"If the Woman Doesn't Prevent, You Will Become Pregnant": Exploring Male Involvement in Contraceptive Use Preceding Unplanned Pregnancy in Sierra Leone.

Globally, millions of unintended pregnancies occur each year resulting in a host of social, economic, and health-related problems. Improving knowledge of and access to family planning services is an effective way to prevent unintended pregnancy, and research suggests that men's involvement promotes greater contraceptive uptake. To explore this issue, we assess contraceptive knowledge, attitudes, and behaviors among Sierra Leonean men who experienced an unplanned pregnancy. Findings indicate that men's participation in family planning was limited due to barriers including inadequate knowledge about contraception, poor access to services, and gender norms that consider family planning a woman's responsibility. As a result, men often resorted to a pattern of control that put the onus of contraceptive use on women and blamed women when they became pregnant, without considering their own role in pregnancy prevention. We suggest that family planning policies and interventions both engage men and address the barriers to their participation in reproductive health.

Longitudinal effects of Youth Empowerment Solutions: Preventing youth aggression and increasing prosocial behavior.

Youth violence remains a significant public health problem despite efforts to address it. We describe the evaluation results of Youth Empowerment Solutions (YES), an after-school active learning program implemented by trained local teachers and designed to engage middle school youth in multi-systematic promotive behaviors at the individual-, interpersonal-, and community-level to make lasting positive changes within the context of institutional disadvantages, such as racism. First, we used a modified randomized controlled trial design to examine the direct and indirect influence of YES on prosocial and delinquent behaviors 12 months after the conclusion of the program, through youth empowerment. Next, we evaluated these models by race, to determine if the intervention equitably promotes prosocial outcomes and decreases aggressive behaviors. Among 329 middle school students, YES participation enhanced prosocial behaviors through empowerment, and directly reduced aggressive behaviors a year after the conclusion of the program. This trend was particularly pronounced for African American youth. These effects were found after controlling for age, sex, and behavioral outcomes at baseline, and across different schools and teachers, suggesting that YES can also be sustainable and readily implemented by communities. The implications of the results for youth violence prevention, empowerment theory and intervention development and practice for ethnic minority youth who face structural disenfranchisement are discussed.

Electronic Teen Dating Violence Curves by Age.

Electronic dating violence is a form of violence perpetrated through electronics between dating partners and is associated with worse mental health, greater risk of substance use, and increased risk of in-person forms of dating violence. Though prevalent and seeming to increase in occurrence across adolescence, little is known about trajectories of electronic dating violence throughout adolescence and both risk and protective factors predicting a given trajectory. Latent growth models were used to evaluate change over time in three specific domains of electronic dating violence: harassment, coercion, and monitoring. Data are drawn from two cohorts who were surveyed annually for four years (2013-2017) from age 12 to 15 (n = 543; 48.3% female) and 15 to 18 (n = 597, 46.6% female), respectively. For all three domains of electronic dating violence, a quadratic model fit best. In general, electronic dating violence increased from early adolescence until a peak around age 16 or 17, and then leveled off. Threat-based adverse childhood experiences (i.e., exposure to physical child abuse, parental intimate partner violence, etc.) and earlier engagement in dating behaviors increased long-term risk for both age cohorts. Protective factors such as parental monitoring decreased risk but seemed to only have protective influence at developmentally-specific periods (i.e., during the developmental period of early adolescence). A better understanding of the risk and protective factors that affect the increase of electronic dating violence during adolescence is necessary to develop effective age-appropriate prevention and intervention strategies for youth.

Adolescent Risk of Dating Violence and Electronic Dating Abuse: A Latent Class Analysis.

Electronic forms of dating violence among youth are common yet little is known about how these forms of violence overlap with the commonly studied domains of physical, sexual and verbal teen dating violence. Using factor analysis and latent class analysis, this study identifies patterns of electronic, verbal, physical and sexual dating violence victimization and perpetration in 9th and 12th graders. Data are from 470 9th (n = 190; 60.5% female; mean age = 12.0 years, age range: 11.3-13.8) and 12th graders (n = 280; 63.9% female; mean age = 14.9 years, age range: 14.0-16.6) from southeastern Michigan. A 5-class solution for 9th graders and a 6-class solution for 12th graders were selected given fit and interpretability. Classes were characterized by domain(s) of violence, as opposed to perpetration or victimization. Three domains of electronic dating aggression were identified: monitoring, harassment, and coercion. Electronic dating aggression was present in the majority of classes, and overlapped substantially with other domains of violence. The highest risk class had risk of victimization and perpetration for all types of dating violence (electronic monitoring, electronic harassment, electronic coercion, verbal violence, physical violence and sexual violence). Drug use and experiencing one or more adverse childhood experiences predicted membership in a higher risk group for the older cohort, while alcohol consumption predicted higher risk for the younger cohort. The findings from this study show overlap between dating violence domains and imply that domains of electronic dating violence are important to consider in conjunction with physical, sexual and verbal domains, to address teen dating violence.

Adolescent Exposure to Violence and Intimate-Partner Violence Mediated by Mental Distress.

Adolescent exposure to violence (ETV) is associated with multiple negative health outcomes. Despite evidence linking adolescent ETV with later experiences of physical, sexual and psychological intimate partner violence (IPV) victimization, more longitudinal evidence is needed, and potential explanatory mechanisms should be tested. We examine data collected over 17 years to analyze the mediating effects of mental distress and substance use on the association between cumulative ETV in adolescence and IPV in adulthood. Adolescent (M ages=15-18 years) ETV was associated with IPV outcomes in adulthood (M age=32 years). In parallel mediation models, mental distress in emerging adulthood (M ages=20-23 years) fully mediated the effect of adolescent ETV on later IPV outcomes. Although substance use predicted experience of IPV, it did not mediate the association between ETV and IPV. These findings have implications for understanding trajectories of risk following violence exposure and inform intervention work through identifying developmental periods where ETV contributes to later IPV victimization.

Community-Engaged Neighborhood Revitalization and Empowerment: Busy Streets Theory in Action.

Busy streets theory predicts that engaging residents in physical revitalization of neighborhoods will facilitate community empowerment through the development of sense of community, social cohesion, collective efficacy, social capital, and behavioral action. Establishing safe environments fosters positive street activity, which reinforces neighborhood social relationships. A community-engaged approach to crime prevention through environmental design (CE-CPTED) is one promising approach to creating busy streets because it engages residents in collaborative interactions to promote safer environments. Yet, few researchers have studied how CE-CPTED may be associated with busy streets. We interviewed 18 residents and stakeholders implementing CE-CPTED in Flint, Michigan. We studied three neighborhoods with different levels of resident control over CE-CPTED. Participants described how CE-CPTED implementation affected their neighborhood. Participants from all three neighborhoods reported that CE-CPTED was associated with positive street activity, sense of community, and collective efficacy. Participants from neighborhoods with higher resident control of CE-CPTED reported more social capital and behavioral action than those from neighborhoods with less resident control. Our findings support busy streets theory: Community engagement in neighborhood improvement enhanced community empowerment. CE-CPTED that combines physical revitalization with resident engagement and control creates a potent synergy for promoting safe and healthy neighborhoods.

Associations between perceived threats and firearm behaviors among US adults.

INTRODUCTION: The number of US adults who own and carry a firearm for self-defense is rising. Research has established that owning or carrying a firearm increases the risk of injury and death for firearm owners and the people in their lives. The present study sought to better understand this paradox by estimating associations of perceived specific and diffuse threats with firearm behaviors among US adults. METHODS: The team used data from the 2023 National Firearm Attitudes and Behaviors Study, a nationally representative cross-sectional survey of US adults. Binary and ordinal logistic regression estimated associations of perceived specific (fear of attack in the community, fear of someone breaking into the home) and diffuse threats (belief in a dangerous world) with firearm ownership and carriage frequency, overall and stratified by gender. Adjusted models controlled for violence exposures and demographic characteristics. The team conducted analyses in 2024. RESULTS: Among all US adults, the perceived specific threat of someone breaking into the home was associated with firearm ownership (aORs: 1.09[0.98, 1.23]). Among firearm-owning adults, the diffuse threat of belief in a dangerous world was associated with firearm carriage frequency (1.11[0.98, 1.25]). Both associations persisted among men (aORs=1.27[1.05-1.52] and 1.15[1.01-1.31], respectively), and analyses found no associations between perceived threats and firearm behaviors among women. CONCLUSIONS: Perceived threats are associated with firearm behaviors among US men, even after accounting for the actual violence they report experiencing or witnessing.

Measuring Electronically Shared Rape Myths: Scale Creation and Correlates.

Increased access to information online (e.g., social media) provides opportunities for exposure to rape myths (i.e., false beliefs about incidents of sexual assault). Social media, in particular, may serve a critical role in shaping rape culture. Thus, it is important to identify ways to assess online exposure to rape myths, especially given the influence online exposure may have on offline behaviors. Data were analyzed from 2,609 18-25-year-old participants (mean age = 20.9 years; 46.1% male; 71.6% White) recruited in 2017 through social media to complete an online survey on experiences and perceptions of sexual violence. We used exploratory and confirmatory factor analyses (EFA, CFA) to evaluate the relatedness of nine items adapted to reflect rape myths posted by friends on social media. We split the sample into training (50%) and testing (50%) sets for the EFA and CFA, respectively, then evaluated the correlation between experiences of sexual violence, substance use, and social media use and exposure to online rape myths. Eigenvalues (1-factor: 5.509; 2-factor: 0.803; 3-factor: 0.704; 4-factor: 0.482), factor loadings, fit statistics (RMSEA: 0.03; CFI: 0.99; TLI: 0.99; SRMR: 0.057), interpretability, and existing theory supported a 1-factor solution, which was supported by CFA fit statistics (RMSEA: 0.021; CFI: 0.99; TLI: 0.99; SRMR: 0.038). Cronbach's alpha of the nine items was .77. Greater exposure to online rape myths was associated with greater likelihood of attempted rape perpetration (ß = .052, SE = .016, p < .005), rape victimization (ß = .045, SE = .009, p < .005), use of illicit drugs (ß = .021, SE = 0.008, p < .05), being male (ß = .017, SE = .008, p < .05), and being younger (ß = -.008, SE = .002, p < .005). Our findings support assessing exposure to online rape myths, which may be important for informing sexual violence prevention and intervention efforts.

Longitudinal Effects of Electronic Dating Violence on Depressive Symptoms and Delinquent Behaviors Across Adolescence.

Depressive symptoms and delinquent behaviors that emerge during adolescence pose both short- and long-term negative outcomes. Though there is growing evidence that exposure to teen dating violence is also associated with a greater likelihood of depressive symptoms and delinquent behaviors such as engaging in peer violence and substance use, less is known about the effects of specific forms of electronic dating violence (i.e., electronic harassment, electronic coercion, and electronic monitoring) across adolescence on depressive symptoms and delinquent behaviors. Data were drawn from a 4-year prospective longitudinal study of two cohorts of youth followed from age 12 to 15 (n = 526, 52% female) and age 15 to 18 (n = 592, 53% female). Two mixed-effects models (stratified by cohort) were employed to evaluate depressive symptoms and delinquent behavior outcomes by exposure to electronic harassment, electronic coercion, and electronic monitoring, while accounting for verbal dating violence, physical dating violence, sexual dating violence, exposure to threat-based adverse childhood experiences, exposure to deprivation-based adverse childhood experiences, and gender across all four waves of data collection. Higher exposure to electronic sexual coercion was predictive of increased depression (ß = .015, p = .018). Increased exposure to electronic sexual coercion (ß = .007, p = .004) and electronic monitoring (ß = .008, p = .045) were both predictive of more delinquency across adolescence. By delineating the effects of in-person verbal, physical, and sexual dating violence with unique electronic domains, we found unique additional risk from domains of electronic dating violence, which was particularly pronounced for youth who reported electronic sexual coercion. Electronic sexual coercion heightens the risk of depressive symptoms and delinquent behaviors in males and females beyond the risk presented by in-person forms of dating violence and should be accounted for in prevention and intervention programs. Future research should explore the effect of perceived normativity on the prevalence of electronic harassment and subsequent influence on outcomes.

Suicidal Ideation in American Indian and Alaskan Native College-Attending Students.

INTRODUCTION: Despite being at the highest risk of suicide, American Indian/Alaskan Native (AIAN)-emerging adults are underrepresented in mental health research. There is great diversity in individual and community experiences and access within AIAN-identifying individuals, prompting the need for research on risk and protective factors of suicidality within AIAN-emerging adults. METHODS: Data from AIAN-identifying emerging adults (mean age = 24.4 years) collected between 2017 and 2020 (n=2,551) were drawn from the Healthy Minds Study, a national annual panel study on mental/behavioral health within higher education settings. Multivariate logistic regressions (conducted in 2022) were used to evaluate the risk and protective factors associated with suicidality (ideation, planning, attempt) by gender (male, female, trans/gender nonbinary). RESULTS: Suicidal ideation rates were high; over 1 in 5 AIAN-emerging adults reported ideation, 1 in 10 reported planning, and 3% reported attempt in the previous year. AIANs identifying as a gender minority (trans/nonbinary) were 3 times more likely to report suicidality across event type. Across all gender identities, suicidality was significantly associated with nonsuicidal self-injury and self-perceived need for help; flourishing was predictive of lower odds of suicidality event for male- and female-identifying AIAN students. CONCLUSIONS: Suicidality is high for AIAN college-attending students, particularly for gender minority-identifying students. Embracing a strength-based approach to highlight student awareness of mental health services is critical. Future research should examine the protective factors as well as community and structural factors that might provide meaningful support within and outside of university contexts for students facing individual, relational, or challenges within their communities.

Evaluating Community Factors Associated With Individually Held Intimate Partner Violence Beliefs Across 51 Countries.

Globally, one in three women will experience intimate partner violence (IPV) within her lifetime. IPV attitudes are highly predictive of IPV. While a wealth of literature on risk factors related to IPV exist, an overarching critique in the field is the lack of studies examining risk factors across the socioecological framework. Using data from multiple administrative and individual surveys, this study fills a gap in the literature by evaluating the effect of meso-influences on physical IPV attitudes (i.e., permissibility of a man beating his wife) while accounting for known micro- and macro-risk factors in 64,466 individuals across 51 low-, middle- and high-income countries. Mixed-effects modeling was used to evaluate factors and identify comparative contributions of each factor representing the socio-ecological levels. We tested five multivariate logistic models. The final model indicated that greater perceived neighborhood disorder and less perceived neighborhood security were associated with physical IPV attitudes, while individual endorsement of interpersonal violence, belief in corporal punishment of children, holding greater patriarchal beliefs, being male, being separated from a significant partner, reporting greater household hunger and nationally lower levels of female literacy were associated with beliefs that IPV is acceptable. Overall, the findings of this study support that IPV is a complex behavior, influenced by factors across socio-ecological domains. However, data on neighborhood structural factors (i.e., exosystem) would help unpack the mechanisms between macro-, meso- and micro-level factors and may be important for protecting women from violence.

Male and Female Perceptions and Experiences of Sexual and Gender-based Violence in South Kivu, Eastern DRC.

Conflict settings are often the context of some of the highest rates of sexual and gender-based violence (SGBV). Although women are disproportionately the victims of SGBV, they are not the only victims. Indirect impacts of SGBV also impact men, families, and communities. Examining SGBV as only a woman's concern reinforces the hegemonic gender-binary view that SGBV somehow does not include men, who can be direct victims of SGBV, family members of female victims of SGBV, and/or perpetrators of SGBV. This qualitative study seeks to fill a gap by exploring the impact of SGBV on individuals, families, and communities, and potential options to ameliorate those issues. Data were collected in 2019 from community-based discussions in South Kivu, Democratic Republic of Congo. Women described being direct victims of SGBV, as well as the burden of being at constant alert to the possible threat of violence. Men talked more about SGBV being perpetrated against women, and the indirect effect on men's perception of their social husband and/or father role to protect and provide for their family. Taken together, women and men describe three types of violence: sexual violence by an unknown assailant who is often associated the rebel groups or the military; sexual violence from a known assailant within one's community; and sexual or physical violence within intimate partnerships (i.e., intimate partner violence). Women focused more on community-based solutions to reduce their exposure to violence, while men discussed the government's responsibility to end the long-standing conflict that has severely disrupted lives. Practically, these findings support the need to specify different types of SGBV, and the opportunity to tailor interventions by type.

Mental health problems among children in Sierra Leone: Assessing cultural concepts of distress.

Globally, over 13% of children and adolescents are affected by mental disorders, yet relatively little scholarship addresses how risk factors, symptoms, and nosology vary by culture and context, especially in young children living in post-conflict and low-resource settings. To address this gap, we conducted a qualitative study to identify and describe the most salient mental health problems facing children aged 6 to 10 years in Sierra Leone, as well as the thoughts, feelings, and behaviors related to these problems. Free list interviews (N = 200) and semi-structured interviews (N = 66) were conducted among caregivers, children, and other relevant key informants to explore risk factors and locally meaningful concepts of distress. Our findings indicate that children are faced with a variety of challenges in their social environments that contribute to distress, including hunger, unmet material needs, and excessive work. Our research identifies five contextually defined mental health problems faced by young children: gbos gbos (angry, destructive behavior), poil at (sad, disruptive behavior), diskoraj (sad, withdrawn), wondri (excessive worry), and fred fred (abnormal fear). The manifestations of these distress concepts are described in detail and contextualized according to Sierra Leone's history of war and current backdrop of poverty and insecurity. Implications are discussed for locally relevant diagnosis and treatment as well as for the wider literature on global child mental health.

Adolescent Adverse Childhood Experiences and Risk of Adult Intimate Partner Violence.

INTRODUCTION: Exposure to adverse experiences during adolescence may have significant implications for intimate partner violence during adulthood because it is during this developmental stage that many youth begin to have romantic relationships. Yet, few prospective longitudinal analyses on this topic exist. This study aims to fill a gap in the literature by examining the adverse childhood experiences during adolescence and intimate partner violence 15 years later during adulthood. METHODS: Multilevel negative-binomial regression was used to examine the relationship between adolescent adverse childhood experiences (age 13-19 years) and adult intimate partner violence (age 28-34 years) in 499 participants over 5 waves of data from a 24-year longitudinal study (Wave 1: 1994) based in Flint, Michigan. Adolescent adverse childhood experiences included being a victim of violence, observed family conflict, parental intoxication, parental divorce, and observed community violence. Data analysis was conducted between 2019 and 2020. RESULTS: First, investigators modeled the adverse childhood experience variables as a summary score to predict intimate partner violence during adulthood while controlling for known risk factors and individual random effects. Secondly, this study examined individual adverse childhood experiences iteratively to understand which adverse experiences predicted intimate partner violence in adulthood and found that observed community violence remained significant when accounting for all other adverse childhood experiences (ß=0.276, p<0.05). CONCLUSIONS: These findings support the negative effects of community violence in adolescence on later risk of intimate partner violence. Prevention interventions that focus on community health and violence prevention with a focus on healthy adolescent development may be pertinent in lowering intimate partner violence victimization in adulthood.

Perceived Neighborhood Characteristics and Experiences of Intimate Partner Violence: A Multilevel Analysis.

Within a lifetime, one in four women and more than one in 10 men will experience intimate partner violence (IPV). Researchers have begun to examine physical and social neighborhood risk factors of IPV, often using cross-sectional data. Most studies focus on risk or promotive factors. Often, neighborhood factors are studied through the lens of social disorganization theory, which focuses on how a neighborhood slips into a violent and crime-ridden place. Busy streets theory provides an alternative perspective, focusing on how building up community assets and resources may help create a safe and vibrant neighborhood. A conceptual approach that utilizes risk and promotive neighborhood variables may help develop new conceptual frameworks for understanding how context may decrease risk for, or moderate, the negative consequences of IPV. Using five waves of data from a 24-year longitudinal study, we employ multilevel linear regression models to examine the trajectory of IPV experiences in relation to positive perceptions of neighborhood, neighborhood cohesion, and informal social control in individuals aged 28 to 33 years. We control for the neighborhood and individual-level risk factors of alcohol consumption, drug use, observed neighborhood violence, and demographic factors of age, race, sex, and socioeconomic status. We found that positive perceptions of neighborhood, alcohol consumption, drug use, economic need, and observed neighborhood violence are associated with IPV. Levels of IPV risk were relatively constant within individuals across waves, but varied significantly between individuals. The measure of positive perceptions of neighborhood is derived from busy streets theory, which may be a useful conceptual framework for understanding how neighborhoods may contribute to positive social contexts that can protect residents from IPV experiences, and potentially other violent behavior. Additional research examining promotive social neighborhood features derived from busy streets theory may help expand our understanding of contextual factors that affect IPV.

Parenting and discipline in post-conflict Sierra Leone.

BACKGROUND: While the literature on physical punishment concludes that it has negative effects on children, the practice remains common in many countries. In post-conflict countries with nongovernmental organizations (NGO) operating in child protection, traditional disciplinary practices may conflict with international child rights agendas. The country of Sierra Leone has a unique history of conflict, abject poverty, low literacy, and weak governance - often, NGO agents are responsible for providing social services that the government is unable to consistently provide. OBJECTIVE: We examined how Sierra Leonean caregivers think about appropriate discipline for children, and whether they perceived any changes in their attitudes toward disciplinary practices since the end of the war. PARTICIPANTS AND SETTING: We collected data from parents and caregivers in urban, peri-urban, and rural areas of Sierra Leone's four districts. METHODS: We used focus groups (12 groups, n = 92) and individual interviews (n = 21) to collect data in 2013. Focus groups and interviews were conducted by research assistants fluent in Krio and English. We used a thematic content analysis approach. RESULTS: We found that physical discipline-"beating"-was widely acceptable and common. A few parents mentioned other means of discipline, such as withholding food. Parents widely agreed that parenting had changed since the war, and reported that child rights movements supported by NGOs had made it more difficult to discipline their children in traditional ways. CONCLUSIONS: Discipline was seen a central component of child-rearing and a means of ensuring safe and proper development. This may be a protective mechanism in the precarious, high poverty environment of post-war Sierra Leone. The negative responses of parents to NGO efforts to reduce physical punishment and other forms of child abuse suggest that grassroots approaches are needed to address this pervasive problem.