Seasonal Trends in Emergency Department Visits for Mental and Behavioral Health Conditions Among Children and Adolescents Aged 5-17 Years - United States, January 2018-June 2023.

Mental and behavioral health conditions among school-aged children, including substance use disorders and overall emotional well-being, are a public health concern in the United States. Timely data on seasonal patterns in child and adolescent conditions can guide optimal timing of prevention and intervention strategies. CDC examined emergency department (ED) visit data from the National Syndromic Surveillance Program for 25 distinct conditions during January 2018-June 2023 among U.S. children and adolescents aged 5-17 years, stratified by age group. Each year, during 2018-2023, among persons aged 10-14 and 15-17 years, the number and proportion of weekly ED visits for eight conditions increased in the fall school semester and remained elevated throughout the spring semester; ED visits were up to twice as high during school semesters compared with the summer period. Among children aged 5-9 years, the number and proportion of visits increased for five mental and behavioral health conditions. Seasonal increases in ED visits for some conditions among school-aged children warrant enhanced awareness about mental distress symptoms and the challenges and stressors in the school environment. Systemic changes that prioritize protective factors (e.g., physical activity; nutrition; sleep; social, community, or faith-based support; and inclusive school and community environments) and incorporate preparedness for increases in conditions during back-to-school planning might improve child and adolescent mental health.

Structural and social determinants of inequities in violence risk: A review of indicators.

There is disproportionate risk for violence conditioned on inequities due to race, socioeconomic status, gender, and where people live. Consequently, some communities are more vulnerable to violence and its repercussions than other communities. This study aims to share indicators that might be useful for violence prevention researchers interested in measuring structural or social determinants that position communities for differential risk of experiencing violence. An existing database of indicators identified in a previous review was reassessed for measures of factors that shape community structures and conditions, which place people at risk for violence. Indicators of 86 community constructs are reported. These indicators may help to advance the field by offering innovative metrics that can be used to investigate further the structural and social determinants that serve as root causes of inequities in violence risk.

Indicators for Evaluating Community- and Societal-Level Risk and Protective Factors for Violence Prevention: Findings From a Review of the Literature.

Programs geared toward preventing violence before it occurs at the community and societal levels of the social ecology are particularly challenging to evaluate. These programs are often focused on impacting the antecedents (or risk and protective factors) to violence, making it difficult to determine program success when solely relying on measures of violence reduction. The goal of this literature review is to identify indicators to measure risk and protective factors for violence that are accessible and measured at the community level. Indicators of community- and societal-level risk and protective factors from 116 articles are identified. These indicators strengthen violence prevention researchers' and practitioners' ability to detect proximal effects of violence prevention programs, practices, and policies, and provide timely feedback on the impact of their work. Thus, opportunities exist for violence prevention researchers to further study the associations between various indicators and different violent outcomes and to inform practitioner, evaluator, and funder developed logic models that include indicators of relevant risk and protective factors for crosscutting violence prevention measures and outcomes.

Connecting the Dots: State Health Department Approaches to Addressing Shared Risk and Protective Factors Across Multiple Forms of Violence.

Violence takes many forms, including intimate partner violence, sexual violence, child abuse and neglect, bullying, suicidal behavior, and elder abuse and neglect. These forms of violence are interconnected and often share the same root causes. They can also co-occur together in families and communities and can happen at the same time or at different stages of life. Often, due to a variety of factors, separate, "siloed" approaches are used to address each form of violence. However, understanding and implementing approaches that prevent and address the overlapping root causes of violence (risk factors) and promote factors that increase the resilience of people and communities (protective factors) can help practitioners more effectively and efficiently use limited resources to prevent multiple forms of violence and save lives. This article presents approaches used by 2 state health departments, the Maryland Department of Health and Mental Hygiene and the Colorado Department of Public Health and Environment, to integrate a shared risk and protective factor approach into their violence prevention work and identifies key lessons learned that may serve to inform crosscutting violence prevention efforts in other states.

The Power of Academic-Practitioner Collaboration to Enhance Science and Practice Integration: Injury and Violence Prevention Case Studies.

One of the most substantial challenges facing the field of injury and violence prevention is bridging the gap between scientific knowledge and its real-world application to achieve population-level impact. Much synergy is gained when academic and practice communities collaborate; however, a number of barriers prevent better integration of science and practice. This article presents 3 examples of academic-practitioner collaborations, their approaches to working together to address injury and violence issues, and emerging indications of the impact on integrating research and practice. The examples fall along the spectrum of engagement with nonacademic partners as coinvestigators and knowledge producers. They also highlight the benefits of academic-community partnerships and the engaged scholarship model under which Centers for Disease Control and Prevention-funded Injury Control Research Centers operate to address the research-to-practice and practice-to-research gap.

Disparities and Trends in Middle School Students' Suicidal Thoughts and Behaviors: Results From the Youth Risk Behavior Survey, 2015-2019.

PURPOSE: To examine trends and racial and ethnic disparities in early adolescent suicidal thoughts and behaviors in the years immediately prior to the COVID-19 pandemic. METHODS: This study used pooled data from Centers for Disease Control and Prevention's middle school Youth Risk Behavior Survey (n = 127,912) between 2015 and 2019. Three dichotomized measures of suicide-related behaviors were assessed: suicidal thoughts, planning, and attempts. Weighted prevalence estimates with 95% confidence intervals were calculated for each survey year. Linear trends examined disparities in the prevalence of suicidal thoughts and behaviors, overall and by student demographic characteristics. Main effects odds ratios compared estimates among racial and ethnic minority adolescents with non-Hispanic White students, controlling for sex and grade. RESULTS: Significant linear increases were observed for the percentage of middle school students who reported seriously thinking about suicide (18.2%-22.3%), ever making a suicide plan (11.8%-14.7%), and ever attempting suicide (6.9%-9.3%). Racial and ethnic minority students, other than non-Hispanic Asian, showed higher odds of suicidal thoughts and behaviors compared with non-Hispanic White students. DISCUSSION: Findings indicate a need for comprehensive suicide prevention to address health equity and disparities in suicide-related behaviors among middle school-aged adolescents.

A Standard Framework for Evaluating Large Health Care Data and Related Resources.

Since 2000, the availability and use of large health care data and related resources for conducting surveillance, research, and evaluations to guide clinical and public health decision-making has increased rapidly. These trends have been related to transformations in health care information technology and public as well as private-sector efforts for collecting, compiling, and supplying large volumes of data. This growing collection of robust and often timely data has enhanced the capability to increase the knowledge base guiding clinical and public health activities and also has increased the need for effective tools to assess the attributes of these resources and identify the types of scientific questions they are best suited to address. This: MMWR supplement presents a standard framework for evaluating large health care data and related resources, including constructs, criteria, and tools that investigators and evaluators can apply and adapt.

Scoping Review of Family and Community Engagement Strategies Used in School-Based Interventions to Promote Healthy Behaviors.

BACKGROUND: School efforts to promote health among students are more successful when families and community members are involved. METHODS: We conducted a scoping review to summarize and categorize family and community engagement strategies used in US school and out-of-school time (OST) interventions to address physical activity (PA) and nutrition in kindergarten through 12th grade students. RESULTS: The National Network of Partnership Schools' Six Keys to Success framework was useful in organizing the types of family and community engagement strategies used in included interventions. Many interventions used multiple family and community engagement strategies, with the most common being communicating with families and community members; providing support or education to families; and collaborations among school/OST program and community to support students and their families. CONCLUSIONS: This review identified six common family and community engagement strategies used in school and OST interventions for PA and nutrition. Including family and community engagement strategies in school and OST interventions could play an important role in maximizing support, resources, and expertise to promote healthy behaviors among all students.

Classroom Management and Facilitation Approaches That Promote School Connectedness.

BACKGROUND: When children and youth feel connected to their school, family, and others in their community, they are less likely to engage in risky behaviors and experience negative health. Disruptions to school operations during the COVID-19 pandemic have led many teachers and school administrators to prioritize finding ways to strengthen and re-establish a sense of connectedness among students and between students and adults in school. METHODS: We conducted a systematic search of peer-reviewed literature that reported on US-based research and were published in English from January 2010 through December 2019 to identify classroom management approaches that have been empirically tied to school connectedness-related outcomes in K-12 school settings. FINDINGS: Six categories of classroom management approaches were associated with improved school connectedness among students: (1) teacher caring and support, (2) peer connection and support, (3) student autonomy and empowerment, (4) management of classroom social dynamics, (5) teacher expectations, and (6) behavior management. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Prioritizing classroom management approaches that emphasize positive reinforcement of behavior, restorative discipline and communication, development of strong, trusting relationships, and explicitly emphasize fairness has potential to promote equitable disciplinary practices in schools. CONCLUSIONS: Classroom management approaches most linked to school connectedness are those that foster student autonomy and empowerment, mitigate social hierarchies and power differentials among students, prioritize positive reinforcement of behavior and restorative disciplinary practices, and emphasize equity and fairness.

School Connectedness and Risk Behaviors and Experiences Among High School Students - Youth Risk Behavior Survey, United States, 2021.

School connectedness, defined as students' belief that adults and peers in their school care about their learning as well as about them as persons, has been linked to positive educational, behavioral, and health outcomes in adolescence and into adulthood. Data from the 2021 nationally representative Youth Risk Behavior Survey, conducted during the COVID-19 pandemic, were used to estimate prevalence of students' perception of school connectedness and examine associations between school connectedness and seven risk behaviors and experiences: poor mental health, marijuana use, prescription opioid misuse, sexual intercourse, unprotected sex, experiencing forced sex, and missing school because of feeling unsafe. Prevalence estimates were generated and pairwise t-tests were used to detect differences among student subpopulations by sex, grade, race and ethnicity, and sexual identity; Wald chi-square tests were used to detect differences in risk behaviors by level of connectedness within a subpopulation. Logistic regression models were used to estimate prevalence ratios comparing the prevalence of risk behaviors and experiences of students with high connectedness with students with low connectedness, stratified by demographics. During 2021, 61.5% of U.S. high school students reported feeling connected to others at school. In addition, school connectedness was associated with lower prevalence of every risk behavior and experience examined in this study, although certain associations differed by race and ethnicity and sexual identity (e.g., school connectedness was associated with better mental health outcomes for youths with heterosexual, bisexual, and questioning or other sexual identities, but not for youths who identified as lesbian or gay). These findings can guide public health interventions that promote youth well-being by creating school environments where all youths have a sense of belonging and feel they are cared for and supported.

Parental Monitoring and Risk Behaviors and Experiences Among High School Students - Youth Risk Behavior Survey, United States, 2021.

Parents have an important role in the promotion of healthy adolescent behaviors that can influence positive developmental trajectories and health outcomes. Parental monitoring is a central component of the parent-child relationship with the potential to reduce adolescent risk behaviors. Data from CDC's 2021 nationally representative Youth Risk Behavior Survey were used to describe the prevalence of parental monitoring reported by U.S. high school students and examine associations between parental monitoring and adolescent behaviors and experiences. Behaviors and experiences included sexual behaviors, substance use, violence, and indicators of poor mental health. This report marks the first national assessment of parental monitoring among U.S. high school students. Point prevalence estimates and corresponding 95% CIs were generated in the bivariate analyses between parental monitoring and the outcomes, stratified by demographic characteristics (sex, race and ethnicity, sexual identity, and grade). Multivariable logistic regression analyses were conducted to estimate the main effects of parental monitoring (categorized as high = always or most of the time and low = never, rarely, or sometimes) for each outcome, controlling for all demographics. Overall, 86.4% of students reported that their parents or other adults in their family know where they are going or with whom they will be all or most of the time. Reports of high parental monitoring were protective for all risk behaviors and experiences, with models controlling for sex, race and ethnicity, sexual identity, and grade. Results highlight the need for public health professionals who develop public health interventions and programs to conduct further research on the relation between parental monitoring and student health outcomes.

Associations Between School Absence and School Violence by Sexual Identity.

INTRODUCTION: Sexual minority youth are disproportionately exposed to school violence compared with their heterosexual peers. It is unknown whether the associations between school absence and exposure to school violence vary by sexual identity. METHODS: In 2021, data were combined from the 2015, 2017, and 2019 national Youth Risk Behavior Surveys to produce nationally representative samples of U.S. high-school students who identified as gay/lesbian (n=1,061), identified as bisexual (n=3,210), were not sure of their sexual identity (n=1,696), or identified as heterosexual (n=35,819). Associations were examined between 3 school violence exposures (being threatened/injured with a weapon at school, being bullied at school, and being in a physical fight at school) and school absence due to safety concerns. In each sample, multivariable logistic regression models were used to calculate adjusted prevalence ratios adjusted for sex, race/ethnicity, grade, current substance use, being offered/sold drugs at school, feeling sad/hopeless, and suicidal thoughts. Adjusted prevalence ratios were considered statistically significant if 95% CIs did not include 1.0. RESULTS: Exposure to school violence and school absence due to safety concerns were more prevalent among sexual minority students than among heterosexual students. Associations between exposure to school violence and school absence due to safety concerns were similar across sexual identity groups. For example, school absence was associated with being threatened/injured with a weapon at school among gay/lesbian (adjusted prevalence ratio=3.00), bisexual (adjusted prevalence ratio=3.66), those not sure (adjusted prevalence ratio=4.56), and heterosexual (adjusted prevalence ratio=3.75) students. CONCLUSIONS: Associations between school absenteeism and school violence exist in each sexual identity group. Therefore, programs providing safe and supportive school environments may result in reduced absenteeism among all students.

Addressing HIV/Sexually Transmitted Diseases and Pregnancy Prevention Through Schools: An Approach for Strengthening Education, Health Services, and School Environments That Promote Adolescent Sexual Health and Well-Being.

Adolescents' health behaviors and experiences contribute to many outcomes, including risks for HIV, other sexually transmitted diseases, and unintended pregnancy. Public health interventions and approaches addressing risk behaviors or experiences in adolescence have the potential for wide-reaching impacts on sexual health and other related outcomes across the lifespan, and schools are a critical venue for such interventions. This paper describes a school-based program model developed by the Centers for Disease Control and Prevention's Division of Adolescent and School Health for preventing HIV/sexually transmitted diseases, unintended pregnancy, and related health risk behaviors and experiences among middle and high school students. This includes a summary of the theoretical and evidence base that inform the model, and a description of the model's activities, organized into three key strategies (sexual health education, sexual health services, and safe and supportive environments) and across three cross-cutting domains (strengthening staff capacity, increasing student access to programs and services, and engaging parent and community partners). The paper also outlines implications for adolescent health professionals and organizations working across schools, clinics, and communities, to address and promote adolescent sexual health and well-being.

A systemic approach to achieving population-level impact in injury and violence prevention.

The contemporary public health model for injury and violence prevention is a four-step process, which has been difficult to fully actualize in real-world contexts. This difficulty results from challenges in bridging science to practice and developing and applying population-level approaches. Prevention programmes and policies are embedded within and impacted by a range of system-level factors, which must be considered and actively managed when addressing complex public health challenges involving multiple sectors and stakeholders. To address these concerns, a systemic approach to population-level injury and violence prevention is being developed and explored by the Division of Analysis, Research, and Practice Integration in the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention. This article makes the case for and provides a high-level overview of this systemic approach, its various components, and how it is being applied in one governmental unit.

Current Prescription Opioid Misuse and Suicide Risk Behaviors Among High School Students.

BACKGROUND AND OBJECTIVES: In previous studies, researchers have reported that youth with a lifetime history of prescription opioid misuse (POM) are at an increased risk for suicidal ideation, planning, and attempts. In this study, we investigate whether the association between youth POM and suicide outcomes differs by recency of POM (ie, none, past, or current misuse). METHODS: In this report, we use data from the 2019 Youth Risk Behavior Survey to examine associations between recency of POM (current POM, past POM, and no POM) and suicide risk behaviors among US high school students. RESULTS: After controlling for demographics, alcohol, and other drug use, both current POM and past POM were significantly associated with all suicide risk behaviors compared with no POM. Students who reported current POM had the highest adjusted prevalence ratios (aPRs) for suicidal ideation (aPR: 2.30; 95% confidence interval [CI] 1.97-2.69), planning (aPR: 2.33; 95% CI 1.99-2.79), attempts (aPR: 3.21; 95% CI 2.56-4.02), and feeling sad or hopeless (aPR: 1.59; 95% CI 1.37-1.84). Students who reported current POM also were significantly more likely than youth who reported past POM to report that they had seriously considered attempting suicide, made a suicide plan, and attempted suicide. CONCLUSIONS: Although POM, particularly current POM, is associated with increases in the risk for suicide-related behaviors and experiences of youth, comprehensive prevention approaches that address the intersections between suicide and POM provide a promising path forward for addressing these public health challenges among youth.

Suicidal Ideation and Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2019.

Suicide is the second leading cause of death among high school-aged youths 14-18 years after unintentional injuries. This report summarizes data regarding suicidal ideation (i.e., seriously considered suicide) and behaviors (i.e., made a suicide plan, attempted suicide, and made a suicide attempt requiring medical treatment) from CDC's 2019 Youth Risk Behavior Survey. Results are reported overall and by sex, grade, race/ethnicity, sexual identity, and sex of sexual contacts, overall and within sex groups. Trends in suicide attempts during 2009-2019 are also reported by sex, race/ethnicity, and grade. During 2009-2019, prevalence of suicide attempts increased overall and among female, non-Hispanic white, non-Hispanic black, and 12th-grade students. Data from 2019 reflect substantial differences by demographics regarding suicidal ideation and behaviors. For example, during 2019, a total of 18.8% of students reported having seriously considered suicide, with prevalence estimates highest among females (24.1%); white non-Hispanic students (19.1%); students who reported having sex with persons of the same sex or with both sexes (54.2%); and students who identified as lesbian, gay, or bisexual (46.8%). Among all students, 8.9% reported having attempted suicide, with prevalence estimates highest among females (11.0%); black non-Hispanic students (11.8%); students who reported having sex with persons of the same sex or with both sexes (30.3%); and students who identified as lesbian, gay, or bisexual (23.4%). Comprehensive suicide prevention can address these differences and reduce prevalence of suicidal ideation and behaviors by implementing programs, practices, and policies that prevent suicide (e.g., parenting programs), supporting persons currently at risk (e.g., psychotherapy), preventing reattempts (e.g., emergency department follow-up), and attending to persons who have lost a friend or loved one to suicide.

Societal determinants of violent death: The extent to which social, economic, and structural characteristics explain differences in violence across Australia, Canada, and the United States.

In this ecological study, we attempt to quantify the extent to which differences in homicide and suicide death rates between three countries, and among states/provinces within those countries, may be explained by differences in their social, economic, and structural characteristics. We examine the relationship between state/province level measures of societal risk factors and state/province level rates of violent death (homicide and suicide) across Australia, Canada, and the United States. Census and mortality data from each of these three countries were used. Rates of societal level characteristics were assessed and included residential instability, self-employment, income inequality, gender economic inequity, economic stress, alcohol outlet density, and employment opportunities). Residential instability, self-employment, and income inequality were associated with rates of both homicide and suicide and gender economic inequity was associated with rates of suicide only. This study opens lines of inquiry around what contributes to the overall burden of violence-related injuries in societies and provides preliminary findings on potential societal characteristics that are associated with differences in injury and violence rates across populations.