Contextualizing school discipline: Examining the role of general peer and teacher discrimination at the individual- and school-level on individual suspension.

Past research has linked peer and teacher discrimination to risk factors for school discipline, but few studies have examined whether peer and teacher discrimination have a direct impact on school discipline. This study examines the effects of general peer and teacher discrimination at the individual- and school-level on school suspension using nationally representative, secondary data on almost 12,000 youth across 131 schools. Hierarchical logistic regression models indicated that general teacher discrimination at the individual- and school-level-but not general peer discrimination-increased the odds of receiving school suspension. Findings suggest that general discrimination by direct learning instructors and teachers representing the broader school culture can shape student conduct. Reducing school discipline thus falls on teachers, staff, principals, and learners.

Effect of acupuncture on ischaemic stroke in patients with rheumatoid arthritis: a nationwide propensity score-matched study.

OBJECTIVE: To demonstrate that acupuncture is beneficial for decreasing the risk of ischaemic stroke in patients with rheumatoid arthritis (RA). DESIGN: A propensity score-matched cohort study. SETTING: A nationwide population-based study. PARTICIPANTS: Patients with RA diagnosed between 1 January 1997 and 31 December 2010, through the National Health Insurance Research Database in Taiwan. INTERVENTIONS: Patients who were administered acupuncture therapy from the initial date of RA diagnosis to 31 December 2010 were included in the acupuncture cohort. Patients who did not receive acupuncture treatment during the same time interval constituted the no-acupuncture cohort. PRIMARY OUTCOME MEASURES: A Cox regression model was used to adjust for age, sex, comorbidities, and types of drugs used. We compared the subhazard ratios (SHRs) of ischaemic stroke between these two cohorts through competing-risks regression models. RESULTS: After 1:1 propensity score matching, a total of 23 226 patients with newly diagnosed RA were equally subgrouped into acupuncture cohort or no-acupuncture cohort according to their use of acupuncture. The basic characteristics of these patients were similar. A lower cumulative incidence of ischaemic stroke was found in the acupuncture cohort (log-rank test, p<0.001; immortal time (period from initial diagnosis of RA to index date) 1065 days; mean number of acupuncture visits 9.83. In the end, 341 patients in the acupuncture cohort (5.95 per 1000 person-years) and 605 patients in the no-acupuncture cohort (12.4 per 1000 person-years) experienced ischaemic stroke (adjusted SHR 0.57, 95% CI 0.50 to 0.65). The advantage of lowering ischaemic stroke incidence through acupuncture therapy in RA patients was independent of sex, age, types of drugs used, and comorbidities. CONCLUSIONS: This study showed the beneficial effect of acupuncture in reducing the incidence of ischaemic stroke in patients with RA.

Disproportionate burden of violence: Explaining racial and ethnic disparities in potential years of life lost among homicide victims, suicide decedents, and homicide-suicide perpetrators.

Research indicates that the burden of violent death in the United States is disproportionate across racial and ethnic groups. Yet documented disparities in rates of violent death do not capture the full extent of this inequity. Recent studies examining race-specific rates of potential years of life lost-a summary measure of premature mortality-indicate that persons of color may die at younger ages than their counterparts, leading to increased trauma among surviving family members, friends, and communities. This study examines racial and ethnic disparities in potential years of life lost among people who died by homicide and suicide. We calculated potential years of life lost using life expectancy values specific to each racial and ethnic group, thereby isolating racial differences in potential years of life lost due to violence. Findings indicated that persons of color were disproportionately impacted by violence. Non-Hispanic African American homicide victims, suicide decedents, and homicide-suicide perpetrators died eleven or more years earlier than their non-Hispanic White counterparts. Similar disparities were observed for non-Hispanic Asian or Pacific Islander decedents. Less pronounced differences were observed for Hispanic and non-Hispanic American Indian or Alaska Native decedents. These racial and ethnic disparities were partly accounted for by a broad array of individual differences, incident characteristics, and contextual factors. The results suggest that homicide and suicide exact a high societal cost, and the burden of that cost is disproportionately high among persons of color.

The salience of social context, opioid antagonist use, and prior opioid exposure as determinants of fatal and non-fatal opioid overdoses.

This study examines the salience of social context for opioid overdoses in Boston from 2014 to 2019. Longitudinal negative binomial models with random effects indicated that higher levels of concentrated disadvantage, residential instability, and illicit drug activity increased annual block group counts of opioid overdoses. Logistic hierarchical and cross-classified random effects models indicated that the use of Narcan and greater exposure to drugs through previous opioid overdose and contextual lillicit drug crime activity reduced the odds of fatal opioid overdose relative to non-fatal opioid overdose. The findings suggest that the accurate tracking of both fatal and non-fatal overdoses, and a consideration of the broader social context, can facilitate effective public health resource allocation to reduce opioid overdoses.

Examining the Factors that Impact Suicide Following Heterosexual Intimate Partner Homicide: Social Context, Gender Dynamics, and Firearms.

Despite a wealth of research on intimate partner homicide, research on intimate partner homicide followed by suicide of the perpetrator is sparse. Existing studies on intimate partner homicide-suicide: tend to be descriptive, not keeping pace with quantitative advances in the epidemiological and social sciences; have yet to examine how context impacts intimate partner homicide-suicide; and are typically limited to male perpetrators, given small localized samples of female-perpetrated intimate partner (homicide and) homicide-suicide. This study uses data on 7584 heterosexual intimate partner homicide and homicide-suicide cases distributed across 2465 places and 42 U.S. states from the National Violent Death Reporting System (2003-2018) to examine the victim and perpetrator characteristics, relationship dynamics, situational factors, and contextual features that influence the likelihood of committing suicide following intimate partner homicide. Hierarchical logistic regression models indicate that victim characteristics that increase the vulnerability to victimization (alcohol and drug use, mental health problems, less than some college education) decrease the odds of committing suicide following intimate partner homicide. Similarly, situational (victim weapon usage, additional perpetrators) and contextual (concentrated disadvantage, residential instability) risk factors decrease the odds of committing suicide following intimate partner homicide. Conversely, impairment of the perpetrator (alcohol use, mental health problems) and a more intimate victim-perpetrator relationship (spousal relationship, caregiver) increases the odds of homicide-suicide. Additionally, results indicate that firearms play an integral part in homicide-suicide as well as in decreasing the gender gap in homicide-suicide. The findings suggest that the internalization of guilt by perpetrators of intimate partner homicide may play a key role in subsequent suicide. Practically, limiting firearm exposure will not only reduce the lethality of intimate partner violence, but will decrease the odds of perpetrator suicide following intimate partner homicide. This is particularly true for female-perpetrated homicide-suicide, which is unlikely to occur without a firearm.

Discrimination in Context: Examining Neighborhood-Level Variation in the Incidence and Adverse Effects of Perceived Racial and Ethnic Discrimination Among Chicago Youth.

A growing body of research links interpersonal racial and ethnic discrimination to adverse youth outcomes. Yet, studies examining the relevance of neighborhood context for discrimination are sparse. This study examines neighborhood-level variation in the incidence and impact of perceived racial and ethnic discrimination on depressive symptoms, suicidal behavior, violent behavior, and substance use. Hierarchical regression models on a sample of 1333 African American and Hispanic youth (52.44% female; x̄ = 13.03 years, SD = 3.25 at wave 1) residing in 238 Chicago neighborhoods from the Project on Human Development in Chicago Neighborhoods indicated little to no neighborhood-level variation in the incidence and impact of discrimination. Findings suggest that the experience of discrimination among youth of color is ubiquitous.

The impact of anticipated, vicarious, and experienced racial and ethnic discrimination on depression and suicidal behavior among Chicago youth.

There is a growing body of research linking racial and ethnic discrimination to adverse youth outcomes. Beyond experienced racial and ethnic discrimination, this study considers the relevance of anticipated and vicarious racial and ethnic discrimination for depression and suicidal behavior. Hierarchical regression models on a diverse sample of 1147 youth (50.31 % female) within 79 neighborhoods from the Project on Human Development in Chicago Neighborhoods indicated that experienced, anticipated, and vicarious racial and ethnic discrimination were associated with an increased risk of depression and suicidal behavior. Additionally, African American and Hispanic youth were disproportionately exposed to-but not differentially impacted by-racial and ethnic discrimination. Findings suggest that developmental research should account for experienced, anticipated, and vicarious racial and ethnic discrimination.

Association of a Crime Prevention Program for Boys With Mortality 72 Years After the Intervention: Follow-up of a Randomized Clinical Trial.

Importance: Mortality is an important outcome in evaluating crime prevention programs, but little is known about the effects on mortality during the full life course. Objective: To determine the long-term outcomes of a crime prevention program on mortality and whether the iatrogenic effects on mortality observed in middle age persist or change in old age. Design: This longitudinal follow-up was conducted in a cohort of boys included in a matched-pair randomized clinical trial (the Cambridge-Somerville Youth Study). Six hundred fifty boys aged 5 to 13 years who lived and attended public and parochial schools in working-class areas of Cambridge and Somerville, Massachusetts, and were identified as at risk for antisocial behavior were matched by age and demographic characteristics. One member of each pair was randomly allocated to the treatment condition. The original trial was performed from June 1, 1939, to December 1945. Follow-up in the present analysis was performed from January 2016 through June 2018. Interventions: Treatment group participants received individual counseling through a range of activities and home visits for an extended duration (mean, 5.5 years). Control group participants received no special services. Main Outcomes and Measures: The 4 outcomes of interest include age at mortality, mortality at latest follow-up, premature mortality (younger than 40 years), and cause of mortality (natural vs unnatural). Results: In the original analysis, 650 participants were matched and randomized to treatment or control conditions, of whom 506 were retained in the analysis (mean [SD] age, 9.8 [1.7] years). Through early 2018, records for 488 participants (96.4%) were located. A total of 446 participants were confirmed dead (88.1%) and 42 alive (8.3%). Matched-pairs analyses showed no significant differences between the treatment and control groups for mortality at latest follow-up (relative risk [RR], 1.05; 95% CI, 0.99-1.11), premature mortality (RR, 1.15; 95% CI, 0.55-2.43), or cause of mortality (RR, 1.19; 95% CI, 0.65-2.18) (P > .05 for all). Cox proportional hazard regression indicated no difference in time to death between groups (hazard ratio, 1.18; 95% CI, 0.98-1.41; P = .09). Conclusions and Relevance: Iatrogenic effects on mortality were not detected in this long-term follow-up. The longitudinal analysis provides information on the utility of life-long assessments of crime prevention programs and draws attention to the need for quality-of-life assessments of participants and their children.

Violent Lives: Pathways Linking Exposure to Violence To Suicidal Behavior in a National Sample.

This study explored the extent to which depression, somatic symptoms, and substance use mediated the effects of exposure to violence on suicidal ideation and attempted suicide, and whether these pathways varied across gender, age, and race/ethnicity. Path analysis was conducted on 12,272 adolescents (mean = 15.3 years) from the National Longitudinal Study of Adolescent to Adult Health. The impact of exposure to violence on suicidal ideation was fully mediated, and the impact of exposure to violence on attempted suicide was partially mediated by depression, somatic symptoms, and substance use. Mediating pathways were stronger for females and for younger adolescents. Understanding the impact of exposure to violence on adolescent suicidal behavior requires the consideration of direct, indirect, and conditional indirect effects.

Examining the Contemporaneous, Short-Term, and Long-Term Effects of Secondary Exposure to Violence on Adolescent Substance Use.

The relationship between secondary exposure to violence-defined as witnessing violence in the home, community, or school-and adolescent substance use is well-documented. Yet, multi-wave empirical studies examining this relationship are sparse. In addition, studies have only begun to examine whether this relationship varies by the situational components of the violent event. Using data from the Project on Human Development in Chicago Neighborhoods (PHDCN), this study examines the contemporaneous, short-term, and long-term effects of secondary exposure to violence on substance use, and whether witnessing violence in which a weapon is present has a different impact on adolescent substance use than does witnessing violence without a weapon. Hierarchical logistic regression models on a racially and ethnically diverse sample of 1670 youth (51.5% female) residing in 79 neighborhoods indicated that: (1) the effects of secondary exposure to violence on alcohol and marijuana use were enduring, albeit attenuated, over time; (2) the effect of secondary exposure to violence on illicit drug use was suppressed in the short-term but significant in the long-term; (3) witnessing violence without a weapon was salient for alcohol and marijuana use at all time points; and (4) witnessing violence with a weapon impacted illicit drug use in the long-term. The results suggest that addressing the consequences of secondary exposure to violence requires prolonged intervention efforts and that the study of secondary exposure to violence requires a more nuanced approach that accounts for situational aspects of the violent event.

Parents, Peers, Perceived Risk of Harm, and the Neighborhood: Contextualizing Key Influences on Adolescent Substance Use.

Recent research has affirmed the need to examine contextual influences on adolescent substance use in a multilevel framework. This study examined the role of neighborhood opportunities for substance use in promoting adolescent substance use. Data came from two components of the Project on Human Development in Chicago Neighborhoods: the Longitudinal Cohort Study, consisting of interviews with youth and their primary caregivers across three waves of data with an average span of 4.5 years; and a Community Survey of neighborhood residents. Analysis used an Item-Response Theory-based statistical approach on 6556 substance use item responses from 1639 youth (49.0 % female) within 80 neighborhoods to assess the extent to which neighborhood opportunities for substance use had direct and indirect effects on adolescent substance use. Neither direct nor mediated effects of neighborhood opportunities for substance use on adolescent substance use were detected. But, analyses revealed moderating effects such that higher levels of neighborhood opportunities for substance use: (1) amplified the detrimental effects of parental substance use and peer substance use on youth substance use; and (2) attenuated the protective effect of adolescents' perceived harm of substance use on adolescent substance use. The results suggest that the ways in which neighborhood characteristics impact adolescent behavior are nuanced. Rather than impact individual-level outcomes directly, neighborhood context may be particularly relevant by conditioning the effects of salient individual-level risk and protective factors for substance use.

Examining Change in Adolescent Street Efficacy and Its Association With Violent Outcomes.

Research suggests that street efficacy-the perceived ability to avoid dangerous situations in one's neighborhood-is related to violent outcomes. We investigated change in street efficacy using data from the Project on Human Development in Chicago Neighborhoods. Measures of street efficacy and violence (offending, victimization, secondary exposure) were constructed at Waves 2 (1997-2000) and 3 (2000-2002) from youth interviews and parent reports. Results from hierarchical overdispersed Poisson models indicated that street efficacy was a malleable construct with stronger contemporaneous than enduring effects. Furthermore, rates of all three violent outcomes were reduced as individuals increased their levels of street efficacy. Findings support (a) teaching youths to safely navigate violent neighborhood situations and (b) continuously reinforcing youths' perceived ability to navigate danger.

Contextual Determinants of Adolescent Perceived Early Fatality.

Adolescents overestimate their risk for early or premature death. In turn, perceived early fatality is associated with a host of adverse developmental outcomes. Research on the correlates of perceived early fatality is nascent, and an examination of the contextual determinants of perceived early fatality is largely absent from the literature. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), this study examines whether friendship networks and the school climate impact youth's perceptions of premature death. Analysis using hierarchical linear models on 9617 youth (52.0 % female) within 113 middle and high schools across the U.S. assess the extent to which peer and school future orientation climate and friendship network characteristics (network size, density, popularity, and centrality) impact respondents' life expectancy. Consistent with hypotheses: (1) higher levels of life expectancy in respondents' friendship networks and schools are associated with more optimistic expectations about the future among sample respondents; and (2) youth embedded in larger and denser friendship networks report higher levels of life expectancy. The results are consistent with the literature on peer effects, studies documenting the insulating effects of extensive and closely knit peer networks, and research on the contextual effects of the school environment. More generally, the results suggest that adolescent friendship networks and the school climate are key contexts in which youth develop expectations for the future.

The power of (Mis)perception: Rethinking suicide contagion in youth friendship networks.

Suicide is a leading cause of death among youth. In the wake of peer suicide, youth are vulnerable to suicide contagion. But, questions remain about the mechanisms through which suicide spreads and the accuracy of youths' estimates of friends' suicidal behaviors. This study addresses these questions within school-aged youths' friendship networks. Social network data were drawn from two schools in the National Longitudinal Study of Adolescent to Adult Health, from which 2180 youth in grades 7-12 nominated up to ten friends. A measure of "perceived" friends' attempted suicide was constructed based on respondents' reports of their friends' attempted suicide. This measure was broader than a "true" measure of friends' attempted suicide, constructed from self-reports of nominated friends who attended respondents' schools. Sociograms graphically represented the accuracy with which suicide attempters estimated friends' suicide attempts. Results from cross-tabulation with Chi-square analysis indicated that approximately 4% of youth (88/2180) attempted suicide, and these youth disproportionately misperceived (predominantly overestimated) friends' suicidal behaviors, compared to non-suicide-attempters. Penalized logistic regression models indicated that friends' self-reported attempted suicide was unrelated to respondent attempted suicide. But, the odds of respondent attempted suicide were 2.54 times higher (95% CI, 1.06-6.10) among youth who accurately perceived friends' attempted suicide, and 5.40 times higher (95% CI, 3.34-8.77) among youth who overestimated friends' attempted suicide. The results suggest that at-risk youth overestimate their friends' suicidal behaviors, which exacerbates their own risk of suicidal behavior. Methodologically, this suggests that a continued collaboration among network scientists, suicide researchers, and medical providers is necessary to further examine the mechanisms surrounding this phenomenon. Practically, it is important to screen at-risk youth for exposure to peer suicide and to use the social environment created by adolescent friendship networks to empower and support youth who are susceptible to suicidal thoughts and behaviors.

Risk Factors for and Behavioral Consequences of Direct Versus Indirect Exposure to Violence.

Research suggests that direct exposure (personal victimization) and indirect exposure (witnessing or hearing about the victimization of a family member, friend, or neighbor) to violence are correlated. However, questions remain about the co-occurrence of these phenomena within individuals. We used data on 1915 youths (with an average age of 12 years at baseline) from the Project on Human Development in Chicago Neighborhoods to examine this issue. Results indicated that youths who tended to be personally victimized were also likely to witness violence; conversely, youths who disproportionately witnessed violence were relatively unlikely to experience personal victimization. In addition, direct and indirect exposures to violence were associated with subsequent adverse outcomes in similar ways. The key distinguishing factor was, rather, the cumulative level of violence (both direct and indirect) to which youths were exposed.

Person-in-context: insights on contextual variation in the victim-offender overlap across schools.

The correlation between victimization and offending (i.e., the victim-offender overlap) is one of the most documented empirical findings in delinquency research, leading researchers to investigate potential contingencies in this relationship. A small number of studies have found evidence of contextual variation in the victim-offender overlap, but these studies have produced conflicting results as to whether urban context amplifies or attenuates this relationship. To add clarity to this body of literature, the present study uses a nationally representative sample of adolescents from the National Longitudinal Study of Adolescent Health (Add Health) to investigate potential variation in the victim-offender overlap across school context. Results indicate that victimization is positively and significantly related to offending in all school contexts but that the relationship between victimization and offending is stronger in non-urban schools than in urban schools. Results also indicate that negative emotionality may play a key role in unpacking the mechanisms through which context moderates the victim-offender overlap.

Detecting specialization in interpersonal violence versus suicidal behavior.

PURPOSE: Research suggests that interpersonal violence and suicidal behavior often co-occur and share a common set of risk factors. This study examined (1) the extent to which individuals specialize in interpersonal violence or suicidal behavior and (2) the shared and unique covariates of individual specialization. METHODS: The Project on Human Development in Chicago Neighborhoods is a longitudinal study of youths embedded within neighborhoods in metropolitan Chicago. Interviews with youths (average age, 15 years at baseline) and their primary caregivers were conducted from 1994 to 1997 (baseline) and from 1997 to 2000 (Wave 2). Analysis used an item response theory-based statistical approach on 19,502 interpersonal violence and suicidal behavior item responses from 1,628 youths within 74 neighborhoods to assess the degree to which individuals specialize in either interpersonal violence (ranging from hitting someone to shooting someone) or suicidal behavior (ideation, planning, and attempted suicide). The extent to which variables distinguished interpersonal violence and suicidal behavior was assessed. RESULTS: Individuals who engaged in high levels of interpersonal violence were unlikely to engage in suicidal behavior. Conversely, individuals who engaged in high levels of suicidal behavior were also likely to engage in interpersonal violence. Several shared (e.g., residential stability, substance use) and distinguishing (e.g., exposure to violent peers, depression) correlates of interpersonal violence and suicidal behavior were detected. CONCLUSIONS: Interventions that address both self- and outward-directed violence must be evidence based. Addressing violence prevention among youths at risk for suicidal behavior appears warranted, but targeting risk factors for suicide among the most violent youths may not be justified.

The covariates of parent and youth reporting differences on youth secondary exposure to community violence.

Survey data for studying youth's secondary exposure to community violence (i.e., witnessing or hearing violence in the community) come from both parents and their children. There are benefits of considering multiple informants in psychosocial assessments, but parents and youths often disagree about comparable information. These reporting differences present challenges for both researchers and clinicians. To shed new light on the individual, family, and neighborhood factors that contribute to parent and youth reporting differences regarding youth's secondary exposure to community violence, this study analyzed hierarchical item response models on a sample of youth respondents from the Project on Human Development in Chicago Neighborhoods. Participants were aged approximately 9, 12, and 15 years (trimodal distribution; mean age = 12.0 years) at baseline (N = 2,344; 49.6% female). Descriptive analyses indicated that parents significantly underestimated their children's exposure to community violence. Logistic hierarchical item response models indicated that absolute discrepancies between parent and youth reports were a function of youth demographic characteristics (male, Hispanic or African American as compared to white, age, 3rd as compared to 1st generation immigrant), individual difference factors (lower levels of self-control, higher levels of violent peer exposure), and family factors (lower household socioeconomic status). Parental under-reporting of youth's exposure to violence was associated with youth demographic characteristics (male, age, 2nd as compared to 3rd generation immigrant), family factors (lower levels of parental supervision), and neighborhood characteristics (higher levels of violence, less access to youth services). The results suggest that a constellation of individual and contextual factors may contribute to the understanding of parent and youth reporting differences. The findings speak to the utility of examining parent and youth reporting differences from a hierarchical lens.

Incorporating Unstructured Socializing Into the Study of Secondary Exposure to Community Violence: Etiological and Empirical Implications.

Secondary exposure to community violence, defined as witnessing or hearing violence in the community, has the potential to profoundly impact long-term development, health, happiness, and security. While research has explored pathways to community violence exposure at the individual, family, and neighborhood levels, prior work has largely neglected situational factors conducive to secondary violence exposure. The present study evaluates "unstructured socializing with peers in the absence of authority figures" as a situational process that has implications for secondary exposure to violence. Results indicate that a measure of unstructured socializing was significantly associated with exposure to violence, net of an array of theoretically relevant covariates of violence exposure. Moreover, the relationships between exposure to violence and three of the most well-established correlates of violence exposure in the literature-age, male, and prior violence-were mediated to varying degrees by unstructured socializing. The results suggest a more nuanced approach to the study of secondary violence exposure that expands the focus of attention beyond individual and neighborhood background factors to include situational opportunities presented by patterns of everyday activities.