Pathways to Psychopathology Among Autistic Adults.

PURPOSE OF REVIEW: Autistic adults frequently require treatment of mental health problems. Increased rates of suicidality and diminished quality of life among autistic people may be partially attributable to psychiatric symptoms. Some risk factors for mental health problems in autistic people are likely the same as risk factors present in neurotypical individuals, but unique factors that are specific to neurodivergent individuals, and some even more specific to autistic people, may exist. Understanding pathways from autism to mental health problems could inform intervention efforts at the individual and societal levels. RECENT FINDINGS: We review a growing body of research identifying risk processes across the affective, cognitive, and social domains. Consistent with the principle of equifinality, different processes appear to independently and jointly lead to heightened risk for the onset of mental health problems. Autistic adults frequently utilize mental healthcare services, and experience heightened risk for chronic impairment as a result of mental health problems. Understanding causal and developmental risk processes in autism should inform personalized treatment. We synthesize extant research on these processes and offer suggestions for addressing them therapeutically and societally.

#ChokeMeDaddy: A Content Analysis of Memes Related to Choking/Strangulation During Sex.

Recent research indicates that some young people initially learn about sexual choking through Internet memes. Thus, a qualitative content analysis was performed on 316 visual and textual memes collected from various social media websites and online searches to assess salient categories related to choking during sex. We identified nine main categories: communication, gendered dynamics, choking as dangerous, choking as sexy, sexualization of the nonsexual, shame and worry, romance/rough sex juxtaposition, choking and religious references, instructional/informational. Given that memes, through their humor, can make difficult topics more palatable and minimize potential harm in the phenomenon they depict, more concerted, synergistic effort that integrates media literacy into sexuality education programming on the potential risks that may ensue for those engaging in sexual choking is warranted.

Reductions in Depression and Anxiety Among Autistic Adults Participating in an Intervention to Promote Healthy Relationships.

IMPORTANCE: Some autistic adults experience depression and anxiety related to their social relationships. There is a need for evidence-based occupational therapy interventions that decrease depression and anxiety and improve the health of social relationships for autistic adults. OBJECTIVE: To determine the feasibility and preliminary effectiveness of the Healthy Relationships on the Autism Spectrum (HEARTS) intervention, a six-session, group-based psychoeducational intervention for the improvement of relationship health. DESIGN: One-group pretest-posttest design with a 3-mo follow-up after baseline. SETTING: United States; online intervention through community organization. PARTICIPANTS: Fifty-five adults, ages 20 to 43 yr, with a professional or self-diagnosis of autism and the capacity to independently participate in an online, group-based, participatory class. INTERVENTION: Participants received 6 90-min weekly sessions that addressed healthy relationship topics, including recognizing abuse, meeting people, maintaining relationships, setting interpersonal boundaries, neurohealth for relationships, and ending relationships. A psychoeducational approach that provided education and involved guided discovery and strategy acquisition was used. OUTCOMES AND MEASURES: All measures were self-administered through an online survey. Depression and anxiety were assessed using instruments from the Patient-Reported Outcomes Measurement Information System. RESULTS: Fifty-five participants completed the intervention. Postintervention scores revealed statistically significant improvements in depression and anxiety. CONCLUSIONS AND RELEVANCE: HEARTS is a promising intervention for improving depression and anxiety among autistic adults and should be investigated further. What This Article Adds: HEARTS offers a potentially effective, nonpharmacological, psychoeducational group-based intervention option to promote healthy relationships for autistic adults. Positionality Statement: This article uses identity-first language (autistic person) in accordance with the preference of autistic self-advocates (Autistic Self Advocacy Network, 2020; Kenny et al., 2016; Lord et al., 2022).

Validity of a three-item dating abuse victimization screening tool in a 11-21 year old sample.

BACKGROUND: Dating abuse (DA) is prevalent and consequential, but no brief DA screening tools are available for use in pediatric or other settings. This study was designed to determine the sensitivity, specificity, and predictive values of the MARSHA-C, which is a three-item DA victimization screening tool. METHODS: The participants were 224 U.S. youth ages 11-21 years old (20% male, 77% female, 3% non-binary gender). Youth completed an online questionnaire about adolescent relationship abuse. The survey included the Measure of Adolescent Relationship Harassment and Abuse (MARSHA), which is a comprehensive DA measurement instrument normed on a nationally representative sample. Of 34 DA victimization items from the MARSHA, the three most prevalent items were hypothesized to have good predictive validity of the full scale score as a brief, screening version (MARSHA-C). The sensitivity, specificity, positive predictive value, and negative predictive value of the MARSHA-C to identify victims of DA was calculated. RESULTS: Using the MARSHA as the reference standard, the cutpoint of 1 on the MARSHA-C screening tool was identified as optimal. The MARSHA-C had a sensitivity of 84%, a specificity of 91%, and positive predictive value of 91%. Thus, for youth who endorse ≥ 1 MARSHA-C items, there is a 91% probability that they have experienced DA in the past year. Exploratory analyses by demographic subgroups suggest that the predictive validity of the MARSHA-C is approximately equivalent for females and males, younger and older adolescents, Asian, Black, Latinx, Multiracial and White youth, and heterosexual and lesbian, gay, and bisexual youth. CONCLUSIONS: The MARSHA-C can be used to detect DA among 11-21-year-old youth via online surveys for research purposes, or in clinical care settings to facilitate proactive patient counseling or parent-oriented anticipatory guidance.

Prevalence of Opioid Use and Intimate Partner Violence among Pregnant Women in South-Central Appalachia, USA.

Background: Recent research indicates that pregnant women in rural communities are at increased risk of experiencing IPV and comorbid illicit opioid use compared to urban-residing pregnant women. Few studies of the interactions among rurality, substance use, and victimization in pregnant women exist. The current study sought to examine the relationship between IPV and opioid use and the interaction effects of rurality in Appalachian pregnant women. Methods: A convenience sample of pregnant women who were enrolled in a smoking cessation research study was used for this analysis. Participants included 488 pregnant women from five prenatal clinics in South-Central Appalachia. Data were from self-reported assessments and semi-structured interviews on substance use and IPV conducted from first trimester of pregnancy through eight months postpartum. Results: Four hundred and ten participants reported experiencing any form of IPV in the past year. Logistic regression results indicated that physical IPV was associated with opioid use, but sexual and psychological IPV were not. The moderation model indicated direct effects between IPV and opioid use, but were not moderated by rurality. Conclusion: This study suggests a need to further understand the relationship between substance use, IPV, and rurality in pregnant women. The specific subtopic of opioid use by pregnant women living in rural communities, and its relationship to IPV victimization and adverse fetal and maternal health outcomes, continues to be an understudied, but critically important area. Limitations and future directions pertaining to IPV screenings and interventions for pregnant women are discussed.

The Prevalence of Using Pornography for Information About How to Have Sex: Findings from a Nationally Representative Survey of U.S. Adolescents and Young Adults.

We analyzed cross-sectional data collected from a U.S. nationally representative survey of individuals ages 14-24 years old on what sources of information from the past year they considered to be the most helpful about how to have sex (n = 600 adolescents ages 14-17 years old, and n = 666 young adults ages 18-24 years old). Among the 324 adolescents who indicated that they had been helped by at least one source of information, helpful information was most likely to have come from parents (31.0%) and friends (21.6%). Only 8.4% of adolescents said pornography was helpful. However, for those in the 18-24-year-old age group, pornography was the most commonly endorsed helpful source (24.5%), as compared to other possible options such as sexual partners, friends, media, and health care professionals. Multivariable regression analyses revealed that indicating that pornography was the most helpful source of information about how to have sex, compared to the other sources, was inversely associated with being female (OR = 0.32, p = .001), inversely associated with identifying as bisexual compared to heterosexual (OR = 0.15, p = .038), positively associated with being Black compared to being white non-Hispanic (OR = 4.26, p = .021), inversely associated with reporting a household income of either $25 K to $49,999 (OR = 0.31, p = .010) or $50 K to $74,999 (OR = 0.36, p = .019) compared to more than $75 K, and positively associated with having masturbated (OR = 13.20, p = .005). Subsequent research should investigate the role of pornography in both adolescent and adult sexual development, including why one-quarter of U.S. young adults say that pornography is a helpful source of information about how to have sex and what they think that they are learning from it.

Evaluation of the One Love Escalation Workshop for Dating Abuse Prevention: a Randomized Controlled Trial Pilot Study with a Sample of US Navy Sailors.

The purpose of this study was to evaluate the efficacy of the Escalation Workshop with a sample of US Navy sailors. Escalation is a one-session workshop designed to promote bystander behavior related to dating abuse. We conducted a two-arm RCT with follow-up at 4 and 8 months. Participants were 335 Navy sailors, recruited from two comparable ships based in the USA. The unit of randomization was the ship. The primary outcomes were as follows: (a) attitudes related to intervening as a bystander in dating abuse situations, (b) injunctive norms about dating abuse, (c) dating abuse-related prevention-oriented behaviors (e.g., such as posting dating violence prevention messages online), and (d) bystander behaviors including acting as a bystander to prevent peer self-harm, peer bullying, peer intoxication, or peer dating abuse, or being a proactive bystander and initiating conversations about dating abuse prevention with friends and others. Hierarchal linear models (HLMs) indicated that, compared to participants in the control group, participants in the intervention group demonstrated improvement in attitudes [ß = .09, p < .001] and had more engagement than controls in prevention-oriented behavior at 8-month follow-up [ß = 0.11, p < .01]. Those in the intervention group also reported larger increases than controls in bystander behavior related to peer self-harm, peer bullying, peer intoxication, and starting conversations about dating abuse. Results for dating abuse bystander behavior were mixed. At 4 months, workshop participation was marginally associated with increased bystander behavior with peers who had perpetrated dating abuse (ß = 0.89, p = 0.06) and with peers experiencing physical or sexual dating abuse, or stalking or threats (ß = 1.11, p = .07). However, workshop participation was not associated with increased bystander behavior with peers experiencing only physical abuse. The Escalation Workshop may be a promising strategy to promote change in dating abuse-related attitudinal change and prevention-oriented behavior, and bystander behavior with peers related to self-harm, bullying, intoxication, and some aspects of dating abuse prevention.

A Pornography Literacy Program for Adolescents.

In 2016, in response to concern about the impact of pornography on adolescents, the Boston Public Health Commission partnered with a university researcher to develop a nine-session media literacy curriculum on pornography for adolescents. The curriculum was pilot-tested with five small classes of adolescents between 2016 and 2019 (n = 31). Many adult teachers of sex education also expressed interest in being trained to use the curriculum, so our team has now trained 300 adults to use it.

The Effects of a Health Care-Based Brief Intervention on Dating Abuse Perpetration: Results of a Randomized Controlled Trial.

Dating abuse (DA) is prevalent and consequential, yet there are no evidence-based interventions for the health care setting that prevent perpetration. The current study's purpose was to test a one-session brief motivational interview-style intervention to decrease DA perpetration. We conducted a two-arm RCT of the Real Talk intervention with follow-up at 3 and 6 months. Participants were 172 youth ages 15-19 years old, recruited from the pediatric emergency department or outpatient care services of an urban hospital in the USA in 2014-2017. The primary outcome was change in self-reported DA perpetration, including subtypes of DA such as physical, sexual, psychological, and cyber DA. Youth in both intervention and control arms reduced DA perpetration over time. GEE models indicated no overall intervention effects for any, physical, sexual, or psychological DA. There were overall effects for cyber DA (RR 0.49, 95% CI 0.27, 0.87). There were also effects at 3 months for psychological DA (RR 0.24, 95% CI 0.06, 0.93) and cyber DA (RR 0.39, 95% CI 0.19, 0.79). Analyses stratified by gender also found overall effects for males for any DA (RR 0.20, 95% CI 0.07, 0.55), physical DA (RR 0.30, 95% CI 0.10, 0.89), and cyber DA (RR 0.04, 95% CI 0.01, 0.27). For males, intervention effects on any DA persisted to 6 months (RR 0.13, 95% CI 0.02, 1.01). This health care-based one-session DA intervention is a potentially promising approach to reduce DA perpetration among adolescents.Clinical trial registration: This study is registered at www.clinicaltrials.gov NCT02080923.

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

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

Perceptions of Community Norms and Youths' Reactive and Proactive Dating and Sexual Violence Bystander Action.

There is enthusiasm for programs that promote bystander intervention to prevent dating and sexual violence (DSV). However, more information about what facilitates or inhibits bystander behavior in DSV situations is needed. The present cross-sectional survey study investigated whether youth perceptions of adults' behavior and community norms were associated with how frequently youth took action and intervened in DSV situations or to prevent DSV. Specifically, study hypotheses were that youths' perceptions of community-level variables, such as adults' willingness to help victims of DSV or prevent DSV, perceptions of community collective efficacy, and perceptions of community descriptive and injunctive norms disapproving of DSV and supporting DSV prevention, would be associated with how frequently youths took reactive and proactive bystander action. Participants were 2172 students from four high schools in one New England state. ANOVA analyses found that descriptive norms were associated with all actionist behaviors, and perceptions of community cohesion were also consistently associated with them. Injunctive norms were associated, but less consistently, with actionist behaviors. Findings suggest that DSV-related social norms, and descriptive norms and community cohesion in particular, might be relevant to youth DSV bystander behavior.

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

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

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

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

State Firearm Laws and Interstate Transfer of Guns in the USA, 2006-2016.

In a cross-sectional, panel study, we examined the relationship between state firearm laws and the extent of interstate transfer of guns, as measured by the percentage of crime guns recovered in a state and traced to an in-state source (as opposed to guns recovered in a state and traced to an out-of-state source). We used 2006-2016 data on state firearm laws obtained from a search of selected state statutes and 2006-2016 crime gun trace data from the Bureau of Alcohol, Tobacco, Firearms, and Explosives. We examined the relationship between state firearm laws and interstate transfer of guns using annual data from all 50 states during the period 2006-2016 and employing a two-way fixed effects model. The primary outcome variable was the percentage of crime guns recovered in a state that could be traced to an original point of purchase within that state as opposed to another state. The main exposure variables were eight specific state firearm laws pertaining to dealer licensing, sales restrictions, background checks, registration, prohibitors for firearm purchase, and straw purchase of guns. Four laws were independently associated with a significantly lower percentage of in-state guns: a waiting period for handgun purchase, permits required for firearm purchase, prohibition of firearm possession by people convicted of a violent misdemeanor, and a requirement for relinquishment of firearms when a person becomes disqualified from owning them. States with a higher number of gun laws had a lower percentage of traced guns to in-state dealers, with each increase of one in the total number of laws associated with a decrease of 1.6 percentage points in the proportion of recovered guns that were traced to an in-state as opposed to an out-of-state source. Based on an examination of the movement patterns of guns across states, the overall observed pattern of gun flow was out of states with weak gun laws and into states with strong gun laws. These findings indicate that certain state firearm laws are associated with a lower percentage of recovered crime guns being traced to an in-state source, suggesting reduced access to guns in states with those laws.

State Intimate Partner Violence-Related Firearm Laws and Intimate Partner Homicide Rates in the United States, 1991 to 2015.

BACKGROUND: To prevent intimate partner homicide (IPH), some states have adopted laws restricting firearm possession by intimate partner violence (IPV) offenders. "Possession" laws prohibit the possession of firearms by these offenders. "Relinquishment" laws prohibit firearm possession and also explicitly require offenders to surrender their firearms. Few studies have assessed the effect of these policies. OBJECTIVE: To study the association between state IPV-related firearm laws and IPH rates over a 25-year period (1991 to 2015). DESIGN: Panel study. SETTING: United States, 1991 to 2015. PARTICIPANTS: Homicides committed by intimate partners, as identified in the Federal Bureau of Investigation's Uniform Crime Reports, Supplementary Homicide Reports. MEASUREMENTS: IPV-related firearm laws (predictor) and annual, state-specific, total, and firearm-related IPH rates (outcome). RESULTS: State laws that prohibit persons subject to IPV-related restraining orders from possessing firearms and also require them to relinquish firearms in their possession were associated with 9.7% lower total IPH rates (95% CI, 3.4% to 15.5% reduction) and 14.0% lower firearm-related IPH rates (CI, 5.1% to 22.0% reduction) than in states without these laws. Laws that did not explicitly require relinquishment of firearms were associated with a non-statistically significant 6.6% reduction in IPH rates. LIMITATIONS: The model did not control for variation in implementation of the laws. Causal interpretation is limited by the observational and ecological nature of the analysis. CONCLUSION: Our findings suggest that state laws restricting firearm possession by persons deemed to be at risk for perpetrating intimate partner abuse may save lives. Laws requiring at-risk persons to surrender firearms already in their possession were associated with lower IPH rates. PRIMARY FUNDING SOURCE: Robert Wood Johnson Foundation.

Ethical and Practical Considerations for Collecting Research-Related Data from Commercially Sexually Exploited Children.

This article presents seven challenges of collecting primary (i.e., firsthand) data from commercially sexually exploited children (CSEC). We drew on our research team's experience collecting longitudinal data from 28 CSEC survivors with a 12-month follow-up period. We used both face-to-face and electronic group brainstorming methods to nominate a list of research-related challenges. The two main themes that were identified were challenges that can limit data quality and concerns about the impact of research on participants, researchers, and others. The three challenges related to data quality are (1) the age of the research participants; (2) questions about obtaining informed consent from parents or guardians; and (3) the over-interrogation of CSEC youth. The four challenges related to concerns about the impact of research were (4) concerns that research participation may further exploit youth; (5) staying in the role of researcher and refraining from providing advocacy; (6) secondary trauma and burnout experienced by research staff; and (7) the additional burden that research and data collection may place on the advocates and direct service providers. Because the process of collecting data from CSEC youth can be complicated, and rife with ethical and practical challenges, we have relayed our experiences with seven specific research-related challenges in order to stimulate discourse and further progress in the field.

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

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

Firearm Ownership and Suicide Rates Among US Men and Women, 1981-2013.

OBJECTIVES: To examine the relationship between state-level firearm ownership rates and gender-specific, age-adjusted firearm and total suicide rates across all 50 US states from 1981 to 2013. METHODS: We used panel data for all 50 states that included annual overall and gender-specific suicide and firearm suicide rates and a proxy for state-level household firearm ownership. We analyzed data by using linear regression and generalized estimating equations to account for clustering. RESULTS: State-level firearm ownership was associated with an increase in both male and female firearm-related suicide rates and with a decrease in nonfirearm-related suicide rates. Higher gun ownership was associated with higher suicide rates by any means among male, but not among female, persons. CONCLUSIONS: We found a strong relationship between state-level firearm ownership and firearm suicide rates among both genders, and a relationship between firearm ownership and suicides by any means among male, but not female, individuals. POLICY IMPLICATIONS: For male persons, policies that reduce firearm ownership will likely reduce suicides by all means and by firearms. For female persons, such policies will likely reduce suicides by firearms.