Blood Lead Levels Among Children Aged <6 Years - Flint, Michigan, 2013-2016.

During April 25, 2014-October 15, 2015, approximately 99,000 residents of Flint, Michigan, were affected by changes in drinking water quality after their water source was switched from the Detroit Water Authority (DWA), sourced from Lake Huron, to the Flint Water System (FWS), sourced from the Flint River.* Because corrosion control was not used at the FWS water treatment plant, the levels of lead in Flint tap water increased over time. Adverse health effects are associated with lead exposure (1). On January 2, 2015, a water advisory was issued because of detection of high levels of trihalomethanes, byproducts of disinfectants.(†)(,)(§) Studies conducted by local and national investigators detected an increase in the prevalence of blood lead levels (BLLs) ≥5 µg/dL (the CDC reference level) among children aged <5 years living in Flint (2) and an increase in water lead levels after the water source switch (3). On October 16, 2015, the Flint water source was switched back to DWA, and residents were instructed to use filtered tap water for cooking and drinking. During that time, pregnant and breastfeeding women and children aged <6 years were advised to consume bottled water.(¶) To assess the impact on BLLs of consuming contaminated drinking water, CDC examined the distribution of BLLs ≥5 µg/dL among children aged <6 years before, during, and after the switch in water source. This analysis enabled determination of whether the odds of having BLLs ≥5 µg/dL before the switch differed from the odds during the switch to FWS (before and after the January 2, 2015, water advisory was issued), and after the switch back to DWA. Overall, among 9,422 blood lead tests in children aged <6 years, 284 (3.0%) BLLs were ≥5 µg/dL during April 25, 2013-March 16, 2016. The adjusted probability of having BLLs ≥5 µg/dL was 46% higher during the period after the switch from DWA to FWS (and before the January 2, 2015, water advisory) than during the period before the water switch to FWS. Although unrelated to lead in the water, the water advisory likely reduced tap water consumption and increased consumption of bottled water. Characterizing exposure to lead contaminated drinking water among children aged <6 years living in Flint can help guide appropriate interventions.

REPRINT OF: Physical and Mental Health Effects of Intimate Partner Violence for Men and Women.

EDITOR'S NOTE: This article is a reprint of a previously published article. For citation purposes, please use the original publication details: Coker AL, Davis KE, Arias I, et al. Physical and mental health effects of intimate partner violence for men and women. Am J Prev Med. 1985;1(6):1-8. BACKGROUND: Few population-based studies have assessed the physical and mental health consequences of both psychological and physical intimate partner violence (IPV) among women or men victims. This study estimated IPV prevalence by type (physical, sexual, and psychological) and associated physical and mental health consequences among women and men. METHODS: The study analyzed data from the National Violence Against Women Survey (NVAWS) of women and men aged 18 to 65. This random-digit-dial telephone survey included questions about violent victimization and health status indicators. RESULTS: A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV (relative risk [RR]=2.2, 95% confidence interval [CI]=2.1, 2.4) and abuse of power and control (RR=1.1, 95% CI=1.0, 1.2), but less likely than men to report verbal abuse alone (RR=0.8, 95% CI=0.7, 0.9). For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores. CONCLUSIONS: Both physical and psychological IPV are associated with significant physical and mental health consequences for both male and female victims.

Linking dating violence, peer violence, and suicidal behaviors among high-risk youth.

BACKGROUND: Gaps in the understanding of how different types of violent behavior are linked have limited the ability to design violence prevention efforts that can address multiple types of violence. The objective of this study was to quantify the associations among suicide attempts, and date and peer violence victimization and perpetration and to determine any differences in these associations by gender. METHODS: Analyses, computed in 2006 and 2007, used data from the Youth Violence Survey conducted in 2004. This survey was administered to over 80% of public school students in grades 7, 9, 11, and 12 (N=4131) in a high-risk, urban school district. Analyses were restricted to adolescents who dated in the past year (n=2888). Five forms of violent behaviors (i.e., dating violence perpetration, dating violence victimization, peer violence perpetration, peer violence victimization, and suicide attempts) were examined. RESULTS: Peer violence victimization was the most common type of violence reported (33.0%), followed by date violence victimization (30.7%), peer violence perpetration (29.9%), date violence perpetration (24.8%), and suicide attempts (11.2%). Among all students, 9.8% reported involvement in at least four of the five violent behaviors examined. All five forms of violent behaviors were associated. The highest ORs were observed for victimization and perpetration within either the dating or peer context. However, associations across contexts were also observed. CONCLUSIONS: There is a substantial overlap among different forms of violent behavior, suggesting that additional research is needed to better understand the factors that contribute to involvement in multiple forms of violence.

Measuring sex differences in violence victimization and perpetration within date and same-sex peer relationships.

This study examines sex differences in the patterns of repeated perpetration and victimization of physical violence and psychological aggression within dating relationships and same-sex peer relationships. Data were obtained from the Youth Violence Survey: Linkages among Different Forms of Violence, conducted in 2004, and administered to all public school students enrolled in grades 7, 9, 11 and 12 (N = 4,131) in a high-risk school district. Analyses of adolescents who dated in the past year (n = 2,888) show that girls are significantly more likely than boys to report physical violence and psychological aggression perpetration within dating relationships. However, boys are significantly more likely than girls to report physically injuring a date. Boys are also significantly more likely than girls to report physical violence victimization and perpetration within same-sex peer relationships. Implications and directions for future research are discussed.

Psychological responses to the sniper attacks: Washington DC area, October 2002.

BACKGROUND: This study assessed the psychological and behavioral responses of residents of the Washington DC metropolitan area to the October 2002 sniper shootings, as well as the association between measures of exposure to the shootings and elevated traumatic stress symptoms. METHODS: Random-digit-dial telephone survey of 1205 adults living in Washington DC and two surrounding counties during the shootings, conducted May 2003. Main outcome measures included self-reports regarding traumatic stress symptoms, perceptions of safety, behavioral responses, and exposures to incidents. RESULTS: Forty-five percent of residents reported going to public spaces such as parks and shopping centers less than usual, and 5.5% reported missing at least 1 day of work because of the sniper attacks. Women who reported living within 5 miles of any shooting incident were significantly more likely to report elevated traumatic stress symptoms-consistent with a probable diagnosis of post-traumatic stress disorder-than women who reported living farther from incidents (odds ratio = 4.2, 95% confidence interval = 1.9-9.3). Among men, there was no significant association between reported residential proximity and elevated traumatic stress symptoms. CONCLUSIONS: These results suggest the substantial behavioral and psychological impact that traumatic events such as these sniper shootings can have on communities. They support the importance of clinicians and community leaders addressing psychological functioning in the setting of such events that threaten a population. The results further suggest that women who report residing closest to such incidents are at greatest risk for experiencing elevated symptoms of traumatic stress, and perhaps warrant special attention.

Telephone survey respondents' reactions to questions regarding interpersonal violence.

Concerns have been raised regarding the appropriateness of asking about violence victimization in telephone interviews and whether asking such questions increases respondents' distress or risk for harm. However, no large-scale studies have evaluated the impact of asking such questions during a telephone interview. This study explored respondents' reactions to questions regarding violence in two large recently completed telephone surveys. After respondents were asked about violence, they were asked if they thought surveys should ask such questions and whether they felt upset or afraid because of the questions. In both surveys, the majority of respondents (regardless of their victimization history) were willing to answer questions about violence and were not upset or afraid because of the questions. More than 92% of respondents thought such questions should be asked. These results challenge commonly held beliefs and assumptions and provide some assurance to those concerned with the ethical collection of data on violent victimization.

The role of shame, anger, and affect regulation in men's perpetration of psychological abuse in dating relationships.

This study determines the relationships between shame, anger, and men's perpetration of psychological abuse in dating relationships. The authors hypothesize the connection between shame proneness and men's use of psychological abuse with a dating partner, with anger's mediating in this relationship. In addition, the authors hypothesize that affect regulation would moderate the relationship between anger and men's use of psychological abuse. Results indicate that shame proneness and use of psychological abuse are significantly related and that anger mediates the relationship. However, affect regulation does not moderate the effects of anger on men's use of psychological abuse. These findings are consistent with theoretical conceptualizations of shame and have implications for intervention and treatment programs for perpetrators of psychological abuse in dating relationships.

Average cost per person victimized by an intimate partner of the opposite gender: a comparison of men and women.

Differences in prevalence, injury, and utilization of services between female and male victims of intimate partner violence (IPV) have been noted. However, there are no studies indicating approximate costs of men's IPV victimization. This study explored gender differences in service utilization for physical IPV injuries and average cost per person victimized by an intimate partner of the opposite gender. Significantly more women than men reported physical IPV victimization and related injuries. A greater proportion of women than men reported seeking mental health services and reported more visits on average in response to physical IPV victimization. Women were more likely than men to report using emergency department, inpatient hospital, and physician services, and were more likely than men to take time off from work and from childcare or household duties because of their injuries. The total average per person cost for women experiencing at least one physical IPV victimization was more than twice the average per person cost for men.

Gender symmetry in dating intimate partner violence: does similar behavior imply similar constructs?

The present study examined the extent to which there is gender symmetry in the topography and experience of dating intimate partner violence (IPV). Self-report data were collected from 450 undergraduate men and women at a large Southeastern university. Perpetration and victimization rates were examined, as were context, function, and experience of fear. Results support the view that dating IPV is generally symmetrical at a topographical level, although significantly more women than men reported perpetration of severe physical assault. However, gender asymmetries were found in the context, function, and experience of fear. These findings suggest that gender-sensitive approaches are crucial to the understanding of dating IPV.

A cost-benefit analysis of three older adult fall prevention interventions.

INTRODUCTION: One out of three persons aged 65 and older falls annually and 20% to 30% of falls result in injury. The purpose of this cost-benefit analysis was to identify community-based fall interventions that were feasible, effective, and provided a positive return on investment (ROI). METHODS: A third-party payer perspective was used to determine the costs and benefits of three effective fall interventions. Intervention effectiveness was based on randomized controlled trial results. National data were used to estimate the average annual benefits from averting the direct medical costs of a fall. The net benefit and ROI were estimated for each of the interventions. RESULTS: For the Otago Exercise Program delivered to persons aged 65 and older, the net benefit was $121.85 per participant and the ROI was 36% for each dollar invested. For Otago delivered to persons aged 80 and older, the net benefit was $429.18 and the ROI was 127%. Tai chi: Moving for Better Balance had a net benefit of $529.86 and an ROI of 509% and Stepping On had a net benefit of $134.37 and an ROI of 64%. CONCLUSIONS: All three fall interventions provided positive net benefits. The ROIs showed that the benefits not only covered the implementation costs but also exceeded the expected direct program delivery costs. These results can help health care funders and other community organizations select appropriate and effective fall interventions that also can provide positive returns on investment.

Physical and mental health effects of intimate partner violence for men and women.

BACKGROUND: Few population-based studies have assessed the physical and mental health consequences of both psychological and physical intimate partner violence (IPV) among women or men victims. This study estimated IPV prevalence by type (physical, sexual, and psychological) and associated physical and mental health consequences among women and men. METHODS: The study analyzed data from the National Violence Against Women Survey (NVAWS) of women and men aged 18 to 65. This random-digit-dial telephone survey included questions about violent victimization and health status indicators. RESULTS: A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV (relative risk [RR]=2.2, 95% confidence interval [CI]=2.1, 2.4) and abuse of power and control (RR=1.1, 95% CI=1.0, 1.2), but less likely than men to report verbal abuse alone (RR=0.8, 95% CI=0.7, 0.9). For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores. CONCLUSIONS: Both physical and psychological IPV are associated with significant physical and mental health consequences for both male and female victims.

The legacy of child maltreatment: long-term health consequences for women.

In 2001, over 903,000 children were victims of physical, sexual, or psychological maltreatment and neglect. Available retrospective and longitudinal data suggest that child maltreatment has a significant negative impact directly on women's physical and mental health in childhood, adolescence, and adulthood. Additionally, childhood maltreatment is a critical risk factor for physical and sexual victimization in adulthood, especially by an intimate partner. The harmful effects of victimization in adulthood among women are substantial, and the negative outcomes of adulthood victimization are especially pronounced when there is a history of childhood maltreatment. Therefore, in addition to the direct effects in childhood, child maltreatment appears to have an indirect effect on women's physical and mental health by increasing the risk for victimization which, in turn, has a direct negative impact on health. The results of existing empirical studies point to the importance of preventing child maltreatment and its short-term and long-term consequences. Intervening at an early stage may reduce a child's likelihood of developing long-term health problems, and also reduce the public health burden of child maltreatment by preventing future health problems and revictimization in adulthood with all its negative health consequences.

Violence against women: the state of batterer prevention programs.

While both men and women can be victims, domestic violence usually consists of assaults on women, and most violence against women occurs within an intimate relationship. In the past twenty years, numerous state and provincial programs to intervene in domestic violence cases have developed. The programs tend to focus on treating batterers, although they also offer counseling to domestic violence victims. The jury remains out on the effectiveness of these programs. A major issue is whether the programs use appropriate standards. After an overview of the prevalence and nature of domestic violence, this article provides a discussion of those standards--their nature, effectiveness, and limitations. Another section discusses use of a batterer intervention program in an urban setting. Yet another section explores the implications of intimate partner violence and looks again at the effectiveness of batterer treatment within intervention programs. The article closes with a look at the way one state addresses domestic violence and treats it as a crime. An inescapable conclusion to be drawn from the discussion is that violence against women has its roots in cultural assumptions that must undergo change if the incidence of that violence is to be reduced.

One-year health assessment of adult survivors of Bacillus anthracis infection.

CONTEXT: Little is known about potential long-term health effects of bioterrorism-related Bacillus anthracis infection. OBJECTIVE: To describe the relationship between anthrax infection and persistent somatic symptoms among adults surviving bioterrorism-related anthrax disease approximately 1 year after illness onset in 2001. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 15 of 16 adult survivors from September through December 2002 using a clinical interview, a medical review-of-system questionnaire, 2 standardized self-administered questionnaires, and a review of available medical records. MAIN OUTCOME MEASURES: Health complaints summarized by the body system affected and by symptom categories; psychological distress measured by the Revised 90-Item Symptom Checklist; and health-related quality-of-life indices by the Medical Outcomes Study 36-Item Short-Form Health Survey (version 2). RESULTS: The anthrax survivors reported symptoms affecting multiple body systems, significantly greater overall psychological distress (P<.001), and significantly reduced health-related quality-of-life indices compared with US referent populations. Eight survivors (53%) had not returned to work since their infection. Comparing disease manifestations, inhalational survivors reported significantly lower overall physical health than cutaneous survivors (mean scores, 30 vs 41; P =.02). Available medical records could not explain the persisting health complaints. CONCLUSION: The anthrax survivors continued to report significant health problems and poor life adjustment 1 year after onset of bioterrorism-related anthrax disease.

The impact of partner psychological abuse on health behaviors and health status in college women.

Previous research documents increased health problems, somatic complaints, and negative health behaviors among victims of physical and sexual violence. This study extended existing literature by examining the unique effects of partner psychological abuse on physical health and the moderating effects of approach and avoidance coping strategies. Psychological abuse was positively related to illegal drug use, physical and role limitations, negative health perceptions, and cognitive impairment in college women even after controlling for physical victimization. Psychological abuse was not related to sleep hygiene, exercise, problem drinking, or smoking. Approach coping moderated the effects of partner psychological abuse on binge drinking and health perceptions. Low approach coping was associated with more binge drinking and negative health perceptions as abuse increased; high approach coping did not show a significant relationship with binge drinking or health perceptions across levels of abuse. Avoidance coping showed only a trend as a moderator of illegal drugs.

Childhood victimization and subsequent adult revictimization assessed in a nationally representative sample of women and men.

The purpose of this study was to identify whether experiences of childhood physical and/or sexual victimization would increase women's and men's risk for victimization in adulthood by different perpetrators (any perpetrator regardless of the relationship to the victim; intimate partner perpetrator; non-intimate perpetrator) using a nationally representative sample. Results of hierarchical logistic regression analyses indicated that childhood victimization increased the risk for adulthood victimization by any perpetrator for men and women, and by an intimate partner for women but not men. Female and male victims of physical and/or sexual child abuse are at higher risk for adult victimization by non-intimate perpetrators. These results suggest the appropriateness of interventions among adults or young adults who have been victims of child abuse, to prevent any future victimization in adulthood. To guide the development of such prevention programs, research is needed to identify factors that affect the probability of adulthood victimization among child abuse victims.

The moderating role of parental warmth on the effects of exposure to family violence.

Previous research has shown parental warmth to have mixed effects on individuals in violent families. While positively associated with psychological health in some victims, parental warmth has also been positively associated with measures of psychological distress in other victims. The current study examined two models (the "buffering" and "inconsistency" theories) to clarify the effects of parental warmth. The current study also sought to clarify the role of parental warmth within the context of exposure to different types of family violence (i.e., witnessing versus victimization). Results differed depending on the type of violence exposure. Both mother and father warmth were negatively associated with secure attachment and self-esteem in combined victims and witnesses of violence, whereas, mother warmth was positively associated with self-esteem in witnesses of violence. Father warmth did not significantly impact either outcome for witnesses. Parental warmth did not influence either outcome for those who had only experienced victimization.

Broadening the approach to youth violence prevention through public health.

Violence is a critical cause of death and nonfatal injuries among youth, and even those who witness violence can suffer serious health and mental health consequences. This highlights the need for prevention programs and policies aimed at reducing risks, promoting prosocial behavior, strengthening families, and creating communities in which youth are safe from violence. The Centers for Disease Control and Prevention's Injury Center is developing a National Public Health Strategy to Prevent Youth Violence. The strategy will establish a full application of the public health approach, ranging from research to practice. It also spotlights what is working, as a way to mobilize community leaders in supporting evidence-based initiatives. With the empirical guidance of articles such as those in this special issue, a shared strategy to prevent youth violence will help focus efforts and resources on solutions that show the most promise, and ensure that American communities undertake more comprehensive and coordinated prevention efforts to protect our nation's youth.