Health education to promote knowledge about sickle cell disease and newborn screening in pregnant women: a community-based pilot study using the healthy beginning initiative.

BACKGROUND: Pregnancy presents a critical period for any maternal and child health intervention that may impact the health of the newborn. With low antenatal care attendance by pregnant women in health facilities in Nigeria, community-based programs could enable increased reach for health education about sickle cell disease (SCD) and newborn screening (NBS) among pregnant women. This pilot study aimed to assess the effect of education on the knowledge about SCD and NBS among pregnant women using the Healthy Beginning Initiative, a community-based framework. METHODS: A pre-post study design was used to evaluate knowledge of SCD and NBS in a convenience sample of 89 consenting pregnant women from three communities. Participants were given surveys prior to and following completion of a health education session. McNemar's test was used to compare the proportion of participants with correct responses. The level of significance was taken as p < 0.05. RESULTS: Compared to pre-test values, post-test values showed that participants understood that SCD is hereditary (93.3% vs. 69.7%), both parents must have at least one gene for someone to have SCD (98.9% vs. 77.5) and blood test is the right way to know if one has SCD (98.8% vs. 78.7%). Also, a large proportion of participants (post-test ~ 89.9%; compared to pre-test ~ 23.6%) understood that the chance of conceiving a child with SCD was 25% for a couple with the sickle cell trait (SCT). Knowledge of the possibility of diagnosing SCD shortly after birth was highly increased in the post test phase of the study when compared to the pre-test phase (93.3% vs. 43.9%, respectively). Concerning the overall knowledge scores, those with high level of knowledge significantly increase from 12.6% pretest to 87.4% posttest (p = 0.015). CONCLUSION: The health education intervention was associated with significant improvement on almost all measures of SCD knowledge. Focused health education for pregnant women using community structures can improve knowledge of SCD and NBS.

Implementing Integrated Early Childhood Mental Health Services in Primary Care: Relationships, Vision, and Sustainability.

The Massachusetts Multi-City Young Children's System of Care Project was a federally funded program to provide integrated early childhood mental health (ECMH) services in primary care for families of very young children (birth-six years old) with Serious Emotional Disturbances across three cities in Massachusetts, U.S.A. This study describes lessons learned from the implementation of this program and makes recommendations for best practices to improve the delivery and efficacy of ECMH services in primary care settings. Staff and leadership (n = 35) from 11 agencies (primary care practices, community service agencies, and local health departments) that co-implemented this program participated in focus groups and semi-structured key informant interviews. Thematic analysis was used to characterize specific facilitators and barriers to successfully implementing system-wide programming for ECMH. Four main themes were identified: (1) Strong multilevel working relationships are critical for integration, (2) Capacity-building activities can be leveraged to improve implementation, (3) Financial challenges are a primary barrier to building efficacious systems of care, and (4) Flexibility and resourcefulness can help overcome logistical challenges in integration. Implementation lessons learned may serve as guidance for other states and institutions in the U.S. seeking to improve the integration of ECMH services into primary care. They may also provide strategies to adapt and scale these interventions to improve the mental health and well-being of young children and their families.

Sleepless in inequality: findings from the 2018 behavioral risk factor surveillance system, a cross-sectional study.

BACKGROUND: Despite the large body of research on the adverse effects of income inequality, to date, few studies have examined its impact on sleep. The objective of this investigation is to examine the association between US state income inequality and the odds for regularly obtaining inadequate (< 7 h) and very inadequate (< 5 h) of sleep in the last 24 h. METHODS: We analysed data from 350,929 adults participating in the US 2018 Behavioral Risk Factor Surveillance System (BRFSS). Multilevel modeling was used to determine the association between state-level income inequality, as measured by the Gini coefficient, and the odds for obtaining inadequate and very inadequate sleep. We also determined if associations were heterogeneous across gender. RESULTS: A standard deviation increase in the Gini coefficient was associated with increased odds for inadequate (OR = 1.06, 95% CI: 1.00, 1.13) and very inadequate sleep (OR = 1.11, 95% CI: 1.03,1.20). Also, a cross-level Gini Coefficient X Gender interaction term was significant (OR = 1.07, 95% CI:1.01,1.13), indicating that increasing income inequality was more detrimental to women's sleep behavior. CONCLUSION: Future work should be conducted to determine whether decreasing the wide gap between incomes can alleviate the burden of income inequality on inadequate sleep in the United States.

Sexual and physical revictimization in U.S. military veterans.

The present study examined revictimization, defined as sexual or physical assault in adulthood that followed a history of childhood maltreatment. We aimed to identify factors associated with revictimization over time in a group of U.S. military veterans deployed following the September 11, 2001, terrorist attacks (9/11). As revictimization is associated with multiple negative mental health outcomes in the literature, identifying risk and protective factors can aid in the prevention of revictimization and associated poor health outcomes among veterans. In this sample, the proportion of adult revictimization was 2.7% for men, 95% CI [2.0, 3.6] and 22.9% for women, 95% CI [20.5, 25.8]. Using multilevel logistic models, we found that women, ß = 2.2, p < .001; Navy veterans, ß = 1.5, p < .001; and participants who reported posttraumatic stress symptoms, ß = 0.2, p = .028, were at significantly higher risk of revictimization across time compared to nonrevictimized counterparts. Social support while in the military was protective, ß = -0.1, p < .001, against revictimization. In addition, childhood abuse experiences combined with characteristics such as female gender were related to an increased risk of revictimization during and following military service. The findings highlight opportunities for intervention and areas of strength within this population; social connection garnered during military service may serve as a protective factor against revictimization. Future research is needed to examine the role of social support in possibly lowering veterans' risk of revictimization over time, particularly for post-9/11 veterans struggling with transitioning from military to civilian life.

Predictors of Service Utilization of Young Children and Families Enrolled in a Pediatric Primary Care Mental Health Promotion and Prevention Program.

Understanding early childhood mental health service utilization in community-based clinical settings is important. Project Linking Actions for Unmet Needs in Children's Health (Project LAUNCH) provided mental health-related services for young children and families within pediatric medical homes. Using data from the Project LAUNCH evaluation (n = 106), we implemented negative binomial regression models to determine if baseline variables were associated with service utilization, defined as the number of encounters between the family and the team. Past-year homelessness emerged as a significant predictor of service utilization. Encounters for families with children who experienced homelessness within the last 12 months occurred at a rate 34.5% lower than those who had not experienced homelessness. Results highlight the importance of addressing homelessness as a barrier to mental health service utilization for families. Screening for recent housing insecurity and developing interventions that integrate housing support services into mental health programs may inform strategies to increase attendance for families with young children.

Engaging and Supporting Young Children and their Families in Early Childhood Mental Health Services: The Role of the Family Partner.

This study explores the role of family partners, peer professionals with lived experiences of raising a child with behavioral health needs, and their value in primary and community-care based mental health services for young children aged 0-8 years. Interviews and focus groups were conducted with staff, leadership, and caregiver participants (n = 38) from two early childhood mental health programs and analyzed using thematic analysis. Five interdependent themes emerged: (1) the centrality of lived experience to the family partner role; (2) the importance of the family partner in family engagement and relationship building; (3) the value added by the family partner in navigating systems; (4) the ability of the family partner to build skills and empower caregivers; (5) the role of the family partner in alleviating caregiver stress and other mental health concerns. Adapting and expanding the role of family partners will improve effective mental health care for children and their caregivers.

Reliability and Validity of the Vicarious Trauma Organizational Readiness Guide (VT-ORG).

The Vicarious Trauma Organizational Readiness Guide (VT-ORG) is an assessment of an organization's readiness to address vicarious trauma (VT), which is exposure to the traumatic experiences of people served. This study reports on the psychometric properties of the VT-ORG. Employees of first responder agencies (e.g., law enforcement, fire, emergency services) and victim assistance agencies are at a high risk for vicarious traumatization, which can lead to PTSD, substance use, and suicidal ideation, among other negative impacts. Organizations that do not address VT may see such effects as employee turnover, reduced efficiency, and negative work environments. The VT-ORG is an assessment tool designed to help organizations complete the first step of organizational change-conducting a needs assessment. Study participants were 3,018 employees across 13 first responder and victim assistance agencies who completed the 67-item VT-ORG and additional measures for evaluation of its validity and reliability. The VT-ORG was found to have excellent internal consistency (Cronbach's α = .98). A structural equation model demonstrated that the subscales of the VT-ORG predicted criterion measures of turnover intention, compassion satisfaction, and organizational resilience, with an overall model fit of CFI = .99, RMSEA = .053. This study found the VT-ORG to be a reliable and valid assessment of organizational responses to vicarious trauma.

Enhancing Early Childhood Mental Health Primary Care Services: Evaluation of MA Project LAUNCH.

Objectives The purpose of this study was to evaluate the efficacy of an innovative early childhood mental health intervention, Massachusetts Project LAUNCH. Early childhood mental health clinicians and family partners (paraprofessionals with lived experience) were embedded within community pediatric medical homes. Methods A longitudinal study design was used to test the hypotheses that (1) children who received services would experience decreased social, emotional and behavioral problems over time and (2) caregivers' stress and depressive symptoms would decrease over time. Families who were enrolled in services and who consented to participate in the evaluation study were included in analyses (N = 225). Individual growth models were used to test longitudinal effects among MA LAUNCH participants (children and caregivers) over three time points using screening tools. Results Analyses showed that LAUNCH children who scored in age-specific clinically significant ranges of social, emotional and behavioral problems at Time 1 scored in the normal range on average by Time 3. Caregivers' stress and depressive symptoms also declined across the three time points. Results support hypotheses that the LAUNCH intervention improved social and emotional health for children and caregivers. Conclusions for Practice This study led to sustainability efforts, an expansion of the model to three additional communities across the state and development of an online toolkit for other communities interested in implementation.

Sweetened beverage consumption is a risk factor for depressive symptoms among adolescents living in Boston, Massachusetts, USA.

OBJECTIVE: To investigate the relationship between sweetened beverage consumption and depressive symptoms among adolescents. DESIGN: In a cross-sectional study, adolescents were asked how often they drank soda and fruit drinks in the past 7 d. Depressive symptoms were measured using a brief adapted version of the Modified Depression Scale. Summation scores were standardized using the Z-transformation. We used multilevel multiple linear regression models to estimate the association between soda and fruit drink consumption and depressive symptoms. SETTING: The 2008 Boston Youth Survey. SUBJECTS: Adolescents (n 1878), high-school students in grades 9-12 of Boston public schools, Massachusetts, USA. RESULTS: Compared with those who never drank soda in the past 7 d, those who consumed soda 2-6 times/week (ß=0·18; 95 % CI 0·04, 0·32) or ≥1 times/d (ß=0·29; 95 % CI 0·13, 0·45) had higher depressive symptoms. Similarly, those who consumed fruit drinks 2-6 times/week (ß=0·14; 95 % CI 0·00, 0·28) and those who consumed ≥1 times/d (ß=0·22; 95 % CI 0·04, 0·40) had higher depressive symptoms. CONCLUSIONS: Frequent consumption of both soda and fruit drinks is associated with greater depressive symptoms among adolescents.

The relationship between neighborhood socioeconomic characteristics and physical inactivity among adolescents living in Boston, Massachusetts.

OBJECTIVES: We sought to determine whether the socioeconomic environment was associated with no participation in physical activity among adolescents in Boston, Massachusetts. METHODS: We used cross-sectional data from 1878 urban adolescents living in 38 neighborhoods who participated in the 2008 Boston Youth Survey, a biennial survey of high school students (aged 14-19 years). We used multilevel multiple regression models to determine the association between neighborhood-level exposures of economic deprivation, social fragmentation, social cohesion, danger and disorder, and students' reports of no participation in physical activity in the previous week. RESULTS: High social fragmentation within the residential neighborhood was associated with an increased likelihood of being inactive (odds ratio = 1.53; 95% confidence interval = 1.14, 2.05). No other neighborhood exposures were associated with physical inactivity. CONCLUSIONS: Social fragmentation might be an important correlate of physical inactivity among youths living in urban settings. Interventions might be needed to assist youths living in unstable neighborhoods to be physically active.

Witnessing a violent death and smoking, alcohol consumption, and marijuana use among adolescents.

Witnessing violence has been linked to maladaptive coping behaviors such as smoking, alcohol consumption, and marijuana use. However, more research is required to identify mechanisms in which witnessing violence leads to these behaviors. The objectives of this investigation were to examine the association between witnessing a violent death and smoking, alcohol consumption, and marijuana use among adolescents, to identify whether exhibiting depressive symptoms was a mediator within this relationship, and to determine if those who had adult support in school were less likely to engage in risky health behaviors. Data were collected from a sample of 1,878 urban students, from 18 public high schools participating in the 2008 Boston Youth Survey. In 2012, we used multilevel log-binomial regression models and propensity score matching to estimate the association between witnessing a violent death and smoking, alcohol consumption, and marijuana use. Analyses indicated that girls who witnessed a violent death were more likely to use marijuana (relative risk (RR) = 1.09, 95% confidence interval (CI) = 1.02, 1.17), and tended towards a higher likelihood to smoke (RR = 1.06, 95% CI = 1.00, 1.13) and consume alcohol (RR = 1.07, 95% CI = 0.97, 1.18). Among boys, those who witnessed a violent death were significantly more likely to smoke (RR = 1.20, 95% CI = 1.11, 1.29), consume alcohol (RR = 1.30, 95% CI = 1.17, 1.45) and use marijuana (RR = 1.33, 95% CI = 1.21, 1.46). When exhibiting depressive symptoms was included, estimates were not attenuated. However, among girls who witnessed a violent death, having an adult at school for support was protective against alcohol consumption. When we used propensity score matching, findings were consistent with the main analyses among boys only. This study adds insight into how witnessing violence can lead to adoption of adverse health behaviors.

The relationship between social fragmentation and sleep among adolescents living in Boston, Massachusetts.

BACKGROUND: Sufficient sleep is needed for the healthy development of youth. However, only a small minority of adolescents obtain adequate amounts of sleep. Although individual-level correlates of sleep have been identified, studies investigating the influence of the environment on sleep are warranted. METHODS: By using cross-sectional data collected from 1878 urban adolescents living in 38 neighborhoods participating in the 2008 Boston Youth Survey (BYS), we determined the association between neighborhood social fragmentation and sleep. Social fragmentation of each participant's residential neighborhood was composed using 2010 US Census data. Multilevel regression models were used to determine the association between social fragmentation and meeting the recommended hours of sleep (>8.5 h) and sleep duration while controlling for individual-level sex, race, age and nativity. RESULTS: Moderate (OR = 0.51, 95% CI = 0.27, 0.97) and high (OR = 0.33, 95% CI = 0.18, 0.61) social fragmentation within the residential neighborhood was associated with a decreased likelihood of obtaining adequate sleep. Those in moderate (ß = -23.9, 95% CI = -43.1, -4.8) and high (ß = -22.1, 95% CI = -43.3, -0.9) socially fragmented neighborhoods obtained fewer minutes of sleep per night. CONCLUSIONS: Social fragmentation may be an important determinant of sleep among youth living in urban settings.

Social support over time for men and women veterans with and without complex trauma histories.

Social support is closely linked to health, but little is known about United States (U.S.) veterans' social support over time and factors that may influence their support trajectories. This study investigates social support over time for U.S. men and women Post-9/11 veterans in relation to trauma history and gender. A secondary analysis of longitudinal cohort data from the Survey of Experiences of Returning Veterans (SERV), which employed a repeated-measures longitudinal design using five waves of data (baseline, 3, 6, 9, 12 months) with 672 combat veterans. Results from random intercept multilevel models found no significant gender differences in social support over time. Veterans with complex trauma histories were at risk for lower social support across waves. A stability trend was also observed; specifically, at baseline, veterans who started with high support maintained their level over time whereas veterans who started with deficits in social support remained low over time. Veterans identifying as African American or Latinx, and those with lower annual incomes, reported lower support compared to White and higher-income veterans. Furthermore, low social support was significantly associated with severe posttraumatic stress symptoms and active suicidal ideation across 12 months. SERV utilized a nonrandom sampling method that may reduce generalizability of findings. There is also potential for residual confounding by factors related to both social support levels and time since discharge that were not available in this data set. Findings have implications for developing clinical and community interventions intended to support veterans as they transition back to the community. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The impact of exposure to interpersonal violence on gender differences in adolescent-onset major depression: results from the National Comorbidity Survey Replication (NCS-R).

BACKGROUND: Beginning in adolescence, females are at significantly higher risk for depression than males. Despite substantial efforts, gaps remain in our understanding of this disparity. This study tested whether gender differences in adolescent-onset depression arise because of female's greater exposure or sensitivity to violence. METHODS: Data came from 5,692 participants in the National Comorbidity Survey Replication. Trained interviewers collected data about major depression and participants' exposure to four types of interpersonal violence (physical abuse, sexual assault, rape, and witnessing violence) using a modified version of the Composite International Diagnostic Interview. We used discrete time survival analysis to investigate gender differences in the risk of adolescent onset depression. RESULTS: Of the entire sample, 5.7% met DSM-IV criteria for depression by age 18; 5.8% of the sample reported being physically abused, 11.7% sexually assaulted, 8.5% raped, and 13.2% witnessed violence by age 18. Females had 1.51 times higher odds of depression by age 18 than males. Exposure to all types of violence was associated with an increased odds of depression in both the past year and the years following exposure. Adjusting for exposure to violence partially attenuated the association between gender and depression, especially for sexual assault (odds ratio [OR] attenuated = 1.28; 15.23%) and rape (OR attenuated = 1.32; 12.59%). There was no evidence that females were more vulnerable to the effects of violence than males. DISCUSSION: Gender differences in depression are partly explained by females' higher likelihood of experiencing interpersonal violence. Reducing exposure to sexual assault and rape could therefore mitigate gender differences in depression.

Factors Impacting HIV Postexposure Prophylaxis Among Sexually Assaulted Patients Presenting to Two Urban Emergency Departments.

INTRODUCTION: Sexually assaulted patients who seek care in emergency departments are often recommended for nonoccupational HIV postexposure prophylaxis treatment. HIV postexposure prophylaxis is an effective method in preventing HIV transmission if the treatment is administered promptly and if a full 28-day course is completed. However, research has shown that only a fraction of patients who start the treatment will complete a 28-day course. Research is needed to explore factors that may be associated with compliance to postexposure prophylaxis so that interventions can be designed to address the factors that put patients at risk for noncompletion. METHODS: A retrospective chart review was conducted examining 246 medical records of sexually assaulted female patients who presented to one of two urban hospitals. A number of patient and event-related factors were examined to determine whether they were associated with HIV postexposure prophylaxis adherence among patients presenting at an emergency room after a sexual assault. RESULTS: Results revealed that five factors showed significant associations with sexually assaulted female patients completing HIV postexposure prophylaxis treatment. These factors include educational level, employment, health insurance, vaginal injuries, and tongue-mouth assaults. IMPLICATIONS FOR PRACTICE: The results of this study represent a starting point from which to inform the development of targeted interventions such that those most at risk for nonadherence can receive additional support or services to improve HIV postexposure prophylaxis adherence.

Chipped or Whole? Listening to Survivors' Experiences With Disclosure Following Sexual Violence.

Sexual violence is a prevalent crime but vastly underreported and with serious long-term health consequences for survivors. Disclosure of sexual violence represents a social experience that may offer support towards healing or further traumatization depending on the response received. Although current research suggests that process of disclosure itself is important, as are social responses, there is a dearth of research examining the perceived impact of initial responses to disclosure on healing and relationships, particularly over time. The current study used data from nine focus groups with 45 survivors to explore the impact of initial disclosure reactions on recovery, from the survivors' perspectives. Constant comparative analysis identified several themes, including subtypes of positive and negative responses to disclosure and long-term impacts on healing and relationships. Survivors disclosed to informal and formal support persons and although many identified responses as positive or negative, some also experienced mixed responses. Survivors identified perceived long-term impacts on healing, interpersonal relationships, and social justice. Our findings suggest disclosures are a critical point for potential intervention after sexual violence. It is through the disclosure process that survivors can be supported and empowered to connect with others and move further along in their journey towards healing and recovery. Public awareness and promotion of positive responses could be designed to reach children and youth, so that the next generation is equipped with the tools to support each other in difficult times, particularly in the aftermath of sexual violence.

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.

Community-Level Prevention of Childhood Maltreatment: Next Steps in a World with COVID-19.

Maltreatment of children continues to be a major public health concern, with high social, economic and health burdens. Rates vary by a number of factors that can be categorized into different levels of the social ecology. Research and theory in this field point to the importance of community-level factors that can contribute to either risk or prevention of child maltreatment. The COVID-19 pandemic context creates additional risks and concerns related to child maltreatment and exacerbates risk factors that existed before: e.g., families and communities are in much worsened states of poverty, unemployment, and food insecurity; losses and grief are affecting mental health; and limitations and safety concerns are affecting in-person child protection work and more. Central to recovery from this pandemic will be the mobilization of community-level resources and the building back up of the social fabric that can support vulnerable children and caregivers. Key to this mobilization will be a better intersectional understanding of structural inequities in the child welfare system and in our communities. Efforts to dismantle structural biases and discrimination are critical to provide safety and support for families and vital for effective child maltreatment prevention. In this context, we discuss the state of the science of community-level prevention of childhood maltreatment, highlighting evidence-based community-level prevention programs and how these types of efforts may be impacted by the current COVID-19 global pandemic.

Neighborhood Income Inequality and Alcohol Use among Adolescents in Boston, Massachusetts.

OBJECTIVES: Previous research has indicated that area-level income inequality is associated with increased risk in alcohol consumption. However, few studies have been conducted among adolescents living within smaller area units, such as neighborhoods. We investigated whether neighborhood income inequality is associated with alcohol consumption among adolescents. METHODS: We analyzed cross-sectional data from a sample of 1878 adolescents living in 38 neighborhoods participating in the 2008 Boston Youth Survey. Multilevel logistic regression modeling was used to determine the role of neighborhood income inequality and the odds for alcohol consumption and to determine if social cohesion and depressive symptoms were mediators. RESULTS: In comparison to the first tertile of income inequality, or the most equal neighborhood, adolescent participants living in the second tertile (AOR = 1.20, 95% CI: 0.89, 1.61) and third tertile (AOR = 1.44, 95% CI: 1.06, 1.96) were more likely to have consumed alcohol in the last 30 days. Social cohesion and depressive symptoms were not observed to mediate this relationship. CONCLUSIONS: Findings indicate that the distribution of incomes within urban areas may be related to alcohol consumption among adolescents. To prevent alcohol consumption, public health practitioners should prioritize prevention efforts for adolescents living in neighborhoods with large gaps between rich and poor.

Systematic Review of Risk and Protective Factors for Revictimization After Child Sexual Abuse.

Child sexual abuse (CSA) is a widespread public health problem in the United States. It has been associated with multiple long-term deleterious outcomes including revictimization in adulthood. This systematic review of 25 studies synthesizes research examining possible risk and protective factors that might explain the established link between CSA and future victimizations. Specific risk factors identified included co-occurring maltreatment in the home, risky sexual behavior (particularly in adolescence), post-traumatic stress disorder, emotion dysregulation, and other maladaptive coping strategies. Only one protective factor was identified: perceived parental care. The review also revealed considerable variability in definitions and measurement of both CSA and adult victimization, particularly in terms of how researchers conceptualized age. Many of the studies were limited in generalizability by including only college-age women. These findings have clinical and research implications. Public health interventions working to prevent revictimization among CSA survivors can utilize these findings when designing programs. For researchers, the results highlight the need for standardized definitions of both CSA and revictimization, for well-validated and consistent measurement, and for inclusion of additional population groups in future research.