Considering the associations of adverse and positive childhood experiences with health behaviors and outcomes among emerging adults.

Childhood is a sensitive period of development during which early life experiences can facilitate either positive or negative health trajectories across subsequent developmental periods. Previous research has established strong links between adverse childhood experiences (ACEs) and adverse health outcomes (e.g., sleep-related problems, pain, substance use). Despite this, less is known about positive childhood experiences (PCEs) and how they may buffer the effects of ACEs on health outcomes. The current study investigated whether PCEs moderate the associations between ACEs and health behavior and health-related outcomes (i.e., cannabis use, alcohol use, sleep disturbance, sleep-related impairment, pain intensity, and pain interference) in a sample of at-risk emerging adults. Participants (N = 165) were undergraduate college students (18-25 years of age) who reported frequent alcohol and/or cannabis use (≥3 times in the past week). A significant positive association was found between ACEs and cannabis use. There were also significant negative associations found between PCEs and pain interference and intensity. PCEs did not moderate any of the associations between ACEs and health behavior and health-related outcomes (i.e., cannabis use, alcohol use, sleep disturbance, sleep-related impairment, pain intensity, and pain interference). Findings suggest that PCEs may be unlikely to serve as a strong enough protective factor during early life to decrease risk for suboptimal health and health behaviors during emerging adulthood among individuals who report a greater accumulation of ACEs. Longitudinal research is needed to identify additional related risk and protective factors during early life to further support health and health behavior during this transitional period of development and beyond.

ADHD Symptoms and Sleep Problems During Middle Childhood: The Indirect Effect of Peer Victimization.

The present cross-sectional study evaluated whether traditional and/or cyber peer victimization served as mechanisms linking ADHD symptoms to sleep disturbance and sleep impairment in a sample of 284 third- through fifth-grade students (51.9% boys; 50.4% Hispanic/Latine) from two elementary schools in the United States. ADHD symptoms were assessed using teacher ratings. Children provided reports of their traditional and cyber victimization as well as their sleep disturbance and impairment. Results from path analysis models revealed significant indirect effects of traditional victimization on the links from ADHD symptoms to sleep disturbance and impairment. There was also a significant indirect effect of cyber victimization on the link from ADHD symptoms to sleep impairment. These findings suggest that experiences of traditional and cyber peer victimization may need to be addressed among children exhibiting ADHD symptoms in order to mitigate their risk for sleep problems and downstream effects on other domains of psychosocial functioning.

Positive Emotion Is Associated with Attentional Focus on Physical Activity and Eating in Adolescents: A Daily Diary Study.

BACKGROUND: There are emerging data linking positive emotion to health behaviors, yet the self-regulatory processes underlying this link are understudied. The purpose of the current study was to examine the associations between daily positive emotion and daily attentional focus on physical activity and overeating as well as the moderating role of trait positive emotion arousal recovery. METHOD: Adolescents (N = 47) aged 11 to 17 completed a baseline measure of their perceived positive emotion arousal regulation and a 7-day diary about their positive emotion and attentional focus. RESULTS: Both within-person increases in and greater average daily approach-oriented positive emotion were associated with greater daily attentional focus on physical activity and overeating. Quicker perceived trait approach-oriented positive emotion arousal recovery dampened the association between within-person increases in daily approach-motivated positive emotion and daily attentional focus on overeating but not physical activity. CONCLUSION: Positive emotion can elicit a narrowing of attentional focus towards emotionally salient health behavior. Future studies should examine the full mechanistic pathway linking positive emotion to health behavior via attentional focus and arousal recovery.

Acceptability of a Self-Led Mindfulness-Based Intervention for Teens with Type 1 Diabetes: Pilot Randomized Controlled Trial.

BACKGROUND: Diabetes distress among adolescents with type 1 diabetes has been associated with suboptimal diabetes outcomes, including lower quality of life, increased diabetes self-management challenges, and suboptimal glycemic outcomes. OBJECTIVE: This study examined the feasibility and acceptability of a scalable self-led mindfulness-based intervention to reduce diabetes distress in adolescents with type 1 diabetes. METHODS: Adolescents (N=25) aged between 14 and 18 years diagnosed with type 1 diabetes completed a baseline assessment. Participants were randomized to receive a 10-week self-guided mindfulness-based stress reduction workbook program (e-book or paper option) immediately (n=15) or after a 10-week wait (n=10). During the intervention period, participants completed weekly assignments and feedback surveys. At 10 weeks and 20 weeks, follow-up assessments were completed. RESULTS: Findings indicated that participants did not find the original intervention feasible or acceptable. Adolescents reported barriers to completing the weekly material, such as that they forgot or that the material was not sufficiently related to their diabetes management. Adolescents also reported that a digital format rather than a workbook or e-book may be more acceptable. Results from weekly surveys provided the foundation for recommendations for future iterations of the mindfulness-based intervention for adolescents with type 1 diabetes. CONCLUSIONS: Participant feedback informed recommendations for self-led mindfulness programs for youth with type 1 diabetes. Adolescents indicated that a shorter, digital mindfulness-based intervention focused on diabetes-specific behaviors may be more helpful. TRIAL REGISTRATION: ClinicalTrials.gov NCT05115175; https://clinicaltrials.gov/study/NCT05115175.

Latent Profiles of Sleep Disturbance and Impairment in Elementary School-Age Youth: Concurrent and Longitudinal Associations with Emotional, Behavioral, and Academic Functioning.

OBJECTIVE: The links from youth sleep problems to emotional, behavioral, and academic functioning are well documented. Latent variable mixture modeling (LVMM) has been used to explore these relations; however, additional research is needed in diverse samples and with self-reports of sleep-related difficulties. The objectives of the current study were to identify profiles based on patterns of sleep disturbance and impairment and explore associations among profiles and functioning at baseline and over a subsequent 6-month period. METHODS: Participants were 278 third- through fifth-grade students (M age = 9.27; 51.8% male; 51.1% Hispanic/Latine) and homeroom teachers. Children completed measures of sleep disturbance and impairment, emotion (dys)regulation, and depressive, anxiety, and anger symptoms. Teachers completed measures of youth's emotional and conduct problems, emotion (dys)regulation, and academic performance. LVMM was conducted. RESULTS: Three profiles emerged: (1) "Average Sleep Disturbance and Impairment" (n = 148); (2) "Elevated Sleep Disturbance and Average Sleep Impairment" (n = 40); and (3) "Elevated Sleep Disturbance and Impairment" (n = 90). Overall, youth with above average sleep problems had worse functioning at baseline. Further, youth in Profile 3 exhibited increases in self-reported symptoms of depression, anxiety, and anger, as well as worsening teacher-reported academic performance and conduct problems. In contrast, youth in Profile 2 exhibited improvements in self-reported symptoms of depression, anxiety, and anger, as well as teacher-reported emotion regulation, conduct problems, and academic performance. CONCLUSIONS: Results highlight the importance of examining self-reports of sleep problems and the need for intervention among children exhibiting elevated sleep disturbance and impairment.

Social power may be associated with health through positive emotion.

Increased social power-defined as one's influence on another's behavior-guides activation of one's behavioral activation system which, in turn, elicits greater positive emotion. Positive emotion has also been linked to greater health. The current research assessed whether power and positive emotion are related to health. In Study 1, participants (N = 403; Mage = 48.33 years) wrote a narrative about a time in which they felt powerful or powerless. Greater self-reported feelings of power, concurrent with more frequent use of positive emotional words within the narrative, was associated with fewer references to health within the narrative. In Study 2, participants (N = 401; Mage = 33.05 years) primed with the concept of power (vs. powerlessness) reported greater health competency through enhanced positive emotion. Findings provided preliminary data supporting the continued study of power to better understand the link between positive emotion and health. Future research should elucidate the long-term relationships between these variables to examine whether increased power can produce downstream positive effects on health and health behavior.

The Effect of Physicians' Acknowledgement of Clinical Decision Support Systems Generated Alerts on Patient Diabetes Management in a Primary Care Setting.

The purpose of the study is to evaluate whether clinician's acknowledgement and adherence to Clinical Best Practice Advisories (BPA) system's alerts improves the outcome of patients with chronic diabetes. We used deidentified clinical data of elderly (65 or older) diabetes patients with hemoglobin A1C (HbA1C) >= 6.5 that were extracted from the clinical database of a multi-specialty outpatient clinic that also provides primary care services. We performed paired ttest to evaluate whether clinician's acknowledgement and adherence to BPA system's alert has any impact on patients' HbA1C management. Our findings showed that the average HbA1C values improved for patients whose alerts were acknowledged by their clinicians. For the group of patients whose BPA alerts were ignored by their clinicians, we found clinicians' acknowledgement and adherence to BPA alerts for chronic diabetes patient management did not have a significant negative effect on improvement in patient outcome.

Pandemic grief risk factors and prolonged grief disorder in bereaved young adults during COVID-19.

OBJECTIVES: This study evaluated whether COVID-19-specific risk factors (e.g., feeling guilty for not being present with the deceased at the time of the loss and feeling emotionally distant from the deceased prior to the loss) were associated with prolonged grief disorder (PGD) symptomatology or diagnosis among young adults bereaved due to any cause (e.g., illness and violent loss). METHODS: We surveyed 196 young adults who had a family member/close friend die during the COVID-19 pandemic. Participants completed the PGD-12 Questionnaire and the 10-item Pandemic Grief Risk Factors (PGRF) Questionnaire. RESULTS: More time spent with the deceased before the loss and greater endorsement of pandemic grief risk factors were associated with increased PGD symptoms and a greater likelihood of meeting the diagnostic criteria for PGD. SIGNIFICANCE OF RESULTS: The COVID-19 pandemic created unique risk factors that affected the grieving process for bereaved individuals, regardless of whether the death was related to COVID-19 infection. These findings add to a growing body of literature examining grief and loss within the unique context of the COVID-19 pandemic and suggest that there may be detrimental long-term psychological outcomes for these bereaved individuals, regardless of the cause of death. Routine screening for these unique risk factors in medical and psychological clinics is warranted to help identify those individuals who could benefit from early intervention. Also, it will be important to understand and possibly modify evidence-based interventions and prevention programs to directly address the identified unique PGRF.

Intervention impact on the perceived emotion regulation repertoire of adolescents at-risk for risky sexual behaviors.

Recent calls have been made to evaluate the range, rather than the frequency of use, of strategies within adolescents' emotion regulation repertoire. It is unknown whether an emotion regulation intervention may increase adolescents' emotion regulation repertoire. To examine the direct effect of an emotion regulation intervention on adolescents' perceived emotion regulation repertoire from baseline to immediately postintervention, when controlling for baseline problems with emotional awareness and participant sex. Seventh-grade students (N = 420) participated in a 6-week emotion regulation and sexual health promotion randomized control trial. Adolescent-report measures of emotion regulation and problems with emotional awareness were collected. On average, adolescents used one additional strategy after completing the intervention; they endorsed using four (out of eight) strategies at baseline and five strategies immediately after the intervention. Emotion regulation interventions may expand adolescents' repertoire. Future research should explore whether such expansion may guide downstream effects on psychosocial functioning and prevent health risk behaviors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Parental separation and death during childhood as predictors of adult psychopathology: An examination of racial differences.

OBJECTIVE: Parental separation and parental death during childhood are common but understudied forms of adverse childhood events (ACEs), thus little is known about the impact on psychological functioning in adulthood. We examined whether parental death and parental separation during childhood was associated with risk of diagnostic criteria for depressive disorders, anxiety disorders, posttraumatic stress disorder (PTSD), or personality disorders during adulthood. Second, we compared parental separation and parental death and psychopathology across African Americans (N = 499) and Whites (N = 782). METHOD: The sample consists of 1,211 participants (n = 669 females). Diagnostic interviews were administered by master's or doctorate-level degree holders in Clinical Psychology or Social Work. There was good to excellent interrater reliabilities (mean kappa of .84 ± .05; range: .79-.93) spanning anxiety, mood, anxiety, trauma, and personality disorders. RESULTS: White participants reporting parental separation during childhood were more likely to report depressive disorders (OR = 2.151, p < .001), PTSD (OR = 2.218, p < .01) and personality disorders (OR = 1.764, p < .001) during adulthood. African American endorsement of parental separation during childhood did not predict depressive disorders (OR = 1.21, p = .357), anxiety disorders (OR = 1.107, p = .659), PTSD (OR = 1.351, p = .425) or personality disorders (OR = 1.432, p = .098) during adulthood. Overall, participants who reported parental death did not have significantly higher rates of depressive disorders (OR = 1.100, p = .668), anxiety disorders (OR = 1.357, p = .207), PTSD (OR = 1.351, p = .425), and personality disorders (OR = 1.432, p = .098). CONCLUSIONS: Parental separation was a significant risk factor for adult psychopathology, but only for White participants. Parental death was not a risk factor for adult psychopathology no matter the person's race. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Call to Action: Using and Extending Human-Centered Design Methodologies to Improve Mental and Behavioral Health Equity.

Mental health disparities directly tie to structural racism. Digital mental health (DMH), the use of technologies to deliver services, have been touted as a way to expand access to care and reduce disparities. However, many DMH fail to mitigate the persistent disparities associated with structural racism that impact delivery (e.g., costs, dependable internet access)-and may even exacerbate them. Human-centered design (HCD) may be uniquely poised to design and test interventions alongside, rather than "for," marginalized individuals. In employing HCD methodologies, developers may proceed with a vested interest in understanding and establishing empathy with users and their needs, behaviors, environments, and constraints. As such, HCD used to mindfully address structural racism in behavioral health care may address shortcomings of prior interventions that have neglected to elevate the voices of marginalized individuals. We argue that a paradigm shift in behavioral health services research is critically needed-one that embraces HCD as a key methodological framework for developing and evaluating interventions with marginalized communities, to ultimately promote more accessible, useful, and equitable care. The current commentary illustrates practical examples of the use of HCD methodologies to develop and evaluate DMH designed with marginalized populations, while also highlighting its limitations and need for even greater inclusivity. Following this, calls to action to learn from and improve upon HCD methodologies will be detailed. Acknowledging potential limitations of current design practices, methodologies must ultimately engage representative voices beyond research participation and invest in their active role as compensated and true collaborators to intervention design.

Trajectories and biopsychosocial predictors of daily acute pain in adolescents receiving treatment for pain: a daily diary study.

Research regarding daily acute pain and its correlates has primarily been conducted with adolescents who have had major surgery or musculoskeletal pain, restraining efforts towards adapting interventions for adolescents with other sources of acute pain. We explored the trajectories and correlates of pain intensity. Adolescents with an opioid prescription to treat acute pain (N = 157) completed demographic questions, and the PROMIS pediatric depression and anxiety subscales. A 10-day daily diary assessed pain intensity, pain interference, sleep quality, and opioid use. Three trajectories of pain intensity emerged: (1) slow decreases in pain, (2) rapid decreases in pain, and (3) stable or slight increases in pain. Teens with stable pain demonstrated the greatest anxiety levels. Higher sleep quality predicted lower next day pain intensity and pain interference, when controlling for opioid use. Future research should employ intensive longitudinal methodology to further guide intervention development and prevent the transition to chronic pain.

A Digital Health Program Targeting Physical Activity Among Adolescents With Overweight or Obesity: Open Trial.

BACKGROUND: Prior studies suggest that mobile health physical activity programs that provide only weekly or daily text-based health coaching evidence limit the efficacy in improving physical activity in adolescents with overweight or obesity. It is possible that incentives, combined with health coaching and daily feedback on goal success, may increase program efficacy; however, such programs have not yet been tested with adolescents with overweight and obesity. OBJECTIVE: This study aims to examine the feasibility and acceptability of a 12-week, incentive-based, mobile health physical activity program with text-based health coaching, goal setting, and self-monitoring for adolescents with overweight or obesity. Program adherence and changes in tracked physical activity (ie, steps and active minutes while wearing a Fitbit [Google LLC]), body mass, and body fat are assessed. METHODS: A total of 28 adolescents aged 13 to 18 years with a BMI ≥90th percentile participated in the program. Of the 28 participants, 2 (7%) were lost to follow-up; thus, data from 26 (93%) participants were used in analyses. RESULTS: Participant-reported acceptability was high, with all mean ratings of text-based coaching, Fitbit use, and the overall program being >5 on a 7-point scale. In addition, 85% (23/26) of participants reported that they would like to continue to wear the Fitbit. Program adherence was also high, as participants wore the Fitbit on 91.1% (SD 12.6%) of days on average and met their weekly goals for an average of 7 (SD 3.5) of 11 possible weeks. There were no demographic (ie, sex, age, and baseline body mass) differences in the percentage of days participants wore their Fitbit. Across the 12-week study, there were significant improvements in tracked daily active minutes (P=.006) and steps (P<.001) and significant pre- to posttest improvements in body fat percentage (P=.04). CONCLUSIONS: The pilot program improved adolescent physical activity and physical health. A larger factorial design trial with adaptive daily goals may clarify the role of each program component in driving physical activity.

Daily Associations Between Positive Emotion and Obesity-Related Behaviors and Their Interconnections Within Adolescent-Caregiver Dyads.

Background Greater overall positive emotion has been linked with increased physical activity and overeating. High approach positive emotions (HAPEs), a subtype of positive emotion, are theorized to facilitate this goal-driven behavior. However, the day-to-day associations of HAPE and physical activity and overeating, including both at the individual level and within caregiver-adolescent dyads, remain unknown. Purpose We examined the independent and dyadic associations between HAPE (positive emotions that occur pregoal and motivate individuals toward approaching/acting upon that motive) and obesity-related behaviors, including physical activity and overeating, in adolescents and their primary caregivers. Methods Adolescents (N = 47) aged 11-17 and their caregivers completed demographic questions and a 7-day diary at the end of each day about daily emotion, and physical activity and overeating behaviors. Results For adolescents and their caregivers, increased day-to-day fluctuations in HAPE and greater average HAPE was associated with increases in their own daily physical activity levels. Greater average caregiver HAPE was also associated with increased overeating in caregivers. When examining interdependency within dyads, greater average caregiver HAPE was associated with greater adolescent overeating behavior. Conclusions There is evidence that HAPE is related to obesity-related health promoting behaviors and health risk behaviors in adolescence and adulthood. Future studies should further explore mechanisms underlying these associations, including within the family system.

Habit and diabetes self-management in adolescents with type 1 diabetes.

OBJECTIVE: The development of habit (i.e., behavioral automaticity, the extent to which a behavior is performed with decreased thresholds for time, attention [effort], conscious awareness, and goal dependence), for goal-directed health behaviors facilitates health behavior engagement in daily life. However, there is a paucity of research examining automaticity for Type 1 diabetes self-management in adolescence. This study examined if greater perceived automaticity for diabetes self-management was associated with increased daily self-management, decreased daily self-regulation failures in glucose checking, and more optimal daily glycemic levels in adolescents with Type 1 diabetes. METHOD: Adolescents aged 13-17 and diagnosed with Type 1 diabetes (n = 79) completed the Self-Report Behavioral Automaticity Index, a measure of automaticity of diabetes self-management (i.e., automaticity of glucose checking, carbohydrate counting, and insulin dosing), and a measure of perceived self-management at baseline. One to 3 months later, a subsample of teens (n = 42) also completed a daily diary for a 7-day period including perceptions of daily self-management, daily self-regulation failures in glucose checking, and daily glucose levels. RESULTS: Greater overall automaticity of diabetes self-management was associated with greater baseline and daily self-management, fewer daily self-regulation failures in glucose checking, and lower average daily mean blood glucose levels but not more optimal daily variations in blood glucose levels. CONCLUSIONS: Greater automaticity for diabetes self-management may support more optimal daily diabetes self-management in adolescence. Further research is needed to clarify the benefits and mechanisms of automaticity and explore possible interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Lifestyles Under Lockdown: A Scoping Review of International Studies on Type 2 Diabetes Self-Management Behaviors During COVID-19.

Background: The effect of the COVID-19 pandemic on diabetes self-management behaviors is unclear. Objectives: This paper is a scoping review of studies examining health behaviors among people with type 2 diabetes during the COVID-19 pandemic. Eligibility Criteria: We searched articles available in English using the Search terms "COVID" and "diabetes", and, separately, each of the following terms: "lifestyle", "health behavior", "self-care", "self-management", "adherence", "compliance", "eating", "diet", "physical activity", "exercise", "sleep", "self-monitoring of blood glucose", or "continuous glucose monitoring". Sources of Evidence: We searched PubMed, PsychInfo, and Google Scholar databases from December 2019 through August 2021. Charting Methods: Data were extracted by 4 calibrated reviewers and study elements were charted. Results: The search identified 1,710 articles. After screening for relevance and eligibility, 24 articles were included in this review. Findings show the strongest evidence for reduced physical activity and stable glucose monitoring and substance use. There was equivocal evidence for deleterious changes in sleep, diet, and medication intake. With one minor exception, there was no evidence for favorable changes in health behaviors. Limitations of the literature include small samples, predominantly cross-sectional study designs, reliance on retrospective self-reports, sampling through social media, and few standardized measures. Conclusions: Early studies of health behaviors among people with type 2 diabetes during the COVID-19 pandemic suggest a need for novel interventions to support diabetes self-management, especially targeting physical activity. Future studies should go beyond documenting changes in health behaviors and examine predictors of change over time.

Impact of COVID on Professionals Addressing Psychosocial Needs of People With Diabetes: An International Survey.

We investigated how COVID-19 has disrupted the work of health professionals who address behavioral and psychosocial needs of people with diabetes (PWD). English language emails were sent to members of five organizations that address psychosocial aspects of diabetes, inviting them to complete a one-time, anonymous, online survey. On a scale from 1=no problem, to 5=serious problem, respondents reported problems with the healthcare system, their workplaces, technology, and concerns about the PWD with whom they work. Respondents (n=123) were from 27 countries, primarily in Europe and North America. The typical respondent was a woman, aged 31-40 years, who worked in an urban hospital in medicine or psychology/psychotherapy. Most judged that the COVID lockdown in their region was moderate or severe. Over half felt moderate to serious levels of stress/burnout or mental health issues. Most participants reported moderate to severe problems due to the lack of clear public health guidelines, concerns with COVID safety of themselves, PWD, and staff, and a lack of access or knowledge on the part of PWD to use diabetes technology and telemedicine. In addition, most participants reported concerns with the psychosocial functioning of PWD during the pandemic. Overall, the pattern of findings reveals a high level of detrimental impact, some of which may be ameliorated with changes in policy and additional services for both health professionals and the PWD with whom they work. Concerns about PWD during the pandemic must go beyond their medical management and also consider the health professionals who provide them with behavioral and psychosocial support.

The role of COVID-19 fears and related behaviors in understanding daily adolescent health behaviors during the pandemic.

We examined the prospective associations of COVID-19 fears and behavior, and daily physical activity and dysregulated eating. Adolescents (N = 31) aged 11-17 completed selected subscales of the Fear of Illness and Virus Evaluation and completed a 7-day health behavior diary. Greater fear of contamination was associated with lower daily physical activity. In contrast, greater COVID-19 precautionary behavior was associated with greater daily physical activity. COVID-19 fears and precautionary behaviors have differential associations with health promoting behavior engagement. Future studies should explore the mechanisms underlying these links to guide adaptation of health behavior interventions for this unique cohort.

Toxins from harmful algae in fish from Scottish coastal waters.

Harmful algal bloom events are increasing in a number of water bodies around the world with significant economic impacts on the aquaculture, fishing and tourism industries. As well as their potential impacts on human health, toxin exposure from harmful algal blooms (HABs) has resulted in widespread morbidity and mortality in marine life, including top marine predators. There is therefore a need for an improved understanding of the trophic transfer, and persistence of toxins in marine food webs. For the first time, the concentrations of two toxin groups of commercial and environmental importance, domoic acid (DA) and saxitoxin (including Paralytic Shellfish Toxin (PST) analogues), were measured in the viscera of 40 different fish species caught in Scotland between February and November, 2012 to 2019. Overall, fish had higher concentrations of DA compared to PSTs, with a peak in the summer / autumn months. Whole fish concentrations were highest in pelagic species including Atlantic mackerel and herring, key forage fish for marine predators including seals, cetaceans and seabirds. The highest DA concentrations were measured along the east coast of Scotland and in Orkney. PSTs showed highest concentrations in early summer, consistent with phytoplankton bloom timings. The detection of multiple toxins in such a range of demersal, pelagic and benthic fish prey species suggests that both the fish, and by extension, piscivorous marine predators, experience multiple routes of toxin exposure. Risk assessment models to understand the impacts of exposure to HAB toxins on marine predators therefore need to consider how chronic, low-dose exposure to multiple toxins, as well as acute exposure during a bloom, could lead to potential long-term health effects ultimately contributing to mortalities. The potential synergistic, neurotoxic and physiological effects of long-term exposure to multiple toxins require investigation in order to appropriately assess the risks of HAB toxins to fish as well as their predators.

The Secondary Traumatic Stress Scale: Confirmatory Factor Analyses With a National Sample of Victim Advocates.

Secondary traumatic stress (STS) is a pattern of psychological symptoms that approximates the symptoms of posttraumatic stress disorder (PTSD) and occurs in professionals who are exposed to individuals who have experienced trauma. While victim advocates are frontline health professionals who are trained to support victims of crime and interpersonal violence and are at risk for developing STS, they have been largely neglected in the extant literature on STS. The STS Scale (STSS) is a 17-item self-report questionnaire utilized to assess frequency of symptoms of intrusion, avoidance, and arousal, specifically related to providing services to victims of trauma. The purpose of this study was to investigate the psychometric properties of the STSS with a sample of victim advocates (N = 135) using confirmatory factor analysis (CFA). Results indicated that both a single-factor model and three-factor model were equivalent. This study represents a first attempt to validate a measure of STS among victim advocates, a unique and understudied population who are at risk for developing STS given their work with individuals who have experienced interpersonal violence. Establishing effective, easy to administer, and efficient measures of STS is important given that this population encounters secondary trauma on a regular basis in the context of their job. While additional theoretical work regarding the construct of STS is needed, the STSS did demonstrate high reliability with this population and thus can be used as part of the assessment of STS among victim advocates.