A qualitative content analysis of cannabis-related discussions on Reddit during the COVID-19 pandemic.

Social media has become an increasingly important way to seek and share experiences, support, knowledge, and advice during the COVID-19 pandemic. Reddit, a pseudonymous social media platform, was one way that young people interacted during the pandemic. Our study goals were two-fold: (1) to categorize information sought and provided by users of r/saplings, a subreddit devoted to cannabis use and is often used by young people, and (2) to examine if conversations changed during the COVID-19 pandemic. We extracted 213 randomly selected posts and 2,546 related comments across four time periods (before the pandemic, during the first wave, summer, and next fall). We assessed the volume of posts and comments throughout our study period and conducted a qualitative content analysis. Quantitatively, the findings demonstrated an increase in the number of posts and comments throughout the study period. Given the substantial growth in subreddit activity throughout our study period, Reddit may play an increasingly important role in youth socialization related to cannabis. From the content analysis, we identified three major themes: how to acquire cannabis, how to use cannabis, and associated consequences. Reddit-users prioritized certain content in their posts at different stages of the pandemic. 'Places to acquire' and 'future use' were most common at the beginning of the pandemic, while the theme of 'consequences' and the topic of 'tolerance' became more prominent during the summer months. The comments to these posts were generally thorough and responsive to the post. Nearly all the information came from opinions or personal experiences. Firstly, our findings suggest that young people viewed Reddit as a viable outlet for conversations about cannabis. Secondly, due to the nature of the peer comments and lack of verifiable information being exchanged, misinformation may still circulate and inadvertently worsen the efforts to reduce cannabis-related harm. Interventions that provide understandable and accurate cannabis-related information in accessible formats may increase young people's ability to access and practice harm reduction.

Rapport Building in Written Crisis Services: Qualitative Content Analysis.

BACKGROUND: Building therapeutic relationships and social presence are challenging in digital services and maybe even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations. OBJECTIVE: This study aims to categorize crisis counselors' efforts to build rapport in written conversations by using deidentified conversation transcripts from the text and chat arms of the National Child Abuse Hotline. Using these categories, we identify the common characteristics of successful conversations. We defined success as conversations where help-seekers reported the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress, as reported by help-seekers. METHODS: The sample consisted of transcripts from 314 purposely selected conversations from of the 1153 text and chat conversations during July 2020. Hotline users answered a preconversation survey (ie, demographics) and a postconversation survey (ie, their perceptions of the conversation). We used qualitative content analysis to process the conversations. RESULTS: Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with less successful conversations, successful conversations tended to include fewer statements that attend to the emotional dynamics. There were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailor their comments to the situation. CONCLUSIONS: Building therapeutic relationships and social presence are essential to digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates characteristics associated with successful conversations that could be adopted in other written help-seeking interventions.

Disparities Among Pediatric Firearm Suicides in the United States: An Analysis of the National Violent Death Reporting System, 2014 to 2018.

Suicide is a leading cause of death in the United States (U.S.), with firearms being the predominant method. This study examines the racial disparity and disproportionality of pediatric firearm suicide from 2014 to 2018 in 17 U.S. states. We used the National Violent Death Reporting System to quantify the burden of pediatric firearm suicide by race/ethnicity and gender and assessed themes among decedents aged 10 to 17 years. Racial disparity and disproportionality were measured using the Disparity Index and Disproportionality Representation Index, respectively. Decedents were primarily non-Hispanic White (NHW, 77.5%) and male (84.0%). NHW children died at a rate that was 1.3 times greater than expected based on their proportion in the general population and were 2.6 times more likely to die by firearm suicide than non-Hispanic Black (NHB) children. NHB children were less likely to disclose suicide intention, suggesting that this group may require more active screening intervention. Qualitative analysis revealed unsafe firearm storage as a common theme among these deaths. Differences in age with respect to social media use and precipitating factors such as bullying and arguments with parents were also identified as contributing factors. Results of this study support the expansion of interventions such as lethal means restriction counseling and implementation of safer firearm storage laws.

County-Level Factors Associated With Influenza and COVID-19 Vaccination in Indiana, 2020‒2022.

Objectives. To assess COVID-19 and influenza vaccination rates across Indiana's 92 counties and identify county-level factors associated with vaccination. Methods. We analyzed county-level data on adult COVID-19 vaccination from the Indiana vaccine registry and 2021 adult influenza vaccination from the Centers for Disease Control and Prevention. We used multiple linear regression (MLR) to determine county-level predictors of vaccinations. Results. COVID-19 vaccination ranged from 31.2% to 87.6% (mean = 58.0%); influenza vaccination ranged from 33.7% to 53.1% (mean = 42.9%). In MLR, COVID-19 vaccination was significantly associated with primary care providers per capita (b = 0.04; 95% confidence interval [CI] = 0.02, 0.05), median household income (b = 0.23; 95% CI = 0.12, 0.34), percentage Medicare enrollees with a mammogram (b = 0.29; 95% CI = 0.08, 0.51), percentage uninsured (b = -1.22; 95% CI = -1.57, -0.87), percentage African American (b = 0.31; 95% CI = 0.19, 0.42), percentage female (b = -0.97; 95% CI = -1.79, ‒0.15), and percentage who smoke (b = -0.75; 95% CI = -1.26, -0.23). Influenza vaccination was significantly associated with percentage uninsured (b = 0.71; 95% CI = 0.22, 1.21), percentage African American (b = -0.07; 95% CI = -0.13, -0.01), percentage Hispanic (b = -0.28; 95% CI = -0.40, -0.17), percentage who smoke (b = -0.85; 95% CI = -1.06, -0.64), and percentage who completed high school (b = 0.54; 95% CI = 0.21, 0.87). The MLR models explained 86.7% (COVID-19) and 70.2% (influenza) of the variance. Conclusions. Factors associated with COVID-19 and influenza vaccinations varied. Variables reflecting access to care (e.g., insurance) and higher risk of severe disease (e.g., smoking) are notable. Programs to improve access and target high-risk populations may improve vaccination rates. (Am J Public Health. 2024;114(4):415-423. https://doi.org/10.2105/AJPH.2023.307553).

Reproductive Health Experiences Shared on TikTok by Young People: Content Analysis.

BACKGROUND: TikTok is a popular social media platform that allows users to create and share content through short videos. It has become a place for everyday users, especially Generation Z users, to share experiences about their reproductive health. Owing to its growing popularity and easy accessibility, TikTok can help raise awareness for reproductive health issues as well as help destigmatize these conversations. OBJECTIVE: We aimed to identify and understand the visual, audio, and written components of content that TikTok users create about their reproductive health experiences. METHODS: A sampling framework was implemented to narrow down the analytic data set. The top 6 videos from each targeted hashtag (eg, #BirthControl, #MyBodyMyChoice, and #LoveYourself) were extracted biweekly for 16 weeks (July-November 2020). During data collection, we noted video characteristics such as captioning, music, likes, and cited sources. Qualitative content analysis was performed on the extracted videos. RESULTS: The top videos in each hashtag were consistent over time; for example, only 11 videos appeared in the top 6 category for #BirthControl throughout the data collection. Most videos fell into 2 primary categories: personal experiences and informational content. Among the personal experiences, people shared stories (eg, intrauterine device removal experiences), crafts (eg, painting their pill case), or humor (eg, celebrations of the arrival of their period). Dancing and demonstrations were commonly used in informational content. CONCLUSIONS: TikTok is used to share messages on myriad reproductive health topics. Understanding users' exposure provides important insights into their beliefs and knowledge of sexual and reproductive health. The study findings can be used to generate valuable information for teenagers and young adults, their health care providers, and their communities. Producing health messages that are both meaningful and accessible will contribute to the cocreation of critical health information for professional and personal use.

Understanding how peers respond to online child maltreatment disclosures: A qualitative content analysis of family violence discussions on social media.

BACKGROUND: Positive, supportive responses to child maltreatment disclosure are critical for victims to receive appropriate resources and support for healing. Young people often prefer to disclose to their peers, frequently on social media platforms. OBJECTIVE: We assessed young people's use of TalkLife, an online peer-to-peer support platform, to respond to the disclosure of child maltreatment. METHODS: We conducted a qualitative content analysis of 1090 comments on childhood maltreatment-related posts on TalkLife between 2013 and 2020. We used an iterative, team-based qualitative content analysis approach to understand how peers responded to maltreatment disclosure. FINDINGS: Peer responses tended to be supportive, including asking questions about the abuse and offering advice, emotional support, and other positive responses. Most commonly, peers advised the victim to report, focus on their strengths instead of the abuse, reach out to adults for more support, or confront the perpetrator. On occasion, however, peers began an irrelevant discussion, joked about the situation, or even directly attacked the discloser. CONCLUSIONS: Learning about child maltreatment disclosures on social media builds the foundation for research to assist in identifying and applying interventions on online platforms. Further, these findings can inform programs that teach how to provide healthy responses to child maltreatment disclosures.

The role of community healthcare professionals in discussing sexual assault experiences during obstetrics and gynecological healthcare appointments.

BACKGROUND: Nearly half of adult women in the US report experiencing sexual assault, with almost one-fifth reporting rape. For many sexual assault survivors, healthcare professionals are the first point of contact and disclosure. This study aimed to understand how healthcare professionals working in community settings perceived their role in discussing sexual violence experiences with women during obstetrical and gynecological healthcare appointments. The secondary purpose was to compare healthcare professionals' perspectives with the patients' to determine how sexual violence conversations should occur in these environments. METHODS: Data were collected in two phases. Phase 1 consisted of 6 focus groups (Sept-Dec, 2019) with women aged 18-45 (n = 22) living in Indiana who sought community-based or private healthcare for women's reproductive healthcare needs. Phase 2 included 20 key-informant interviews with non-physician healthcare professionals (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women's reproductive healthcare. Focus groups and interviews were audio-recorded, transcribed, and analyzed using thematic analyses. HyperRESEARCH assisted in data management and organization. RESULTS: There were three resulting themes: (1) healthcare professionals' approaches to screening for a history of sexual violence varied depending on how they ask, what setting they work in, and type of professional asking; (2) healthcare experiences can compound traumatic experiences and create distrust with survivors; and (3) sexual violence impacts patient healthcare experiences through what services they seek, how professionals may interact with them, and what professionals they are willing to utilize. CONCLUSIONS: Findings offered insight into actionable and practical strategies for enhancing sexual violence screening and discussions in community-based women's reproductive health settings. The findings offer strategies to address barriers and facilitators among community healthcare professionals and the people they serve. Incorporating healthcare professional and patient experiences and preferences for violence-related discussions during obstetrical and gynecological healthcare appointments can assist in violence prevention efforts, improve patient-professional rapport, and yield better health outcomes.

An examination of factors contributing to the racial disparity and disproportionality of paediatric firearm-related homicide: a mixed-methods analysis using the national violent death reporting system (NVDRS).

Firearms are a leading cause of paediatric mortality in the United States. This study examines the contributing factors of racial disparity and disproportionality among paediatric firearm decedents aged 0-17 years.We used the National Violent Death Reporting System (NVDRS) to assess the individual and incident-level circumstances of paediatric firearm homicides from 2014 to 2018 in 17 US states.Among 1085 paediatric firearm homicides, non-Hispanic blacks (NHB) died at a rate three times greater than their proportion in the general population; they were nine times as likely to die by firearm homicide as non-Hispanic whites (NHW). NHW children were more often the victims of firearm homicide perpetrated by a parent/caregiver, and of homicide-suicides.Violence interruption programmes among NHB youth, and family-based interventions among NHW youth may be effective in preventing firearm homicide and homicide-suicide. Systematic investigations into firearm homicide perpetrators are necessary to better understand observed racial disparities.

Intersectionality and Adverse Childhood Experiences: Comparing Subgroups of Sex, Race/Ethnicity, and Sexual Orientation.

INTRODUCTION: This study investigated the intersectionality of adverse childhood experiences (ACEs) among subgroups of sex, race/ethnicity, and sexual orientation. METHODS: Using data from the Behavioral Risk Factor Surveillance Survey across 34 states (N=116,712) from 2009 to 2018, authors stratified subgroups of sex (male/female), race/ethnicity (White/Hispanic/Black/multiracial/other), and sexual orientation (heterosexual/bisexual/gay) to investigate the number of ACEs across groups. Analyses were conducted in 2022. RESULTS: Stratification resulted in 30 distinct subgroups (e.g., bisexual Black females, straight multiracial males) with significant post hoc differences per group. Generally, those identifying as sexual minority individuals had the highest number of ACEs (the top 14 of 30 subgroups), whereas seven of the top ten subgroups were female. Surprisingly, no clear patterns emerged by race/ethnicity, although the two largest groups (straight White females and straight White males) were 27th and 28th of 30, respectively. CONCLUSIONS: Although studies have examined ACEs by individual demographic variables, less is known about the extent to which ACEs are present in stratified subgroups. Sexual minority subgroups (particularly female bisexual subgroups) trend toward a higher number of ACEs, whereas heterosexual subgroups (regardless of sex) comprised the lowest 6 groups with respect to ACEs. Implications include further examination of bisexual and female subgroups (including specific ACE domain investigations) to identify the vulnerable population.

Cumulative life-course victimization and inflammation in a U.S. national sample: Comparing intersections based on sexual orientation, gender, race/ethnicity, and education.

Violence victimization has been associated with low-grade inflammation. Lesbian, Gay, and Bisexual (LGB) individuals are at greater risk for victimization in childhood and young adulthood compared to heterosexuals. Moreover, the intersection of LGB identity with gender, race/ethnicity, and educational attainment may be differentially associated with victimization rates. However, no previous study has examined the role of cumulative life-course victimization during childhood and young adulthood in the association between 1) LGB identity and low-grade inflammation during the transition to midlife, and 2) intersection of LGB identity with gender, race/ethnicity, and educational attainment and low-grade inflammation during the transition to midlife. We utilized multi-wave data from a national sample of adults entering midlife in the United States- the National Longitudinal Study of Adolescent to Adult Health (Add Health; n = 4573) - and tested four bootstrapped mediation models. Results indicate LGB identity, LGB and White, and LGB and Black identities were indirectly associated with low-grade inflammation during the transition to midlife via higher levels of cumulative life-course victimization. Moreover, among LGB adults, the association between 1) less than college education and 2) some college education, and low-grade inflammation was mediated by cumulative life-course victimization. For LGB females, there was a direct association between identity and low-grade inflammation and this association was mediated by cumulative life-course victimization . Reducing accumulation of victimization could be critical for preventing biological dysregulation and disease onset among LGB individuals, particularly for those with multiple marginalized identities.

Female Opioid Court Participants' Narratives of Siloed Medical, Legal, and Social Service Sector Interactions to Inform Future Integrated Interventions.

A gap exists regarding how to design gender-specific interventions for women charged with opioid use disorder (OUD)-related crimes. National recent efforts include opioid courts. Treatment courts present opportunities for earlier intervention for women under judicial supervision. We interviewed 31 female participants in the first known opioid court so they could inform cross-sector integrated approaches to address their needs. Data reveal the complexity of participants' involvement with myriad cross-sector organizations, given the duality of their roles as simultaneous lifetime victims and as OUD-related perpetrators. Participants have difficulty trusting systems intended to help them due to systematic failures to prevent or address abuse and neglect over their lifetimes. The opioid crisis cannot be solved without an understanding of early missed intervention opportunities and a cross-sector approach.

Factors contributing to filicide-suicide: Differences between male and female perpetrators.

BACKGROUND: One-quarter of homicide-suicide deaths in the U.S. are children. Filicide-suicide, a subset of homicide-suicide involving parent or caregiver perpetrators, is the most common form of homicide-suicide involving children. While these incidents have significant impacts, relatively few studies examine modifiable factors that contribute to these incidents. OBJECTIVES: The purpose of this study was to identify patterns of circumstances and contributing factors for filicide-suicide deaths, focusing on the individual and interpersonal differences between male and female perpetrators. PARTICIPANTS: This study utilized data from the National Violent Deaths Reporting System (NVDRS), which included 76 filicide-suicide incidents reported to NVDRS in 32 U.S. states between 2013 and 2015. METHODS: We conducted a qualitative content analysis, which was grounded in the Marzuk, Tardiff, and Hirsch (1992) framework. We reviewed the filicide-suicide narratives and engaged in conversations about codes or themes that emerged for the filicide-suicide narratives. Additional codes were added as needed, and narratives were retroactively coded to ensure codes were consistently applied. RESULTS: Relationship conflict and mental health issues were common among male and female perpetrators, but the manifestation of these factors differed greatly. For female perpetrators, relationship conflict, mental health issues, and children's chronic health issues commonly co-occurred. In contrast, relationship conflict, history of violence, and consequences of violence (e.g., legal issues, job problems) more commonly co-occurred among male perpetrators. CONCLUSION: Filicide-suicides are preventable acts of violence with numerous contributing factors. Our findings highlight the need for prevention efforts to recognize interpersonal experiences, particularly differences between male and female perpetrators.

Multi-type childhood maltreatment exposure and substance use development from adolescence to early adulthood: A GxE study.

BACKGROUND: Childhood maltreatment types can co-occur and are associated with increased substance use during adolescence and early adulthood. There is also a strong genetic basis for substance use which interacts with environmental factors (e.g., childhood maltreatment) to influence substance use phenotype. OBJECTIVE: This research aimed to identify childhood maltreatment sub-groups based on type and chronicity, and their association with substance use change from adolescence to early adulthood, while accounting for the influence of substance use polygenic risk (i.e., genetic risk based on the combined effects of multiple genes). PARTICIPANTS: We used a sample of unrelated European-origin Americans with genetic and childhood maltreatment data (n = 2,664) from the National Longitudinal Study of Adolescent to Adult Health. METHODS: Latent profile analysis was used for sub-group identification and direct and interaction effects were tested for longitudinal trajectories of substance use utilizing generalized estimating equations. RESULTS: Three sub-groups with co-occurring childhood maltreatment exposures were identified: a high sexual abuse sub-group, a high physical abuse sub-group, and a normative sub-group (with low maltreatment exposure). At high polygenic risk, the high physical abuse sub-group had faster increases in substance use over time. In comparison, the high sexual abuse sub-group had faster progression in substance use only at low and medium polygenic risk. CONCLUSIONS: Findings provide initial evidence for biological and environmental differences among maltreatment sub-groups on trajectories of substance use.

Elder Mistreatment Victims during the COVID-19 Pandemic: Administrative Data from San Francisco Adult Protective Services.

This study examined elder mistreatment victims' experiences at the beginning of the COVID-19 pandemic, focusing on their COVID-19 awareness and unmet needs. San Francisco Adult Protective Services (APS) caseworkers conducted phone interviews with clients or collaterals (client's family, trusted other, or service provider) to inquire about clients' awareness of COVID-19 and unmet needs. Nine-hundred-and-thirty-four (71%) of 1,313 APS' past clients or their collaterals were interviewed, with 741 (79%) responding positively to COVID-19-awareness questions, and 697 (75%) having no unmet needs. Binary logistic regression with Firth adjusted maximum likelihood estimation method revealed that older persons (p < .05), self-neglectors (p < .05), and victims of neglect (p < .05) were less aware of COVID-19. Unmet needs varied by mistreatment type. Victims of isolation were more likely to have medical needs (p < .05), while victims of emotional abuse were more likely to report loneliness (p < .001). Case notes reflected clients who were well-prepared for the pandemic, versus those who required additional assistance to follow preventative measures of the COVID-19 pandemic to stay home. Although the majority of San Francisco APS' past clients experienced no unmet needs at the beginning of the COVID-19 pandemic, the prolonged length and intensity of the pandemic could have exacerbated this vulnerable group's situation. Collaboration between service providers is key in assisting victims experiencing unmet needs to live safely in a public health crisis, especially underserved victims of specific ethnic backgrounds.

An examination of fatal child poisonings in the United States using the National Violent Death Reporting System (NVDRS), 2012-2017.

BACKGROUND: Fatal drug overdoses are predominantly attributed to opioids. Women of childbearing age are among those at greatest risk, underscoring the need to understand the overlapping risk of fatal poisoning in children. METHODS: A retrospective analysis of fatal poisonings among decedents aged 0-9 years captured in the National Violent Death Reporting System (NVDRS) from 2012 to 2017 was employed. Poisonings were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes for poisonings (T36-T50, Y10-Y19), toxic effects of substances (T51-T65), and assault (X85-X90). The frequency and types of drugs involved in poisonings were derived from toxicological analysis. Logistic regression was used to model the odds of fatal poisoning by decedent and perpetrator characteristics. Qualitative content analysis was used to contextualize the patterns of fatal poisonings. FINDINGS: 1850 violent deaths were identified; 7% (n = 122) were poisoning-related, and 50% of these were attributed to opioids. Next, benzodiazepines (8%), amphetamines (7%), and antidepressants (5%) were most prevalent. Among poisoning-related deaths, 25% involved homicide-suicide. No differences in deaths were observed according to child race/ethnicity, and the risk of fatal poisoning decreased 6% with each year of child age. Following qualitative analysis, three unique categories of fatal poisoning emerged: "intentional administration without documented benign intent", "intentional administration with benign intent", and "unclear administration". CONCLUSION: The high proportion of fatal poisonings in children attributed to opioids in this study suggests a need for universal dissemination and training of naloxone in households comprised of children living with parents experiencing, or in recovery for substance misuse. Findings also indicate a needed emphasis on safe storage practices and education to parents about the risk of prescription drug toxicity in children.

"They Aren't Going to Do Jack Shit": Text-Based Crisis Service Users' Perceptions of Seeking Child Maltreatment-Related Support From Formal Systems.

Many of the children reported to child protective services (CPS) exhibit signs and symptoms that allow others to recognize their abuse or neglect and intervene; others, especially adolescents, must disclose their experiences to be identified. Relatively little is known about young people's disclosure experiences, but individual, interpersonal, and cultural factors appear to influence when and how young people disclose. Technology-facilitated approaches, such as text- or chat-based hotlines or crisis services, may be one way to help young people share their maltreatment experiences and seek help. The current study contributes to the small body of literature that includes nonsexual maltreatment disclosures and sheds some light on how to support young people during their disclosures. We conducted a qualitative content analysis of all conversations from a text-based crisis service that resulted in a report to CPS (n = 244). Many of the texters had previously sought support from their peers or parents, and some had engaged with more formal systems. Many young people were hesitant to reach out to formal systems in the future, in part because of negative experiences during past disclosure experiences. Young people may be more likely to seek support through their preferred communication medium, so providing text- and chat-based communication may be one way to encourage and facilitate disclosure. As these resources become increasingly available, determining best practices for receiving disclosures through technology-facilitated platforms will be critical.

"They're very passionate about making sure that women stay healthy": a qualitative examination of women's experiences participating in a community paramedicine program.

BACKGROUND: Community paramedicine programs (i.e., physician-directed preventive care by emergency medical services personnel embedded in communities) offer a novel approach to community-based health care. Project Swaddle, a community paramedicine program for mothers and their infants, seeks to address (directly or through referrals) the physical, mental, social, and economic needs of its participants. The objective of this process evaluation was to describe women's experiences in Project Swaddle. By understanding their experiences, our work begins to build the foundation for similar programs and future examinations of the efficacy and effectiveness of these approaches. METHODS: We completed 21 interviews with women living in Indiana (July 2019-February 2020) who were currently participating in or had graduated from Project Swaddle. Interviews were audio-recorded, transcribed, and analyzed using a six-phase approach to thematic analysis. RESULTS: Program enrollment was influenced by the community paramedics' experience and connections, as well as information received in the community from related clinics or organizations. Participants viewed the community paramedic as a trusted provider who supplied necessary health information and support and served as their advocate. In their role as physician extenders, the community paramedics enhanced patient care through monitoring critical situations, facilitating communication with other providers, and supporting routine healthcare. Women noted how community paramedics connected them to outside resources (i.e., other experts, tangible goods), which aimed to support their holistic health and wellbeing. CONCLUSIONS: Results demonstrate Project Swaddle helped women connect with other healthcare providers, including increased access to mental health services. The community paramedics were able to help women establish care with primary care providers and pediatricians, then facilitate communication with these providers. Women were supported through their early motherhood experience, received education on parenting and taking control of their health, and gained access to resources that met their diverse needs.

Characteristics and Circumstances Associated with Work-Related Suicides from the National Violent Death Reporting System, 2013-2017.

Workplaces are critical in suicide prevention because work-related factors can be associated with suicide, and because workplaces can be effective suicide prevention sites. Understanding the circumstances associated with work-related suicides can advance worksite prevention efforts. Data from the United States Centers for Disease Control and Prevention, National Violent Death Reporting System from 2013 to 2017 were used to examine characteristics and circumstances associated with work compared with non-work suicides. Work-related suicides included those indicated as work-related on the death certificate or in which the death investigation mentioned a work problem or work crisis. Of the 84,389 suicides, 12.1% had some relation to the decedent's work. Males, those aged 21-54, and with at least a college education, were most likely to have work-related suicides. The circumstances most strongly associated with work-related suicide were financial problems (Odds Ratio (OR) = 4.7; 95% Confidence Interval (CI) = 4.5-5.0), prior depressed mood (OR = 2.4; 95% CI = 2.3-2.5), and eviction/loss of home (OR = 1.6; 95% CI = 1.4-1.7). Suicides among healthcare practitioners and management occupations had the highest odds of being work-related. Workplace wellness programs can consider incorporating services, such as financial planning and mental health services, as potentially up-stream approaches to prevent work-related suicide.

Ecological factors affecting Infant at Work policies and programs in university settings.

OBJECTIVES: This study identifies the ecological (ie, policy, environment, intrapersonal, and interpersonal) factors affecting the implementation of an Infant at Work program in a university setting. METHODS: Data were collected among faculty, staff, and graduate students at a large Midwestern university from February to July 2020 via focus group (FG) discussions with university employees (n = 22) and semistructured interviews with university administrators (n = 10). We used techniques from expanded grounded theory, allowing for a constant comparative approach to data contextualization and theme identification. RESULTS: Three themes emerged from the FG data: (i) program and policy scope, (ii) employee and employer benefits, and (iii) workplace concerns. Onsite daycares, flexible schedules and participation, and expanded childcare options were some of the programs and policies employees desired. However, barriers to implementing these types of programs include cost, safety, and structure of the work environment. CONCLUSIONS: Findings offer practical recommendations and strategies to improve work/life balance among parents transitioning back to work in a university environment. Findings also provide insight into the feasibility of family-friendly workplace policies and environments. Additionally, findings provide a framework for other organizations to implement similar Infant at Work programs to improve employee work/life balance.

Psychiatric diagnoses are associated with means selection in united states suicide deaths.

PURPOSE: The purpose of this study was to examine whether the choice of means by persons who die by suicide is associated with a prior psychiatric diagnosis. METHODS: In this cross-sectional study, we analyzed suicide surveillance data from 18 states reporting to the National Violent Death Reporting System (NVDRS) between 2003 and 2014. NVDRS compiled data from multiple sources (e.g., coroner's reports, police reports, death certificates) on every violent death within reporting jurisdictions, including information on indicated psychiatric disorders and suicide means. We assessed whether the selected suicide means were associated with diagnoses using multinomial logistic regression. RESULTS: Adjusted models suggested that, compared to decedents using firearms, those using poisoning were more likely to have each psychiatric disorder examined, including bipolar disorder (aOR: 2.17 [95% CI 2.03-2.32]), schizophrenia (aOR: 1.81 [1.61-2.04]), depression (aOR: 1.64 [1.58-1.70]), anxiety disorder (aOR: 1.46 [1.35-1.57]), and PTSD (aOR: 1.41 [1.22-1.64]). A far greater proportion of individuals who died from less common means (other than firearms, suffocation, or poisoning) had schizophrenia (aOR: 4.52 [4.00-5.11]). CONCLUSIONS: Many existing and proposed means restriction interventions have focused on firearms. Additional focus on access to potential agents of poisoning (e.g., the type and quantity of medication administered to patients) among individuals with psychiatric diagnoses may be warranted.