Neighborhood Income Inequality and Adolescent Relationship Aggression: Results of a Nationally Representative, Longitudinal Study.

Adolescent relationship aggression (ARA) is a prevalent public health issue with myriad adverse health outcomes. Experts suggest that a research focus on individual- and family-level risk factors for ARA has been too limited, proposing that research on the "outer layers" of the social-ecological model, including community-level risk factors, may hold promise for the development of interventions targeting ARA. This study assessed the longitudinal association between one community-level risk factor-income inequality-and ARA victimization and perpetration. The study also examined variations of this association by race/ethnicity, income, and/or sex. This study is based on 723 participants (351 male and 372 female participants) from the Survey on Teen Relationships and Intimate Violence (STRiV). We assessed data across two waves (2013 and 2016). Logistic regression models were used to assess the association between neighborhood income inequality and both ARA victimization and perpetration. We included interaction terms to assess whether these associations varied by race/ethnicity and/or income, and we stratified analyses by sex. We did not detect associations between income inequality and ARA victimization or perpetration in the overall sample. However, for female participants from families with more income, living in a neighborhood with more income inequality was associated with increased risk of ARA victimization (odds ratio [OR] = 1.163; p < .05). More affluent, compared with less affluent, adolescent girls in mixed-income neighborhoods may be at increased risk of ARA victimization.

The Impact of State Firearm Laws on Homicide Rates among Black and White Populations in the United States, 1991-2016.

This study aimed to investigate the potential differential effects of state-level firearm laws on black and white populations. Using a panel design, authors examined the relationship between state firearm laws and homicide victimization rates among white people and black people in 39 states during the period between 1991 and 2016. Authors modeled homicide rates using linear regression with year and state fixed effects and controlled for a range of time-varying, state-level factors. Results showed that universal background check laws and permit requirement laws were associated with lower homicide rates among both white and black populations, and "shall issue" laws were associated with higher homicide rates among both white and black populations. Laws that prohibit firearm possession among people convicted of a violent misdemeanor or require relinquishment of firearms by people with a domestic violence restraining order were associated with lower black homicide rates, but not with white homicide rates. Author identification of heterogeneity in the associations between state firearm laws and homicide rates among different racial groups has implications for reducing racial health disparities.

The Role of Racial Residential Segregation in Black-White Disparities in Firearm Homicide at the State Level in the United States, 1991-2015.

OBJECTIVE: To investigate the relationship between racial residential segregation and differences in Black-White disparities in overall firearm homicides across U.S states. METHODS: Using a linear regression, we evaluated the relationship between racial residential segregation, as measured by the index of dissimilarity, and the Black-White firearm homicide disparity ratio in 32 states over the period 1991-2015. To account for clustering of observations within states, we used a generalized estimating equations approach. RESULTS: After controlling for measures of White and Black deprivation, multivariate analysis showed that racial segregation was positively associated with the Black-White firearm homicide disparity. For each 10-point increase in the index of dissimilarity, the ratio of Black to White firearm homicide rates in a state increased by 39%. After controlling for levels of White and Black deprivation, racial segregation remained negatively associated with White firearm homicide rates and positively associated with Black firearm homicide rates. CONCLUSIONS: These findings suggest that racial segregation may increase the disparity in firearm homicide between the Black and White population.

Association Between Health Literacy and Parental Self-Efficacy among Parents of Newborn Children.

OBJECTIVE: To determine whether health literacy was associated with parental self-efficacy in a diverse sample of parents of newborns. We hypothesized that parents with lower health literacy would have lower parental self-efficacy. STUDY DESIGN: We conducted a cross-sectional analysis of baseline surveys from 253 English and Spanish speaking parents >18 years old with newborns <28 days old enrolled in a trial testing a multisite primary care-based parenting intervention. Surveys assessed parental, child, and environmental characteristics, and used validated instruments to measure health literacy and parental self-efficacy (total and 4 subtypes). Bivariate analyses identified parental, child, and environmental characteristics associated with parental self-efficacy. Multivariable linear regression models examined the associations between health literacy and parental self-efficacy, adjusting for covariates. RESULTS: Parents (median age, 29 years) were 92.1% female, 54.5% black/African American, and 29.6% Hispanic/Latino. More than one-half (58.9%) had completed some college education or more, 49.0% spoke mostly English, and 16.2% had low health literacy. In bivariate analyses, parental self-efficacy was significantly lower in parents with fewer household residents. In multivariable analyses, parents with low compared with high health literacy had significantly lower parental self-efficacy scores (total and 4 subtypes including caretaking procedures, evoking behaviors, reading behaviors and signaling, and situational beliefs). CONCLUSIONS: Lower health literacy was associated with lower parental self-efficacy in parents of newborns. To maximize impact on positive parenting behaviors and child outcomes, interventions assisting parents with low parental self-efficacy should consider strategies to address low health literacy.

The escalation dating abuse workshop for college students: Results of an efficacy RCT.

OBJECTIVE: Assess the efficacy of a college dating abuse (DA) prevention workshop. PARTICIPANTS: 85 students from Greek organizations. METHODS: Two fraternities and two sororities were randomized to intervention or waitlist control. Participants completed a baseline and 3-month follow-up survey. Data were analyzed using MANOVA. RESULTS: As compared to those in the control group, students assigned to the DA workshop felt more prepared to act as bystanders at follow-up and were more convinced that DA was a problem on campus. Those who saw the workshop also recognized more opportunities when they could intervene as bystanders with friends and strangers at follow-up than did controls. CONCLUSIONS: The DA workshop appears to have influenced students in the desired way, although not substantially. It is likely that a longer follow-up period and larger sample would reveal more meaningful changes from pre- to post-test.

PREVALENCE AND TYPES OF GENDER-AFFIRMING SURGERY AMONG A SAMPLE OF TRANSGENDER ENDOCRINOLOGY PATIENTS PRIOR TO STATE EXPANSION OF INSURANCE COVERAGE.

OBJECTIVE: Transgender individuals now have many options for medical intervention, including gender-affirmation surgeries. However, it is unknown how common it is for transgender individuals to undergo these surgeries. The purpose of this cross-sectional study was to assess the prevalence of gender-affirming surgeries among transgender patients in 2015, which was immediately prior to insurance changes that made gender-affirming surgery more affordable for Massachusetts residents. METHODS: A retrospective chart review of 99 transgender patients was performed at the Endocrinology Clinic at Boston Medical Center, an urban safety net hospital. The records for 99 transgender subjects who received treatment between 2004-2015, including 28 transmen and 71 transwomen, were examined. The outcome measures were the types of medical interventions chosen by transgender patients, which included hormone therapy, chest surgery, gonadectomy, genital surgery, and facial surgery. RESULTS: Thirty-five percent of subjects had undergone at least one gender-affirming surgery. Transmen were more likely to have had surgery than transwomen (54% vs. 28%). Twenty-five percent of patients had chest surgery, 13% had genital surgery or gonadectomy, and 8% had facial surgery. CONCLUSION: In 2015, a majority of transgender endocrinology clinic patients had not undergone any type of gender-affirmation surgery. Among those who did elect to have a surgery, genital surgery or gonadectomy were uncommon. The low rate of surgery among this sample of transgender patients may be attributable to the financial cost, lack of interest in surgery, or that genital surgery is not a high priority for transgender individuals relative to surgery to change visible features such as face and chest. Abbreviation: HT = hormone therapy.

Should US Physicians Support the Decriminalization of Commercial Sex?

According to the World Health Organization, "commercial sex" is the exchange of money or goods for sexual services, and this term can be applied to both consensual and nonconsensual exchanges. Some nonconsensual exchanges qualify as human trafficking. Whether the form of commercial sex that is also known as prostitution should be decriminalized is being debated contentiously around the world, in part because the percentage of commercial sex exchanges that are consensual as opposed to nonconsensual, or trafficked, is unknown. This paper explores the question of decriminalization of commercial sex with reference to the bioethical principles of beneficence, nonmaleficence, and respect for autonomy. It concludes that though there is no perfect policy solution to the various ethical problems associated with commercial sex that can arise under either criminalized or decriminalized conditions, the Nordic model offers several potential advantages. This model criminalizes the buying of sex and third-party brokering of sex (i.e., pimping) but exempts sex sellers (i.e., prostitutes, sex workers) from criminal penalties. However, ongoing support for this type of policy should be contingent upon positive results over time.

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.

Social and environmental contexts of adolescent and young adult male perpetrators of intimate partner violence: a qualitative study.

The purpose of the current study was to examine qualitatively the life contexts of young males enrolled in programs addressing perpetration of intimate partner violence (IPV). Semistructured interviews were conducted with 19 males recruited from these programs. Interviews were coded to examine life contexts and analyzed using a content analysis approach. Five themes emerged across interviews: (a) disruptive home environment; (b) lack of positive male role models; (c) a peer context characterized by substance use, gang involvement, and behaviors supporting the sexual maltreatment of girls; (d) school circumstances characterized by a lack of academic support; and (e) community exposures to violence. These factors were often interrelated within the various contexts of participants. Further research is needed to provide insight into whether and how these issues may contribute to IPV perpetration. Efforts to support young males regarding a broad array of concerns should be included in programming to reduce IPV perpetration.

Batterer intervention program enrollment and completion among immigrant men in Massachusetts.

This study describes immigrant clients enrolled in Massachusetts batterer intervention (BI) programs from 2002 to 2004 (N = 480). Our study sought to (a) describe the immigrant men enrolled in Massachusetts BI programs, (b) investigate whether immigrants were more or less likely to complete BI programs than were nonimmigrants, and (c) investigate whether immigrants in non-English, culturally specific groups were more or less likely to complete BI programs than were immigrants in mainstream groups. Of BI program clients, 14% were immigrants. Of these, 73% were not U.S. citizens. Immigrants were more likely to complete the programs than were nonimmigrants (54% vs. 38%). Although a greater proportion of immigrants who attended non-English groups completed the programs than did immigrants who attended mainstream groups (66% and 46%), neither the bivariate nor the adjusted odds ratio was statistically significant. Possible reasons for differences between immigrant and nonimmigrant characteristics and program completion rates 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.