Promoting anti-racism in the legal system: an application of the STYLE framework.

Racism is a critical social problem, and we present a framework to guide professionals in engaging in anti-racist practices. Professionals on the frontlines in psychology and related fields such as social work and public health have a responsibility to engage in anti-racist practices. Part of the professional role must be to advocate for justice through increased proximity to the issues and engagement in anti-oppressive practices. The current discourse introduces a framework through which people working in psychology and other related professions can promote anti-racism work, highlighting the legal system for illustrative purposes. While some professionals in psychology may not have direct experience with the legal system, many of the individuals served by psychologists do (e.g., clients/patients, students, community members). Our framework is represented by the acronym STYLE (Self-examination, Talk about racism, Yield time to anti-racism work, Learn about structural racism, Evaluate policies and practices). The goal of STYLE is to expand anti-racism science and practice within psychology and related fields. We describe new roles for professionals in dismantling health inequities and offer specific pathways to develop critical partnerships toward this aim. STYLE explicitly encourages active, intentional involvement of affected community members in the development and evaluation of approaches to health services. To achieve equity and to promote individual and organizational growth in anti-racism and ultimately anti-oppression work, professionals must focus on changing their STYLE.

State-Level Alcohol Environments and Sexual Identity Disparities in Binge Drinking in the Behavioral Risk Factor Surveillance System.

Purpose: Binge drinking disparities by sexual identity are well documented. Stronger alcohol policy environments reduce binge drinking in the general population. We examined whether state-level alcohol policy environments have the same association with binge drinking among lesbian, gay, and bisexual (LGB) adults as among heterosexual adults. Methods: Binge drinking, sexual identity, and demographic characteristics were extracted from the 2015 to 2018 Behavioral Risk Factor Surveillance System. The strength of the alcohol policy environment was measured by using the Alcohol Policy Scale (APS) score. We estimated the association between APS score and binge drinking by using logistic regression and included an interaction term between APS score and sexual identity. Results: The interaction between APS score and sexual identity was not significant, and findings differed between women and men. Among women, a higher APS score was associated with lower odds of binge drinking (adjusted odds ratio [aOR]: 0.96, 95% confidence interval [CI]: 0.94-0.99). Differences in binge drinking by sexual identity remained after adjusting for individual and state-level factors (e.g., the percentage of LGB adults in the state). Compared with heterosexual women, the odds of binge drinking were 43% higher (aOR: 1.43, 95% CI: 1.17-1.75) among lesbian women and 58% higher (aOR: 1.58, 95% CI: 1.40-1.79) among bisexual women. A higher APS score was not associated with binge drinking among men. Conclusion: Stronger state-level alcohol policy environments were associated with lower binge drinking among women. Lesbian and bisexual women were still more likely to engage in binge drinking compared with heterosexual women even in states with stronger alcohol policy environments.

Mental Distress in the United States at the Beginning of the COVID-19 Pandemic.

Objectives. To assess the impact of the COVID-19 pandemic on mental distress in US adults.Methods. Participants were 5065 adults from the Understanding America Study, a probability-based Internet panel representative of the US adult population. The main exposure was survey completion date (March 10-16, 2020). The outcome was mental distress measured via the 4-item version of the Patient Health Questionnaire.Results. Among states with 50 or more COVID-19 cases as of March 10, each additional day was significantly associated with an 11% increase in the odds of moving up a category of distress (odds ratio = 1.11; 95% confidence interval = 1.01, 1.21; P = .02). Perceptions about the likelihood of getting infected, death from the virus, and steps taken to avoid infecting others were associated with increased mental distress in the model that included all states. Individuals with higher consumption of alcohol or cannabis or with history of depressive symptoms were at significantly higher risk for mental distress.Conclusions. These data suggest that as the COVID-19 pandemic continues, mental distress may continue to increase and should be regularly monitored. Specific populations are at high risk for mental distress, particularly those with preexisting depressive symptoms.

Race/Ethnicity Differences in Trends of Marijuana, Cigarette, and Alcohol Use Among 8th, 10th, and 12th Graders in Washington State, 2004-2016.

Accurate estimates of substance use in the teenage years by race/ethnicity may help identify when to intervene to prevent long-term substance use disparities. We examined trends in past 30-day use of marijuana, cigarette, and alcohol among 8th, 10th, and 12th graders in Washington State, which passed a recreational marijuana law in 2012 and initiated retail marijuana sales in 2014. Data are from the 2004-2016 Washington Healthy Youth Surveys (n = 161,992). We used time series regression models to assess linear and quadratic trends in substance use for the full sample and stratified on race/ethnicity and grade level and examined relative differences in prevalence of use by race/ethnicity. In Washington, across all racial/ethnic groups, marijuana use peaked in 2012. Although there was not a significant overall change in marijuana use for the full sample across the study period, there was a statistically significant increase in use among 12th graders and a statistically significant decrease among 8th graders. Relative to Whites, Asians had a lower prevalence of marijuana use, whereas all other race/ethnicity groups had a higher prevalence of use. Prevalence of marijuana use is particularly high among American Indian/Alaska Native and Black youth and has increased most rapidly among 12th grade Hispanic/Latinx youth. There were large and statistically significant decreases in alcohol and cigarette use across the study period for the full sample, as well as for each race/ethnicity group. These findings highlight the need for continued monitoring of trends in use among these groups and potentially warrant consideration of selective interventions that specifically focus on students of color and that include developmentally-appropriate strategies relevant to each grade.

Validation of a substance and alcohol use assessment instrument among orphans and vulnerable children in Zambia using Audio Computer Assisted Self-Interviewing (ACASI).

BACKGROUND: Substance and alcohol misuse is a global problem that increases the risk of HIV infection. This is a concern among orphans and vulnerable children (OVC) in sub-Saharan Africa who may have elevated substance use rates. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) is a reliable and valid instrument of substance use among adults in primary care high-income settings. This study examined psychometric properties of the ASSIST among OVC in Zambia using Audio Computer Assisted Self-Interviewing (ACASI). METHODS: Baseline data from an ongoing randomized trial of interventions to reduce HIV risk behaviors were analyzed. The analysis included 502 OVC ages 13-17 living in low-income, high-density neighborhoods in Lusaka, Zambia. Internal consistency of the ASSIST was assessed and discriminant validity was measured using items from the Youth Self Report as criterion variables. RESULTS: Internal reliability was strong with a Cronbach's alpha of ≥0.80 for each of the specific substance scales and total substance involvement. For all substances except tobacco and sedatives, discriminant validity was demonstrated in distinguishing between low risk use and moderate use. Sensitivity and specificity analysis indicated adequate area under the curve across substance types (AUC range: 0.68-0.80). Discrimination between moderate and high risk was demonstrated for alcohol and total substance involvement. CONCLUSIONS: ASSIST administered via ACASI is a reliable instrument and an appropriate tool for distinguishing between low and hazardous substance use among adolescent OVC populations in sub-Saharan Africa. Additional examination is warranted to determine its ability to measure gradations of severity within hazardous use.

Not in My Back Yard: A Comparative Analysis of Crime Around Publicly Funded Drug Treatment Centers, Liquor Stores, Convenience Stores, and Corner Stores in One Mid-Atlantic City.

OBJECTIVE: This research examined whether publicly funded drug treatment centers (DTCs) were associated with violent crime in excess of the violence happening around other commercial businesses. METHOD: Violent crime data and locations of community entities were geocoded and mapped. DTCs and other retail outlets were matched based on a Neighborhood Disadvantage score at the census tract level. Street network buffers ranging from 100 to 1,400 feet were placed around each location. Negative binomial regression models were used to estimate the relationship between the count of violent crimes and the distance from each business type. RESULTS: Compared with the mean count of violent crime around drug treatment centers, the mean count of violent crime (M = 2.87) was significantly higher around liquor stores (M = 3.98; t test; p < .01) and corner stores (M = 3.78; t test; p < .01), and there was no statistically significant difference between the count around convenience stores (M = 2.65; t test; p = .32). In the adjusted negative binomial regression models, there was a negative and significant relationship between the count of violent crime and the distance from drug treatment centers (ß = -.069, p < .01), liquor stores (ß = -.081, p < .01), corner stores (ß = -.116, p < .01), and convenience stores (ß = -.154, p < .01). CONCLUSIONS: Violent crime associated with drug treatment centers is similar to that associated with liquor stores and is less frequent than that associated with convenience stores and corner stores.

Racial/ethnic differences in associations between neighborhood socioeconomic status, distress, and smoking among U.S. adults.

Neighborhood disadvantage may increase smoking by increasing distress, while neighborhood affluence may reduce smoking by increasing positive affect. We examined whether relationships between neighborhood socioeconomic status (SES) and daily smoking operated through distress and positive affect. Simultaneous multivariate path models used pooled cross-sectional data from the 2000 and 2005 National Alcohol Surveys (15,963 respondents; weighted N = 10,753) and the 2000 Decennial Census. Multiple groups analysis assessed differences by gender and race/ethnicity. Covariates included neighborhood immigrant concentration and individual-level demographics. In the full sample, neighborhood disadvantage significantly increased smoking and neighborhood affluence significantly decreased smoking, with no indirect paths through either distress or positive affect. Unique among Hispanics, affluence resulted in decreased smoking indirectly through reduced distress. Relationships between affect and smoking also varied by race/ethnicity, with no significant differences by gender. Interventions targeting neighborhood socioeconomic status and distress may help reduce smoking, particularly for racial/ethnic minorities.

Evaluating Nighttime Observational Measures of Neighborhood Disorder: Validity of the Nighttime NIfETy Assessment.

While there are a growing number of observational instruments to assess the built and social dimensions of the neighborhood environment, there are few reliable and validated instruments; there are no instruments that assess the neighborhood environment during nighttime hours, a potential peak period of health and safety risk. The purpose of this investigation is to establish the metric properties of Neighborhood Inventory for Environmental Typology (NIfETy) Instrument nighttime ratings. Reliability of the scale was measured by internal consistency reliability and test re-test correlation. Validity was evaluated through correlation with the daytime NIfETy rating and regression models with local violent crime data. The nighttime items had good internal consistency (α = .81-82) for the total scale and acceptable internal consistency for a seven-item nighttime disorder scale (α = .66-.71). Future investigations will examine the nighttime NIfETy and its association with specific risk behaviors to evaluate changes in neighborhood environment.

Mental health service use among high school students exposed to interpersonal violence.

BACKGROUND: Violence-exposed youth rarely receive mental health services, even though exposure increases risk for academic and psychosocial problems. This study examines the association between violence exposure and mental health service contact. The 4 forms of violence exposure were peer, family, sexual, and witnessing. METHODS: Data are from 1534 Boston public high school students who participated in a 2008 self-report survey of violence exposure and its correlates. Multivariate logistic regressions estimated associations between each form of violence with service contact, then examined whether associations persisted when controlling for suicidality and self-injurious behaviors. RESULTS: In unadjusted models, violence-exposed students more often reported service contact than their peers. However, in multivariate models, only exposure to family (odds ratio [OR] = 1.69, 95% confidence interval [CI] = 1.23-2.31) and sexual violence (OR = 2.34, 95% CI = 1.29-4.20) were associated with service contact. Associations attenuated when controlling for suicidality and self-injurious behaviors, indicating they were largely explained by self-harm. Sexual violence alone remained associated with mental health service contact in fully adjusted models, but only for girls (OR=3.32, 95% CI=1.30-8.45), suggesting sex-specific pathways. CONCLUSIONS: Associations between adolescent violence exposure and mental health service contact vary by forms of exposure. Outreach to a broader set of exposed youth may reduce the impact of violence and its consequences for vulnerable students.

The Modified Depression Scale (MDS): A Brief, No-Cost Assessment Tool to Estimate the Level of Depressive Symptoms in Students and Schools.

Adolescent health researchers and practitioners are frequently interested in assessing depression as part of student screening and for school-wide prevention and intervention planning. However, this task is challenging given the lack of free, brief assessments of depressive symptoms in youth. This study evaluated the psychometric properties of an adapted version of the Modified Depression Scale (MDS). Data came from a school-based survey of 9th-12th graders in Boston (N=1,657). We assessed internal consistency reliability and known-groups validity, in addition to the feasibility of establishing a dichotomous cut-point to classify adolescents as having high versus low depressive symptoms. We also evaluated the validity of the adapted MDS as a school-wide measure. At the student-level, the adapted MDS demonstrated acceptable internal consistency. Students engaging in risk behaviors (e.g., substance use) or who were victimized (e.g., bullied) had significantly higher depressive symptom scores. Students who endorsed four or five MDS symptoms often or always had a heightened risk of suicidal ideation, substance use, and failing grades when compared to students who endorsed three or fewer symptoms often or always. At the school-level, higher mean levels of depressive symptoms in a school were associated with higher mean levels of suicidal ideation and failing grades. Results of this study suggest that the adapted MDS is a promising measurement tool that could be useful to school-based professionals and researchers to evaluate depressive symptoms in adolescents and ascertain the prevalence of depressive symptoms in schools.

Training mental healthcare providers to reduce at-risk patients' access to lethal means of suicide: evaluation of the CALM Project.

The objective of this study was to evaluate the "CALM" (Counseling on Access to Lethal Means) training, in which community-based mental health care providers were trained to work with at-risk clients and their families to assess and reduce access to lethal means of suicide, including firearms. In 2006, CALM trainers conducted workshops in 7 community-based mental health care centers in New Hampshire towns. Participants completed a post-test immediately after the workshop and a follow-up questionnaire approximately 6 weeks later. At follow-up, 65% reported that they had counseled clients' parents about access to lethal means (n = 111). Findings also indicate that the workshop influenced participants' attitudes, beliefs, and skills regarding conducting lethal means counseling.

The growth of neighborhood disorder and marijuana use among urban adolescents: a case for policy and environmental interventions.

OBJECTIVE: This study examines the growth of neighborhood disorder and subsequent marijuana use among urban adolescents transitioning into young adulthood. METHOD: Data are derived from a longitudinal sample of 434 predominately African American 12th graders followed-up at 2 years after high school. The data are rich in repeated measures documenting substance use and misuse and neighborhood characteristics. Growth mixture modeling was used to examine how neighborhood disorder trajectories, measured through the presence of abandoned buildings on the blocks where participants reside, influence subsequent drug use beginning in late adolescence and into young adulthood. RESULTS: A four-class solution characterizing neighborhood growth was selected as the final model and included rapidly improving, slightly improving, always-good, and deteriorating neighborhoods. Young adults living in neighborhoods that had been deteriorating over time were 30% more likely to use marijuana 2 years after high school than adolescents living in always-good neighborhoods (odds ratio = 1.30, p = .034). There was no relationship between living in a neighborhood that was improving and marijuana use. CONCLUSIONS: This study identified a salient and malleable neighborhood characteristic, abandoned housing, which predicted elevated risk for young-adult marijuana use. This research supports environmental strategies that target abandoned buildings as a means to improve health and health behaviors for community residents, particularly young-adult substance use.

Neighborhood-level factors associated with physical dating violence perpetration: results of a representative survey conducted in Boston, MA.

Neighborhood-level characteristics have been found to be associated with different forms of interpersonal violence, but studies of the relationship between these characteristics and adolescent dating violence are limited. We examined 6 neighborhood-level factors in relation to adolescent physical dating violence perpetration using both adolescent and adult assessments of neighborhood characteristics, each of which was aggregated across respondents to the neighborhood level. Data came from an in-school survey of 1,530 public high school students and a random-digit-dial telephone survey of 1,710 adult residents of 38 neighborhoods in Boston. Approximately 14.3% of the youth sample reported one or more acts of physical aggression toward a dating partner in the month preceding the survey. We calculated the odds of past-month physical dating violence by each neighborhood-level factor, adjusting for school clustering, gender, race, and nativity. In our first 6 models, we used the adolescent assessment of neighborhood factors and then repeated our procedures using the adult assessment data. Using the adolescent assessment data, lower collective efficacy (AOR = 1.95, 95% CI = 1.09-3.52), lower social control (AOR = 1.92, 95% CI = 1.07-3.43), and neighborhood disorder (AOR = 1.19, 95% CI = 1.05-1.35) were each associated with increased likelihood of physical dating violence perpetration. However, when we used the adult version of the neighborhood assessment data, no neighborhood factor predicted dating violence. The implications and limitations of these findings are discussed.

Gun possession among Massachusetts batterer intervention program enrollees.

Batterers with access to firearms present a serious lethal threat to their partners. The purpose of this exploratory study is to estimate the prevalence of and risk markers for gun possession among Massachusetts men enrolled in batterer intervention programs. The authors found that 1.8% of the men reported having a gun in or around their home. Those most likely to report having a gun were White, earned 25,000 US dollars or more per year, had served in the military, engaged in problem gambling, and had attempted homicide or threatened their partner with a firearm. Recommendations for strengthening relevant gun laws both within and outside of Massachusetts are discussed.