Child Sexual Abuse in the United States: A Commentary on Current Policy Approaches to Prevention and Aspirations for the Future.

Child sexual abuse (CSA) is a significant threat to the health and well-being of children in the United States (US). Public policies are a key public health strategy for the primary prevention of violence, including CSA. In 2021, the Enough Abuse Campaign and Prevent Child Abuse America published a comprehensive report entitled A Call to Action for Policymakers and Advocates: Child Sexual Abuse Prevention Legislation in the States to encourage state leaders to create a comprehensive strategy to prevent CSA in the US. Findings from the report show that the nation has made some effort to address CSA, but more focus needs to be given to primary prevention strategies that stop it from occurring in the first place. The report also illustrates the variability of CSA prevention policies across the US and highlights critical gaps in current approaches that must be addressed. In the spirit of the special issue, the authors reflect on key policy issues in the field, including the lack of a federal policy framework for CSA prevention, dedicated funding for the prevention of CSA, and research on the effectiveness of policies intended to prevent CSA. Suggestions for future directions in relation to policy development provided in this commentary will be useful to a variety of stakeholders interested in the topic of CSA prevention policy.

Disparities Associated with Shared Decision-making in Prostate Cancer Screening.

BACKGROUND: Prostate cancer screening guidelines recommend shared decision-making (SDM) regarding prostate-specific antigen (PSA) testing. However, it is unclear who undergoes SDM and whether any disparities exist. OBJECTIVE: To examine sociodemographic differences in participation of SDM and its association with PSA testing in prostate cancer screening. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cross-sectional study was conducted among men aged 45-75 yr undergoing PSA screening, using the 2018 National Health Interview Survey database. The evaluated sociodemographic features included age, race, marital status, sexual orientation, smoking status, working status, financial difficulty, US geographic regions, and cancer history. Questions regarding self-reported PSA testing and whether respondents discussed its advantages and disadvantages with their healthcare provider were analyzed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Our primary outcome was to evaluate the possible associations between various sociodemographic factors and undergoing PSA screening and SDM. We used multivariable logistic regression analyses to detect potential associations. RESULTS AND LIMITATIONS: A total of 59596 men were identified, of whom 5605 answered the question regarding PSA testing, with 2288 (40.6%) undergoing PSA testing. Of these men, 39.5% (n = 2226) discussed the advantages and 25.6% (n = 1434) discussed the disadvantages of PSA testing. On a multivariable analysis, older (odds ratio [OR] 1.092; 95% confidence interval [CI] 1.081-1.103, p < 0.001) and married (OR 1.488; 95% CI 1.287-1.720, p < 0.001) men were more likely to undergo PSA testing. Although Black men were more likely to discuss PSA advantages (OR 1.421; 95% CI 1.150-1.756, p = 0.001) and disadvantages (OR 1.554; 95% CI 1.240-1.947, p < 0.001) than White men, this did not correlate with higher rates of PSA screening (OR 1.086; 95% CI 0.865-1.364, p = 0.477). The lack of important clinical data remains a limitation. CONCLUSIONS: Overall, SDM rates were low. Older and married men had an increased likelihood of SDM and PSA testing. Despite higher rates of SDM, Black men had similar rates of PSA testing to White men. PATIENT SUMMARY: We evaluated sociodemographic differences in shared decision-making (SDM) in prostate cancer screening using a large national database. We found that SDM had varying results in different sociodemographic groups.

The effect of intensified illuminance and artificial light at night on fitness and susceptibility to abiotic and biotic stressors.

Changing light conditions due to human activities represents an important emerging environmental concern. Although changes to natural light conditions can be independently detrimental, in nature, organisms commonly face multiple stressors. To understand the consequences of altered light conditions, we exposed a model amphibian (wood frog; Lithobates sylvaticus) to a control and two anthropogenic light conditions: intensified daytime illuminance and artificial light at night - ALAN (intensified daytime illuminance + extended photoperiod). We measured (1) metrics of fitness (hatching success as well as survival to, size at, and time to metamorphosis) (2) susceptibility (time to death) to a commonly co-occurring anthropogenic stressor, road salt (NaCl) and (3) susceptibility (infection load) to a common parasite (trematode). We also explored behavioral (swimming activity) and physiological (baseline corticosterone (CORT) release rates) changes induced by these light conditions, which may mediate changes in the other measured parameters. We found that both intensified daytime illuminance and ALAN reduced hatching success. In contrast, for amphibians that successfully hatched, neither treatment affected amphibian survival or time to metamorphosis but individuals exposed to ALAN were larger at metamorphosis. The light treatments also had marginal effects; individuals in ALAN treatments were more susceptible to NaCl and trematodes. Finally, tadpoles exposed to ALAN moved significantly less than tadpoles in the control and intensified daytime illuminance treatments, while light had no effect on CORT release rate. Overall, changes in light conditions, in particular ALAN, significantly impacted an amphibian model in laboratory conditions. This work underscores the importance of considering not only the direct effects of light on fitness metrics but also the indirect effects of light with other abiotic and biotic stressors. Anthropogenic-induced changes to light conditions are expected to continue increasing over time so understanding the diverse consequences of shifting light conditions will be paramount to protecting wildlife populations.