was highest among sexual minority females (55.3%; 95% CI, 48.0%-62.4%) and gender minority individuals (53.4%; 95% CI, 33.5%-72.2%). Rates of sexting were highest among cisgender sexual minority females (38.8%; 95% CI, 19.1%-58.8%) and gender minority individuals (36.7%; 95% CI, 19.1%-58.8%) and represented the strongest risk factor for TFA exposure (odds ratio, 5.7; 95% CI, 4.0-8.0). However, it explained little variation in TFA across groups once early in-person adversity, sexual abuse, bullying, and maltreatment were taken into account. Conclusions and Relevance: This study demonstrates the risk of TFA among sexual and gender minority youths and the need to target prevention efforts toward these vulnerable groups. In addition to strategies to reduce risky behavior, efforts to lower the risk of early sexual abuse, bullying, and maltreatment are likely to also be effective in decreasing TFA among these marginalized groups.

Contexts and Characteristics of Imaged-Based Sexual Exploitation and Abuse of Children: Incident Dynamics in a National Sample.

This paper describes incident characteristics and dynamics associated with six specific forms of image-based sexual exploitation and abuse of children (IBSEAC). Data were collected on a national sample of 2639 individuals aged 18-to-28 from a probability-based online panel. Respondents completed a self-administered survey questionnaire, providing detailed follow-up information on their experiences of image-based sexual victimization before the age of 18. A total of 607 incidents of IBSEAC were included in the analyses. Findings show substantial diversity in incident characteristics within and across the six forms of IBSEAC (nonconsensual sharing of sexual images, nonconsensual taking or making of images, forced image recruitment, threatened sharing, voluntary image sharing with an older adult, and commercial sexual exploitation involving images). Some notable patterns include frequent involvement of perpetrators who are other youth or young adults, who are known in-person to the victim, and who are intimate partners. The diversity and complexity of dynamics revealed in this study underscores the need for careful design and evaluation of prevention programs and the core messages directed at youth.

Help-Seeking From Websites and Police in the Aftermath of Technology-Facilitated Victimization.

This study looked at experiences of help-seeking from websites and police following an episode of technology-facilitated abuse. It used data from a nationally representative online panel of adults aged 18 to 28, sampled from Ipsos Knowledge Panel. A total of 1,952 unique victimization episodes from childhood and adulthood were identified and used in analyses. Participants were asked about whether they experienced 11 different types of technology-facilitated abuse (TFA), whether the incident was reported to the website or police, barriers to reporting, and features of the website's or law enforcement's response. Other follow-up information included victim gender, age, relationship to the perpetrator, and negative emotional impact (NEI) associated with the incident. Results found very low rates of reporting to both websites (7.3%) and law enforcement (4.8%). Image-based offenses had higher rates of reporting. A greater NEI significantly increased the odds of reporting to each source. Participants were largely unsatisfied with response from websites and police. Only 42.2% said the website did something helpful and only 29.8% found police helpful. Our findings suggest a need for major improvements in how websites and law enforcement respond to victims of technology-facilitated offenses. They need to have more helpful information and more ways of offering support. Websites need more specifics about the types of violations that warrant reporting, clearer signposts, and encouragement about how to get help and a better publicized commitment to a rapid and serious review. Law enforcement needs more education and training to avoid dismissive and judgmental reactions and to ensure sympathetic and respectful responses.

Predictors of Online Child Sexual Abuse in a U.S. National Sample.

As technology has become increasingly integrated into the everyday lives of young people and social interactions have moved online, so too have the opportunities for child sexual abuse. However, the risk factors for online sexual abuse, and their similarities or differences with those of offline sexual abuse have not been clarified, making it difficult to design prevention strategies. Using a nationally representative online survey panel of young adults ages 18 to 28, the current study sought to identify risk factors for online childhood sexual abuse and compare their relevance and strength in predicting offline sexual abuse. The 2,639 participants, ages 18 to 28, were sampled from the Ipsos KnowledgePanel and were asked questions about 11 different kinds of technology-facilitated online sexual abuse that occurred in childhood, follow-up questions about their dynamics and offenders, and a variety of potential risk factors. Results indicated that: (1) being cisgender female, nonheterosexual, and having parents with less than a high school education emerged as important demographic predictors of online child sexual abuse (OCSA); and (2) early offline sexual abuse was the strongest predictor of OCSA, when considering both its direct and indirect effects through online risky behavior. Findings suggest that prevention programs directed at reducing risk of sexual abuse, in general, are likely to be effective against online sexual abuse, provided they also incorporate efforts to educate youth on the need to avoid risky online behaviors.

Independent and Cumulative Effects of Recent Maltreatment on Suicidal Ideation and Thoughts of Self-harm in a National Sample of Youth.

PURPOSE: This study examines the impact of several forms of past-year maltreatment on thoughts of self-harm and suicidal ideation and considers how these effects may vary by gender. METHODS: Analyses are based on telephone interviews with a nationally representative sample of 6,364 youth aged 10-17 years, from three waves (2008, 2011, and 2014) of the National Survey of Children's Exposure to Violence. Suicidal and self-harm ideation were measured with items from the Trauma Symptoms Checklist for Children. Emotional maltreatment, physical maltreatment, neglect, and witnessing family violence were measured using items from the Juvenile Victimization Questionnaire. RESULTS: Over 8% of the sample reported suicidal and/or self-harm ideation in the past month, with females more likely to report these outcomes than males. Youth who experienced recent emotional maltreatment, neglect, or witnessing family violence were more likely to report suicidal or self-harm ideation, independent of the other maltreatment types, presence of an internalizing disorder, and demographics. A dose-response relationship between the number of types of maltreatments and these outcomes was also evident. Finally, females were more negatively affected by emotional abuse and by experiencing two forms of past-year maltreatment than their male counterparts. CONCLUSIONS: Emotional abuse was the type of maltreatment most strongly related to thoughts of self-harm and/or suicidal ideation and was particularly detrimental to females in this sample. Given the especially damaging effects of exposure to multiple forms of maltreatment, our research highlights the importance of including comprehensive maltreatment assessment in youth suicide and self-harm prevention efforts.

Past Year Technology-Involved Peer Harassment Victimization and Recent Depressive Symptoms and Suicide Ideation Among a National Sample of Youth.

This article aims to better understand the complex role of technology in peer victimization events with recent depressive symptomatology and suicide ideation (SI). Telephone interviews were conducted with a national sample of 791 youth in the United States, aged 10 to 20 years, collected from December 2013 to March 2014. Rates of any peer harassment victimization varied by past month depressive symptomatology and SI -28% of youth with no/low depressive symptomatology reported past year peer harassment as did 43% of youth with high depressive symptomatology without SI, and 66% of youth with SI. When examining the role of technology in peer harassment, youth experiencing any mixed harassment (i.e., those incidents that occurred both in-person and through technology) were almost 4 times more likely to report past month depressive symptoms without SI (RRadj = 3.9, 95% confidence interval [CI] = [1.5, 10.0], p ≤ .01) and 7.5 times (95% CI = [1.9, 28.9], p ≤ .01) more likely to report past month SI compared with youth who had no past year peer harassment. Given the multilayered relationships among these variables, schools, medical, and mental health professionals might screen youth who are involved in higher risk peer victimization situations, for depressive symptoms and SI to improve their access to appropriate mental health services.

Exposure to Family and Friend Homicide in a Nationally Representative Sample of Youth.

This study examines the lifetime prevalence and distribution of family/friend homicide exposure among children and adolescents age 2 to 17 in the United States, and assesses the impact of family/friend homicide on emotional and behavioral outcomes, while controlling for potential co-occurring factors. Data were collected by telephone about the experiences of youth in 2008, 2011, or 2014, as part of the National Surveys of Children's Exposure to Violence (NatSCEV). Analyses are based on a pooled sample (n =11,771) from these three surveys. Approximately 8% of all children and youth ages 2 to 17 were exposed to a family/friend homicide. Older adolescents, Black youth, those living in single parent and nonparent family households, those from lower socioeconomic status households, and youth living in large cities were overrepresented among youth experiencing family or friend homicide. Exposed youth were also substantially more likely to be poly-victims, experience other major adversities, and live in neighborhoods with more community disorder. Exposure to family/friend homicide was significantly related to trauma symptoms. However, when other co-occurring factors were taken into account, only family/friend homicide that occurred within the last 2 years remained significant. With respect to delinquency, only nonfamily homicide exposure remained significant with these other factors controlled. Findings suggest that family/friend homicide represents a powerful marker for a broad level of victimization risk and adversity, demonstrating that family/friend murder is often just one relatively small part of a more complicated life of adversity. Although recent exposure is certainly distressing to youth, it is the wider, co-occurring context of poly-victimization and other types of adversity that appears most impactful in the longer term.

Understanding the Impact of Seeing Gun Violence and Hearing Gunshots in Public Places: Findings From the Youth Firearm Risk and Safety Study.

There is a current public health emphasis on finding strategies for reducing the risks associated with children's gun violence exposure. This article examines the impact of seeing and hearing gun violence on youth of different ages and living in urban and nonurban areas. Participants were 630 youth, aged 2 to 17. Youth, ages 10 to 17, completed a self-report survey, and caregivers of young children, ages 2 to 9, completed the survey as a proxy for that child. Participants resided in Boston, MA; Philadelphia, PA; and rural areas of eastern TN. Participants were recruited through a variety of techniques including pediatric clinics, housing authorities, youth-serving agencies, festivals, word of mouth, and local e-mail lists for classified advertisements. Data were collected between October 2017 and April 2018 and analyzed in 2019. In total, 41% of youth in this study reported ever seeing or hearing gun violence; 32% had such an experience in the past year. Among exposed youth, 50% took protective action to keep themselves safe, and 58% reported being very or extremely afraid, sad, or upset as a result of the indirect gun violence. More youth living in urban compared with nonurban areas took some protective action. Females and younger children had increased odds of experiencing high fear as a result of the violence. Current gun violence prevention has typically targeted adolescents; however, current findings suggest the need to focus on younger children as well, including the distress resulting from indirect exposure to gun violence.

The Youth Firearm Risk and Safety Tool (Youth-FiRST): Psychometrics and Validation of a Gun Attitudes and Violence Exposure Assessment Tool.

This study reports on the development of a comprehensive assessment of exposure to guns and gun-related violence for evaluating the risk of gun-related trauma. Gun access, gun attitudes, gun safety education, and exposure to gun violence were measured. Participants were 630 youth, aged 2-17. Youth, ages 10-17, completed a self-report survey and caregivers of young children, ages 2-9, completed the survey as a proxy for that child. The youth were from urban (n = 286) and rural (n = 344) areas. Factor analysis, item response theory, and structural equation modeling were used. Two factors described access to guns, two factors described gun attitudes, and a single construct captured gun safety education. The gun violence exposure factor showed strong associations with trauma symptomatology. The individual constructs showed good psychometric properties and measurement noninvariance by urbanicity.

Exposure to Multiple Forms of Bias Victimization on Youth and Young Adults: Relationships with Trauma Symptomatology and Social Support.

Research has documented that a significant portion of youth are exposed to bias victimization. However, less is known about whether experiencing certain types of bias victimization (e.g., sexual orientation bias) is more or less likely to be related to a more extensive bias victimization history (i.e., experiencing multiple types of bias victimization) and whether exposure to multiple types of bias victimization explains any relationships between specific types of bias victimization and negative outcomes. To address these gaps, the current study explores relationships between exposure to multiple types of bias-motivated victimization, trauma symptomatology and perceived social support. Participants were 854 youth and young adults (60.9% female) from three higher risk communities who completed a survey on personal experiences with bias-related victimization. The average age of participants was 16.6 years; 28.5% of the sample described themselves as Black or African American; 13.4% as Hispanic or Latino (any race); 45.3% as White, and 12.8% as another race. Sixty-nine percent of the sample described their sexual orientation as heterosexual; 8.9% as gay, lesbian, or homosexual; 12.5% as bisexual; and 9.5% as another sexual orientation. Sixty-three percent of participants reported at least one type of bias victimization in their lifetime, and more than one in three youth (38.7%) experienced two or more types of bias victimization in their lifetimes (18.1% two types, 12.1% three types, and 8.5% four or more types). Experiencing multiple types of bias victimization was related to higher trauma symptomatology and less perceived social support. Experiencing multiple types of bias victimization attenuated or eliminated the association between individual types of bias victimization and well-being. The findings contribute to a growing body of research demonstrating the damaging mental health effects of occupying multiple marginalized statuses, and points to the cumulation of bias victimization experiences as an important factor contributing to significant differences in well-being and support among youth and young adults.

Strengthening the predictive power of screening for adverse childhood experiences (ACEs) in younger and older children.

BACKGROUND: There is increasing interest in routine screening for Adverse Childhood Experiences (ACEs) to help identify high-risk children who would benefit from interventions. However, there has not yet been sufficient research concerning which particular set of ACEs would be most predictive as a potential screening tool. OBJECTIVE: This study compared 40 Adverse Childhood Experiences (ACEs), covering 11 different conceptual domains, in their ability to predict trauma symptoms in childhood. PARTICIPANTS AND SETTING: The current study uses pooled data from three National Surveys of Children's Exposure to Violence (NatSCEV) conducted in 2008, 2011, and 2014. Each survey collected information on children aged one month to 17 years. METHODS: Samples were obtained from a mix of random digit dialing and address based sampling methods. Telephone interviews were conducted with children 10 years and older and with caregivers, if the randomly selected child was under age 10. RESULTS AND CONCLUSION: A different set of 15 items best predicted trauma symptoms for younger (2-9-year-old) compared to older (10-17-year-old) youth. Some conventional ACEs, like physical and emotional abuse, proved important for both age groups. However, family-related factors were more predictive for younger children, while community and peer violence exposures were more predictive for older children. Our new proposed measures explained substantially more variance in subsequent trauma symptoms than did the original ACE measure (R2 = .31 vs .18 for 2-9 year olds; R2 = .43 vs .26 for 10-17 year olds; p < .001 for all) and identified a larger percentage of children with high levels of trauma.

Peer Victimization Patterns and Trauma Symptoms in a National Longitudinal Sample of Youth.

Using a nationally representative sample of 791 youth, ages 8-17 at baseline, this study identified patterns over a 2-year period in specific forms of peer victimization and examined differences in the mental health consequences of those patterns. Findings show that, among the victimized, physical assault had relatively high persistence compared to other forms, while physical intimidation and emotional bullying had relatively high rates of desistence. Emotional bullying at T1 was associated with increased risk of T2 Internet harassment and Internet harassment at T1 strongly predicted T2 dating violence. Patterns of victimization over time differed in their relationship with trauma symptoms. Findings emphasized the importance of recency and the distress of new victimization experiences, rather than the chronicity or repetition of victimization. Understanding variations in peer victimization patterns and outcomes over time can help to inform interventions that better target sources of risk across adolescence.

Gun Violence Exposure and Posttraumatic Symptoms Among Children and Youth.

Although statistics on youth homicide and injury from gun violence are available, little research has focused on how gun violence overlaps with other victimizations or on the psychological impact of gun violence on children. Pilot survey data were collected on the experiences of 630 U.S. children (age range: 2-17 years) from Boston, Philadelphia, and rural areas of eastern Tennessee. Youth aged 10-17 years completed a self-report survey on a wide range of gun violence exposures, and parents of younger children (aged 2-9 years) completed the survey as a proxy for that child. Direct gun violence exposure, witnessing gun violence, and hearing gunshots were all significantly associated with other forms of victimization, rs = .10-.38, p < .001. The findings suggest that youth who experience direct gun violence are often exposed to multiple violent contexts. For older youth (ages 10-17 years) polyvictimization was most strongly associated with posttraumatic symptoms, ß = .35, p < .001, although witnessing gun violence still uniquely predicted a higher level of symptoms, ß = .18, p < .01. For younger children (ages 2-9 years), hearing and witnessing gun violence were both related to posttraumatic symptoms, ß = .15, p < .01 for both, even after controlling for polyvictimization. Mental health professionals and trauma-informed services should be mindful that the traumatic impact of gun violence for children may not necessarily be attached to direct victimization experiences but may also result from simply seeing or hearing it in their neighborhoods.

Child Neglect and the Broader Context of Child Victimization.

Using a pooled data set of two waves of the National Surveys of Children's Exposure to Violence, this study investigates links between indicators of socioeconomic resources and lifetime exposure to two different forms of child neglect (physical and supervisory), examines how neglect is associated with the risk of other types of victimization, and estimates the impact of neglect on trauma symptoms. Findings suggest that physical neglect is directly linked to economic stressors, while low parental education is consequential for both physical and supervisory neglect. Both types of neglect also were strongly associated with risk of other maltreatment and most other forms of victimization. Physical neglect was particularly strongly related to sexual abuse and witnessing sibling abuse, while supervisory neglect was most strongly related to risk for sexual victimization by a nonfamily adult. Although neglect is significantly associated with trauma symptoms, poly-victims had, by far, the highest levels of trauma symptoms.

Youth Exposure to Suicide Attempts: Relative Impact on Personal Trauma Symptoms.

INTRODUCTION: The purpose of this study is to report the prevalence of youth lifetime exposure to suicide attempts by people close to them, and its association with personal nonvictimization adversities, suicidal ideation, thoughts of self-harm, and trauma symptoms. METHODS: Data were collected as part of the National Surveys of Children's Exposure to Violence, comprising three cross-sectional studies conducted in 2008, 2011, and 2014 in the U.S. assessing the experiences of children ages 1 month to 17 years. The current analyses utilized the self-report data from youth, ages 10-17 years (n=6,366), and was analyzed in 2017. RESULTS: Twelve percent (n=779) of youth said someone close to them had tried to kill themselves. Exposure varied by age: 4% of youth aged 10-12 years, 13% of youth aged 13-15 years, and 21% of youth aged 16-17 years reported such exposure. Exposure to suicide attempts also varied by sex with 8% of males and 16% of females reporting this experience. After adjusting for the total number of other types of adversity experienced, the association between exposure to suicide attempts and trauma symptoms (ß=0.5, 95% CI=0.3, 0.7, p≤0.001); suicidal ideation (OR=2.4, 95% CI=1.4, 4.1, p≤0.001); and thoughts of self-harm (OR=3.1, 95% CI=1.9, 5.1, p≤0.001) remained significant, although attenuated. CONCLUSIONS: Study findings that youth exposure to suicidal behavior is associated with negative emotional distress, and that it often co-occurs with other adversities and social risk factors, highlight the need to better understand the causal pathways among these risk factors to improve youth suicide prevention and response interventions.

Beyond residential mobility: A broader conceptualization of instability and its impact on victimization risk among children.

Predictability in a child's environment is a critical quality of safe, stable, nurturing relationships and environments, which promote wellbeing and protect against maltreatment. Research has focused on residential mobility's effect on this predictability. This study augments such research by analyzing the impact of an instability index-including the lifetime destabilization factors (LDFs) of natural disasters, homelessness, child home removal, multiple moves, parental incarceration, unemployment, deployment, and multiple marriages--on childhood victimizations. The cross-sectional, nationally representative sample of 12,935 cases (mean age = 8.6 years) was pooled from 2008, 2011, and 2014 National Surveys of Children's Exposure to Violence (NatSCEV). Logistic regression models controlling for demographics, socio-economic status, and family structure tested the association between excessive residential mobility, alone, and with LDFs, and past year childhood victimizations (sexual victimization, witnessing community or family violence, maltreatment, physical assault, property crime, and polyvictimization). Nearly 40% of the sample reported at least one LDF. Excessive residential mobility was significantly predictive of increased odds of all but two victimizations; almost all associations were no longer significant after other destabilizing factors were included. The LDF index without residential mobility was significantly predictive of increased odds of all victimizations (AOR's ranged from 1.36 to 1.69), and the adjusted odds ratio indicated a 69% increased odds of polyvictimization for each additional LDF a child experienced. The LDF index thus provides a useful alternative to using residential moves as the sole indicator of instability. These findings underscore the need for comprehensive supports and services to support stability for children and families.

Characteristics of bias-based harassment incidents reported by a national sample of U.S. adolescents.

Using a national sample of youth from the U.S., this paper examines incidents of bias-based harassment by peers that include language about victims' perceived sexual orientation, race/ethnicity, religion, weight or height, or intelligence. Telephone interviews were conducted with youth who were 10-20 years old (n = 791). One in six youth (17%) reported at least one experience with bias-based harassment in the past year. Bias language was a part of over half (52%) of all harassment incidents experienced by youth. Perpetrators of bias-based harassment were similar demographically to perpetrators of non-biased harassment. However, bias-based incidents were more likely to involve multiple perpetrators, longer timeframes and multiple harassment episodes. Even controlling for these related characteristics, the use of bias language in incidents of peer harassment resulted in significantly greater odds that youth felt sad as a result of the victimization, skipped school, avoided school activities, and lost friends, compared to non-biased harassment incidents.

Poly-Victimization and Peer Harassment Involvement in a Technological World.

This article explores the ways poly-victimized youth (those experiencing multiple different types of victimization over the course of 1 year) use technology to interact with peers. Particular attention is given to the peer harassment victimization and perpetration experiences of poly-victimized youth compared with less victimized and non-victimized youth-both overall and through technology. Data were collected as part of the Technology Harassment Victimization (THV) study; a national survey of 791 youth, ages 10 to 20 across the United States. Study results document the heightened risks that poly-victimized youth experience when interacting with peers. Low and high poly-victimized youth were both at significantly greater risk of being dual victims and perpetrators of peer harassment when compared with non-victimized youth even after taking into account other potentially explanatory factors. This was not found to be the case for less victimized youth. This was true for high poly-victims and technology-involved harassment risk as well. There were indications that poly-victimized youth were interacting with peers in more intense and risky ways in general using new technology. The increase in attention to poly-victimization in recent years has importantly identified the detrimental role that experiencing different forms of victimization have on youth. This study not only adds to that literature but suggests that there is an opportunity to interrupt additional victimization by understanding how poly-victimized youth interact with peers before and during adolescence. Although preliminary, the differences in technology use by poly-victimized youth versus others suggest that more information is needed to understand how they are relating to peers in both positive and risky ways in this environment.

From Poly-Victimization to Poly-Strengths: Understanding the Web of Violence Can Transform Research on Youth Violence and Illuminate the Path to Prevention and Resilience.

For many years, an overly "siloed" approach has hampered efforts to understand violence and minimize the societal burden of violence and victimization. This article discusses the limitations of an overly specialized approach to youth violence research, which has focused too much on violence in particular contexts, such as the family or the school. Instead, a child-centered approach is needed that comprehensively assesses all exposures to violence. This concept of the total cumulative burden of violence is known as poly-victimization. The poly-victimization framework reveals that many youth are entangled in a web of violence, experiencing victimization in multiple settings by multiple perpetrators. This more accurate view of children's exposure to violence has many advantages for advancing our scientific understanding of violence. Perhaps somewhat surprisingly, this more comprehensive view also points to new insights for resilience and prevention. This includes recognizing a parallel concept, "poly-strengths," which captures the number of resources and assets children and their families can use to help insulate youth from violence (prevention) or assist in coping and promoting well-being after victimization (intervention). Reconceptualizing how resilience is defined and understood among youth populations can help alleviate the true societal burden of youth victimization.

Exposure to Medication Overdose as an Adversity in Childhood.

PURPOSE: To determine the prevalence of youth exposure to medication or pill overdose by someone close to them, as well as how common this is within the spectrum of major stressful events and child victimization experienced by youth. DESIGN AND METHODS: Data were collected as part of the Third National Survey of Children's Exposure to Violence, a nationally representative telephone survey of youth, ages 2-17years (N=3738) conducted in 2013. The analytical subset for the current paper is youth ages 10-17years (n=1959). RESULTS: Estimates indicate that approximately 1 in 12 youth (8%), ages 10-17 have been exposed to medication overdose by someone close to them in their lifetimes. Overdose exposure is related to recent trauma symptoms, alcohol and other substance use. However, these relationships appear to be largely driven by the co-existence of major stressful events these youth are experiencing. Alcohol use is the exception; exposure to medication overdose continues to be related to past year personal alcohol use even after adjusting for other lifetime stressful events. CONCLUSIONS: Having a close family member or friend overdose on a medication is a common experience among U.S. youth and related to high rates of co-occurring stressful events. PRACTICE IMPLICATIONS: Health care providers should be aware that youth exposure to medication overdoses likely indicates exposure to other recognized adversities. Youth with a caregiver who has had an overdose may require an urgent response including referral to crisis intervention through child and family services.