The association between perceived community violence, police bias, race, and firearm carriage among urban adolescents and young adults.

Firearms are a leading cause of death among youth and young adults. Given community violence is an important correlate of youth firearm carriage, we evaluated: 1) If the association between perceived community violence and firearm carriage is stronger when perceived police bias is greater; and 2) If this moderated association differs by race. Cross-sectional data came from screening data for a longitudinal study of firearm behaviors among young adults seeking urban emergency department treatment between July 2017-June 2018 (N = 1264). We estimated Poisson regressions with robust error variance to evaluate associations between perceived community violence, police bias, race, and firearm carriage. Community violence was positively associated with firearm carriage (average marginal effect [AME]: 0.05; 95% Confidence Interval [CI]: 0.03, 0.07). We also found that the positive association between community violence and firearm carriage increased with higher perceptions of police bias (interaction p < 0.05). We did not find evidence of a three-way interaction by which the moderated association between violence exposure and firearm carriage by perceived police bias varied by race of the respondents. Our findings suggest that community-level strategies to reduce violence and police bias may be beneficial to decrease youth firearm carriage in socio-economically disadvantaged urban settings.

Comparison of two screeners predicting the future development of depression and posttraumatic stress disorder in Black men after serious injury.

Background To assess the predictive performance of two established, short clinical screeners in predicting the future development of post-injury depression and PTSD. Methods This was a prospective, cohort design with a 3-month follow-up. Black adult male trauma patients were enrolled at an urban, Level 1 trauma center. The Penn Richmond Screener and the Posttraumatic Adjustment Scale (PAS) were collected in-hospital. Participants were categorized as depressed using the Quick Inventory of Depressive Symptoms-Self Report and as positive for PTSD using the PTSD Check List - 5 (PCL-5) at 3-months post-discharge. Sensitivity, specificity, PPV and NPV of each screener were calculated. We used receiver operating curve (ROC) analyses to calculate the area under the curve (AUC) with 95% CI to assess predictive performance of each screener. Results A cohort of 623 hospitalized, injured Black men were enrolled during acute hospitalization. 503 participants (80.6%) were retained at 3-months and formed the analytic sample. Mean age was 36.8 years (SD 15.4), 53.1% of injuries were intentional; median injury severity score was 9. At 3 months, 35.3% had moderate to severe depression, 32.7% had significant PTSD symptoms, and 22.4% met criteria for both depression and PTSD. Penn Richmond Screener: sensitivity 0.68, specificity 0.56, and AUC 0.62 for PTSD, and sensitivity 0.64, specificity 0.63, and AUC 0.64 for depression. PAS: sensitivity 0.59, specificity 0.73, and AUC 0.66 for PTSD, and sensitivity 0.75, specificity 0.49, and AUC 0.62 for depression. Conclusions This study validated the performance of both screeners within the same population, allowing a direct comparison. Two predictive screeners, developed through different methods and in different countries, showed comparable predictive ability. These findings indicate that risk markers for adverse psychological consequences of traumatic injury share some core similarities across populations and countries.

Adolescent Perceptions of an Interactive Mobile Application to Respond to Teen Dating Violence.

Although research and intervention efforts in the United States have aimed to reduce teen dating violence (TDV), 10-year prevalence estimates suggest that TDV persists. Safety planning is an advocated intervention to reduce intimate partner abuse; yet, safety planning services for adolescents have not been systematically developed or tested. Personalized safety planning interventions that reflect teens' immediate risk, priorities, and resources may be a key prevention and empowerment tool. Thus, the current study examined adolescent perceptions of an existing safety planning app, myPlan. A small convenience sample of adolescents participated in focus groups. Focus groups investigated the feasibility of an app for TDV intervention and elicited feedback on how apps can better assist adolescents experiencing dating violence. Qualitative content analysis was used to identify themes and patterns in the data. The following themes emerged: (a) careful and thoughtful inclusion of diverse adolescents, (b) capturing unique safety dilemmas encountered by adolescents, (c) clarifying the signs of an unhealthy and abusive relationship, and (d) resources for immediate help. Adolescents were thoughtful in their consideration of the myPlan app and articulated specific ways in which future applications could be more responsive to their lived experiences and challenges. Mobile app or electronic interventions that are developed with an eye toward empowering adolescents to understand how abusive behaviors may manifest in their relationships, weigh the risk and benefits of intervening, and are informed about local resources available to them for help may be most successful in reducing TDV.

Advancing Health Equity and Social Justice in Forensic Nursing Research, Education, Practice, and Policy: Introducing Structural Violence and Trauma- and Violence-Informed Care.

Initial conceptualizations of violence and trauma in forensic nursing have remained relatively narrowly defined since the specialty's inception. The advent of trauma-informed care has been important but has limitations that obfuscate social and structural determinants of health, equity, and social justice. As forensic nursing practice becomes more complex, narrow definitions of violence and trauma limit the effectiveness of trauma-informed care in its current incarnation. In keeping with the nursing model of holistic care, we need ways to teach, practice, and conduct research that can accommodate these increasing levels of complexity, including expanding our conceptualizations of violence and trauma to advance health equity and social justice. The objective of this article is to introduce the concepts of structural violence and trauma- and violence-informed care as equity-oriented critical paradigms to embrace the increasing complexity and health inequities facing forensic nursing practice.

Type 2 Diabetes Prevalence, Distribution and Risk Factors in St. Kitts and Nevis, West Indies.

OBJECTIVES: This study in collaboration with the St. Kitts & Nevis Ministry of Health (MOH) investigated the prevalence of type 2 diabetes and its risk factors, the second leading cause of death in the country. METHODS: Medical records of patients between the ages of 18 and 75 as of January 1, 2010 treated between January 1, 2010 and December 31, 2015 in the government-funded health centers (HCs) were eligible for inclusion (N = 2737). All HC visits (n = 4169) generated by a representative sample of patients (n = 761) were evaluated using Caribbean Public Health Association Public Health Association (CARPHA) guidelines for risk ranges. RESULTS: The prevalence of type 2 diabetes is 23% and is concentrated in the 45-64 year-old cohort. Though women outnumber men 3:1 in the sample, gender-prevalence rates are similar (23% and 22% respectively). There is also evidence that comorbidities are prevalent among diabetics (76%) and many nondiabetics are at risk of diabetes (20%). CONCLUSION: This study confirmed the MOH's concerns that type 2 diabetes presents local risk and brings into question historic assumptions that women are at greater risk of diabetes than men.