The Chronic Health Effects of Work-Related Stressors Experienced by Police Communications Workers.

BACKGROUND: Law enforcement communications (i.e., 911 dispatch and call takers) is a challenging and stressful occupation. The purpose of this study is to identify the main stressors associated with employment in law enforcement communications, and to identify and provide context to how these stressors affect workers' health and wellbeing. METHODS: This research study included focus groups with 23 call takers and 911 dispatchers employed by a large, urban law enforcement agency in 2018. Thematic analyses were conducted to identify trends. RESULTS: Four themes of stressors emerged (i.e., the high stakes nature of some 911 calls for service, understaffing, supervisor-related stress, and recruiting practice). Two health-related themes emerged as being occupation-related: weight gain and poor sleep patterns/insufficient sleep). Specifically, participants reported negative eating habits resulting in weight gain and obesity, lack of sleep and irregular sleep schedules, and development of hypertension and/or diabetes since beginning their jobs. CONCLUSION: Law enforcement communications professionals experience a number of the same stressors facing law enforcement officers in patrol. These stressors, combined with the sedentary nature of the job, could result in long-term, chronic health problems.

Disentangling the root causes of COVID-19 related increases in alcohol consumption.

Recent studies suggest that the COVID-19 pandemic has increased alcohol sales and alcohol related problems. This may be due to the synergistic effects of unemployment, stress from childcare or additional caregiving responsibilities, reduced social interactions and negative coping strategies. Weerakoon and colleagues set out to identify the most robust risk factors for alcohol consumption, binge drinking, and changes in drinking patterns due to the COVID-19 pandemic. One-third of the sample reported consuming more alcohol after COVID-19 compared to pre-COVID-19. In addition, each additional week spent at home under stay-at-home orders was increased the odds of binge drinking by 19%. Individuals who have been diagnosed with depression and were currently experiencing depressive symptoms were more than three times more likely (OR = 3.37) to have increased their alcohol consumption during COVID-19 compared to those with no history or symptoms of depression. Parents of children was associated with decreased COVID-19 related binge drinking (OR = .74). As many daily life factors have been altered due to the pandemic, a more holistic lifestyle disruption construct may help further investigate the long term effects of social isolation on alcohol use as the pandemic continues. Furthermore, the role of social support in mitigating COVID-19-related stress has yet to be examined and may be a protective factor against alcohol related problems. As stress continues, researchers should continue assessing the longitudinal effects of COVID-19 lockdowns with the goal of early identification for those at the highest risk of problematic alcohol use.

Trends in Family Violence Are Not Causally Associated with COVID-19 Stay-at-Home Orders: a Commentary on Piquero et al.

COVID-19 has caused a wave of research publications in academic and pre-print outlets which have resulted in several high-profile retractions. While the breadth of emerging research has been instrumental in understanding and curbing the global pandemic in near real-time, unfortunately manuscripts with major methodological challenges have fallen through the cracks. In this perspective, we illustrate this issue in light of a recent manuscript by Piquero et al. (2020). In the study, a statistically significant association between stay-at-home orders and family violence was not detected; however, the authors widely disseminated a "12.5% increase in family violence" offenses to a variety of media outlets. This negligent dissemination of inaccurate research findings has important implications for policy and the virus mitigation efforts, which might urge policymakers to terminate stay-at-home orders in an effort to reduce family violence and other social risk factors. Changes may ultimately result in more COVID-related deaths as stay-at-home orders are prematurely and inappropriately lifted to prevent purported injuries in the home. Therefore, the widespread propagation of these claims in the absence of scientific evidence of an increase has great potential to cause harm.

Cumulative, high-stress calls impacting adverse events among law enforcement and the public.

BACKGROUND: The unpredictable, and sometimes dangerous, nature of the occupation exposes officers to both acute and chronic stress over law enforcement officers' (LEO)  tenure. The purpose of this study is two-fold: 1) Describe multi-level characteristics that define high-stress calls for service for LEO; and 2) Characterize factors that impact cumulative stress over the course of a LEO's shift. METHODS: Qualitative data were collected from 28 LEOs at three law enforcement agencies in the Dallas-Fort Worth areas from April 2019 to February 2020. Focus group data were iteratively coded by four coders using inductive and deductive thematic identification. RESULTS: Five multi-level factors influenced officer stress: 1) officer characteristics (e.g. military experience; gender); 2) civilian behavior (e.g. resistance, displaying a weapon); 3) supervisor factors (micromanagement); 4) environmental factors (e.g. time of year); and, 5) situational factors (e.g. audience present; complexity of calls). Four themes that characterized cumulative stress: 1) cyclical risk; 2) accelerators; 3) decelerators; and 4) experience of an adverse event. CONCLUSIONS: LEOs become susceptible to adverse events (e.g. injury, excessive use of force) after repeated exposure to high-stress calls for service. Ongoing exposures to stress continue to occur throughout the shift. Our long-term goal is to interrupt this repetitive, cumulative process by restricting the number of consecutive high-risk, high-intensity calls an officer is permitted to respond to.

Evaluation of the Detection of Elder Mistreatment Through Emergency Care Technicians Project Screening Tool.

Importance: Elder mistreatment is underdetected and underreported. The more than 800 000 medics providing services in every county in the United States represent an important and underused surveillance system. Objective: To investigate the association between the Detection of Elder Mistreatment Through Emergency Care Technician (DETECT) screening tool use and the number of medic reports made to Adult Protective Services (APS) over a period of approximately 3 years. Design, Setting, and Participants: This quality improvement study used a difference in difference in differences design and included adults aged 65 years and older who were reported to Texas APS in the study region (246 cities in Denton, Johnson, and Tarrant Counties) between December 31, 2014, and February 28, 2018. Exposures: The DETECT screening tool. Main Outcomes and Measures: Reports to APS. Results: The mean (SD) age of the 11 178 older adults included in this study was 76 (8) years (range, 65-105 years); there was no reported data on patient sex. A total of 18 080 reports of elder mistreatment were recorded. Medics within the study region reported more cases of elder mistreatment during the implementation of the screening tool (relative risk [RR], 4.14; 95% CI, 3.25-5.27). After adjusting for changes in the number of elder mistreatment reports in the comparison groups (ie, underlying changes in reporting trends), the number of reports to APS increased (RR, 3.03; 95% CI, 2.06-4.46). The occurrence of elder mistreatment was validated in 83% (95% CI, 75%-91%) of the reports investigated by APS during the periods when medics did not have access to the screening tool compared with 82% (95% CI, 77%-87%) during the periods when medics had access to the screening tool, indicating that there were no differences in the proportion of reports that resulted in a validated APS investigation. Conclusions and Relevance: The findings suggest that incorporating the DETECT screening tool into the routine practices of medics is associated with substantial increases in the frequency with which clinicians report potential cases of elder mistreatment to APS.

The Value of Lived Experience With the Criminal Justice System: A Qualitative Study of Peer Re-entry Specialists.

The aim of this article was to describe the implementation and qualitative outcomes of peer reentry specialists ("peers") on housing attainment, mental health, and substance use problems, and increased life domain functioning. One-on-one interviews were conducted with peers and clients to understand the program implementation, peer experiences, and progress toward target outcomes. Data were iteratively coded using inductive thematic identification and data reduction. Results suggest that peers' lived experiences were useful in building rapport with clients. Peers applied their lived experiences to assist clients in seeking treatment for substance use and mental health conditions, in addition to helping them locate housing and employment. Several structural barriers prevented peers from addressing client needs. Peer time was routinely consumed by assisting clients in seeking identification, requisite for treatment or use of health care services, housing or securing employment. Findings suggested peers were working to address many client needs. Future research should examine the effectiveness of peer assistance on client-level health outcomes, including recidivism.

Self-reporting discrepancies of bullying victimization and perpetration measures.

PURPOSE: To evaluate the relationship between sociodemographics and the prevalence of bullying victimization and perpetration using single-item and multiple-item measures. METHODS: Longitudinal survey data were obtained from 4297 children at fifth, seventh, and tenth grade in three U.S. cities. Bullying victimization and perpetration were measured in two ways: 1) a single-item recall measure; and 2) a separate multiple-item measure using specific behaviors indicating bullying victimization and perpetration. Multilevel logistic regression modeled the relationship between sociodemographics and bullying, stratified by measurement type. RESULTS: In fifth grade, 4% of children were identified as victims using the single-item approach but not the multiple-item approach, 27% were identified as victims using the multiple-item approach but not the single-item approach, and 17% were identified as victims using both approaches. For perpetration, 3% were identified using the single-item approach but not the multiple-item approach, 18% were identified using the multiple-item and not the single-item approach, and 4% were identified using both approaches. The odds of victimization were significantly lower in seventh and tenth grades than in fifth grade using both approaches. The single-item odds of perpetration were significantly lower in tenth grade than fifth grade, but the multiple-item odds of perpetration significantly increased over time. CONCLUSIONS: Bullying prevalence rates are sensitive to the structure of measures. Future research should identify whether these differences reflect a lack of awareness of types of bullying and/or cognitive variability in answering sensitive survey questions.

Mechanisms and Frequency of Violent Injuries Among Victims and Perpetrators of Bullying.

PURPOSE: This article aims to (1) evaluate whether bullying typology predicts violent injury; (2) longitudinally examine whether violent injury trajectories differ across bullying typology as children age; and (3) longitudinally determine whether children who consistently reported perpetration or victimization (i.e., reported bullying at fifth, seventh, and 10th grade) were different from children who inconsistently reported perpetration or victimization. METHODS: Longitudinal data were obtained from 4,297 children at three waves (fifth, seventh, and 10th grade) in three United States communities. Children were categorized into four mutually exclusive bullying typologies: neither victim nor perpetrator; victim only; perpetrator only; victim-perpetrator. Children self-reported mechanisms of violent injuries that needed medical attention in the past year. Regression models were used to evaluate the relationship between bullying group and the likelihood of violent injury over time. RESULTS: Seventeen percent (n=857) of children in fifth grade reported a violent injury. Prevalence of overall violent injuries, and specifically firearm and knife injuries, increased over time. Children who reported perpetration in the absence of victimization were at increased odds for violent injury (adjusted odds ratio = 1.41, 95% confidence interval: 1.24, 1.60) compared with children who reported neither victimization nor perpetration, while children who reported victimization in the absence of perpetration were at decreased odds (adjusted odds ratio=.84, 95% confidence interval: .73, .97). A significant linear dose-response relationship was observed between duration of bullying perpetration and violent injury. CONCLUSIONS: The relationship between bullying perpetration and violent injury over time was strong. Future research should investigate potential mediating behaviors, such as weapon access, which might explain the observed relationship.

Does military veteran status and deployment history impact officer involved shootings? A case-control study.

BACKGROUND: Despite veterans' preference hiring policies by law enforcement agencies, no studies have examined the nature or effects of military service or deployments on health outcomes. This study will examine the effect of military veteran status and deployment history on law enforcement officer (LEO)-involved shootings. METHODS: Ten years of data were extracted from Dallas Police Department records. LEOs who were involved in a shooting in the past 10 years were frequency matched on sex to LEOs never involved in a shooting. Military discharge records were examined to quantify veteran status and deployment(s). Multivariable logistic regression was used to estimate the effect of veteran status and deployment history on officer-involved shooting involvement. RESULTS: Records were abstracted for 516 officers. In the adjusted models, veteran LEOs who were not deployed were significantly more likely to be involved in a shooting than non-veteran officers. Veterans with a deployment history were 2.9 times more likely to be in a shooting than non-veteran officers. CONCLUSIONS: Military veteran status, regardless of deployment history, is associated with increased odds of shootings among LEOs. Future studies should identify mechanisms that explain this relationship, and whether officers who experienced firsthand combat exposure experience greater odds of shooting involvement.

Violence against women increases cancer diagnoses: Results from a meta-analytic review.

The purpose of this project was to assess the magnitude of the relationship between violence against women and cancer; to identify the exposures and cancers for which this relationship was particularly robust; to identify the effect of violence exposure on cancer screening. We conducted a meta-analysis of 36 studies to determine the relationship between violence against women and cancer outcomes, including screening, in 2017. Results from this review provide evidence of a significant, positive relationship between violence and cancer diagnoses, particularly for cervical cancer. Women who were victims of intimate partner violence and sexual abuse were more likely to be diagnosed with cancer compared with non-victims. Violence against women did not appear to be related to cancer screening practices and routine clinical service utilization; however, violence was associated with greater odds of abnormal pap test results. Victims of intimate partner violence and women who suffered physical abuse were more likely to have abnormal pap test results. In conclusion, use of screening tools for violence against women in clinical settings may improve the breadth and quality of research on violence against women and cancer. Investigators should consider how to creatively apply case-control and retrospective cohort designs to investigate the complex mechanisms and moderators of the relationship between violence against women and cancer.

Using mHealth to Increase Treatment Utilization Among Recently Incarcerated Homeless Adults (Link2Care): Protocol for a Randomized Controlled Trial.

BACKGROUND: There is a significant revolving door of incarceration among homeless adults. Homeless adults who receive professional coordination of individualized care (ie, case management) during the period following their release from jail experience fewer mental health and substance use problems, are more likely to obtain stable housing, and are less likely to be reincarcerated. This is because case managers work to meet the various needs of their clients by helping them to overcome barriers to needed services (eg, food, clothing, housing, job training, substance abuse and mental health treatment, medical care, medication, social support, proof of identification, and legal aid). Many barriers (eg, limited transportation, inability to schedule appointments, and limited knowledge of available services) prevent homeless adults who were recently released from incarceration from obtaining available case management, crisis management, substance abuse, and mental health services. OBJECTIVE: The aim of the Link2Care study is to assess the effectiveness of a smartphone app for increasing case management and treatment service utilization, and in turn reduce homelessness and rearrest. The goals of this research are to (1) assess the impact of an innovative smartphone app that will prompt and directly link recently incarcerated homeless adults to community-based case management services and resources and (2) utilize in-person and smartphone-based assessments to identify key variables (eg, alcohol or drug use, social support, psychological distress, and quality of life) that predict continued homelessness and rearrest. METHODS: Homeless adults (N=432) who enroll in a shelter-based Homeless Recovery Program after release from the Dallas County Jail will be randomly assigned to one of the three treatment groups: (1) usual case management, (2) usual case management plus smartphone, and (3) usual case management with a study-provided smartphone that is preloaded with an innovative case management app (smartphone-based case management). Those assigned to smartphone-based case management will receive smartphones that prompt (twice weekly) connections to shelter-based case managers. The app will also offer direct links to case managers (available during normal business hours) and crisis interventionists (available 24 hours a day, 7 days a week) with the touch of a button. RESULTS: Recruitment began in the spring of 2018, and data collection will conclude in 2021. CONCLUSIONS: This research represents an important step toward integrated service connection and health care service provision for one of the most underserved, high need, and understudied populations in the United States. TRIAL REGISTRATION: ClinicalTrials.gov NCT03399500; https://clinicaltrials.gov/ct2/show/NCT03399500 (Archived by WebCite at http://www.webcitation.org/6zSJwdgUS). REGISTERED REPORT IDENTIFIER: RR1-10.2196/9868.

Gender differences in substance use treatment and substance use among adults on probation.

BACKGROUND: Although many formal and informal substance use treatment programs were originally designed for men, no studies have investigated how gender affects the use of substance use treatment modalities, and how gender differences in treatment utilization impact substance use in the unique probation context. OBJECTIVE: To describe gender differences in use and effectiveness of substance use treatment modalities (formal and informal) among probationers. METHODS: Longitudinal data were obtained from 335 individuals (93 women) who participated in the Motivational Assessment Program to Initiate Treatment (MAPIT) study. Timeline follow-back measures were used to quantify daily substance use and treatment modality (formal treatment included inpatient and outpatient treatment; informal treatment included self-help, religious, and all other group meetings). Multivariate generalized estimating equations were used to examine relationships between gender, treatment, and substance use. RESULTS: Gender was not associated with alcohol use. Use of formal treatment programs reduced the odds of alcohol use by 15%. The probability of alcohol use was the lowest (8%) for men who participated in formal treatment. For men using informal treatment programs, the probability of alcohol use was 11%. The probability of alcohol use for women was similar regardless of the type of treatment utilization (15-16%). No differences in illicit drug use by gender or type of treatment were detected. CONCLUSION: This research found limited evidence of a relationship between gender, substance use treatment modality, and alcohol use. These findings have clinical significance in that both formal and informal treatment approaches are similarly effective across both men and women.

Conduct Disorder and Neighborhood Effects.

There has been a considerable amount of scholarly attention to the relationship between neighborhood effects and conduct disorder, particularly in recent years. Having said this, it has been nearly two decades since a comprehensive synthesis of this literature has been conducted. Relying on a detailed and comprehensive search strategy and inclusion criteria, this article offers a systematic and interdisciplinary review of 47 empirical studies that have examined neighborhood effects and conduct disorder. Described results suggest that there are generally robust linkages between adverse neighborhood factors and conduct disorder and externalizing behavior problems, as 67 of the 93 (72.04%) effect sizes derived from these studies yielded statistically significant neighborhood effects. The review also identifies salient mediating and moderating influences. It discusses study limitations and directions for future research as well.

Gradual escalation of use-of-force reduces police officer injury.

OBJECTIVE: To examine how escalation through the force continuum predicts officer injury in the presence of citizen aggression, while controlling for extraneous factors, like citizen and officer characteristics. METHODS: Cross-sectional data were extracted from 2244 use-of-force reports from the Dallas Police Department in 2015. Multilevel, mixed logistic regression models were used to evaluate the relationship between use of force and officer injury. Multilevel path analysis tested indirect and direct relationships between citizen aggression and officer injury. RESULTS: Results suggest that gradual escalation through the force continuum significantly decreases officer injury when a citizen is actively aggressive (ß=-1.06, p value <0.001). Further, non-Hispanic black officers (ß=-0.22, p value <0.001) and Hispanic officers (ß=-0.08, p value <0.05) are less likely to gradually escalate through the force continuum, due to lower odds of verbal commands (black: OR=0.51, 95% CI 0.39 to 0.68; Hispanic: OR=0.77, 95% CI 0.60 to 0.99) and hard-empty hand control (black: OR=0.58, 95% CI 0.43 to 0.77) compared with white officers. Finally, officers with higher tenure (ß=-0.01, p value <0.001) are less likely to gradually escalate through the force continuum. CONCLUSIONS: Escalation through the force continuum significantly reduces police officer injury. Future research should assess whether further environmental or situational factors contribute to the strong relationship between use of force and officer injury. Also, reliability and validity testing of use-of-force reports is an imperative direction for future research.

Acute Alcohol Use, History of Homelessness, and Intent of Injury Among a Sample of Adult Emergency Department Patients.

BACKGROUND: The literature is clear that adults who are currently homeless also have higher rates of intentional injuries, such as assault and suicide attempts. No study has assessed whether intentional injuries are exacerbated because of substance use among adults with a history of homelessness. METHODS: Data were obtained from a cohort of adults admitted to 3 urban emergency departments (EDs) in Texas from 2007 to 2010 (N = 596). Logistic regression analyses were used to determine whether a history of homelessness was associated with alcohol use at time of injury in intentional violent injuries (gunshot, stabbing, or injury consistent with assault). RESULTS: 39% adults with a history of homelessness who were treated at trauma centers for a violent injury. Bivariate analyses indicated that adults who had ever experienced homelessness have 1.67 increased odds, 95% confidence interval (CI) [1.11, 2.50], of any intentional violent injury and 1.95 increased odds (95% CI [1.12, 3.40]) of a stabbing injury than adults with no history of homelessness. CONCLUSIONS: Adults who experienced homelessness in their lifetime were more likely to visit EDs for violencerelated injuries. Given our limited knowledge of the injuries that prompt ED use by currently homeless populations, future studies are needed to understand the etiology of injuries, and substance-related injuries specifically, among adults with a history of homelessness.

Dissecting the Complexities of the Relationship Between Police Officer-Civilian Race/Ethnicity Dyads and Less-Than-Lethal Use of Force.

OBJECTIVES: To examine how sublethal use-of-force patterns vary across officer-civilian race/ethnicity while accounting for officer-, civilian-, and situational-level factors. METHODS: We extracted cross-sectional data from 5630 use-of-force reports from the Dallas Police Department in 2014 and 2015. We categorized each officer-civilian interaction into race/ethnicity dyads. We used multilevel, mixed logistic regression models to evaluate the relationship between race/ethnicity dyads and the types of use of force. RESULTS: Forty-eight percent of use-of-force interactions occurred between a White officer and a non-White civilian (White-non-White). In bivariate models, the odds of hard-empty hand control and intermediate weapon use were significantly higher among White-Black dyads compared with White-White dyads. The bivariate odds of intermediate weapon use were also significantly higher among Black-Black, Hispanic-White, Black-Hispanic, and Hispanic-Black dyads compared with White-White dyads. However, after we controlled for individual and situational factors, the relationship between race/ethnicity dyad and hard-empty hand control was no longer significant. CONCLUSIONS: Although we observed significant bivariate relationships between race/ethnicity dyads and use of force, these relationships largely dissipated after we controlled for other factors.

Trends in Fighting and Violence Among Adolescents in the United States, 2002-2014.

OBJECTIVES: To examine trends in and correlates of fighting and violence among youths from the 3 largest racial/ethnic groups in the United States. METHODS: We derived race/ethnicity-specific prevalence estimates for fighting, group fighting, and attacks with intent to harm from the National Survey on Drug Use and Health, a population-based study of youths aged 12 to 17 years. RESULTS: The prevalence of youth fighting and violence decreased significantly in all racial/ethnic groups over the study period (2002-2014), dropping from a high of 33.6% in 2003 to a low of 23.7% in 2014, reflecting a 29% decrease in the relative proportion of young people involved in these behaviors. However, there was also a clear severity gradient in which year-by-year point estimates for fighting and violence were consistently highest among non-Hispanic African American youths, followed by Hispanic and then non-Hispanic White youths. CONCLUSIONS: Although fighting and violence are on the decline among young people in general and across racial/ethnic subgroups, there is a stable pattern of disparities in youth involvement in these behaviors.

Prevalence and correlates of alcohol and tobacco use among pregnant women in the United States: Evidence from the NSDUH 2005-2014.

Alcohol and tobacco use during pregnancy are among the strongest and most preventable risk factors for adverse neonatal health outcomes, but few developmentally sensitive, population-based studies of this phenomenon have been conducted. To address this gap, the present study examined the prevalence and correlates of alcohol and tobacco use among pregnant adolescents (aged 12-17) and adults (aged 18-44) in the United States. Data were derived from the population-based National Survey of Drug Use and Health (80,498 adolescent and 152,043 adult women) between 2005 and 2014. Findings show disconcerting levels of past-month use among pregnant women with 11.5% of adolescent and 8.7% of adult women using alcohol, and 23.0% of adolescent and 14.9% of adult women using tobacco. Compared to their non-pregnant counterparts, pregnant adolescents were less likely to report past 30-day alcohol use (AOR=0.52, 95% CI=0.36-0.76), but more likely to report past 30-day tobacco use (AOR=2.20, 95% CI=1.53-3.18). Compared to their non-pregnant adult counterparts, pregnant adults were less likely to report using alcohol (AOR=0.06, 95% CI=0.05-0.07) and tobacco (AOR=0.47, 95% CI=0.43-0.52). Compared to pregnant abstainers, pregnant women reporting alcohol/tobacco use were more likely to have had a major depressive episode in the past 12months, report criminal justice system involvement, and endorse comorbid alcohol/tobacco use. Given alcohol and tobacco's deleterious consequences during pregnancy, increased attention to reducing use is critical. Findings suggest that tobacco use is especially problematic for both adolescents and adults and is strongly linked with depression and criminal justice involvement, especially among adults.