Population-level effects of Hurricane Sandy on adolescent health.

BACKGROUND: Disasters are increasing in frequency and intensity due to climate change. Youth are the largest and most vulnerable group exposed to disasters. More evidence is needed regarding how youth mental health and health behaviors vary based on disaster exposure, how mental health influences health behaviors, and how diverse groups of youth may be differentially affected. METHODS: Using data from the Youth Risk Behavior Survey and Federal Emergency Management Agency, we examined the impact of Hurricane Sandy (2012) on mental health (sadness, suicidality) and health behaviors (substance use, physical activity, screen time, sexual behaviors) of 240,365 youth. Difference-in-differences regression analyses evaluated pre-disaster (2005-2011) and post-disaster (2013-2019) changes. RESULTS: There were 83,442 (34.7 %) adolescents (51.2 % female, 18.1 % non-Hispanic White) located in 6 districts exposed to Hurricane Sandy and 156,923 (65.3 %) adolescents located in 13 non-exposed districts. Exposure was associated with differences in substance use, physical (in)activity, and risky sexual behaviors, but not mental health outcomes. Mental health did not moderate the association between disaster exposure and health behaviors. Hispanic adolescents and those identifying as Other races/ethnicities were most vulnerable to post-disaster negative health outcomes. LIMITATIONS: Study limitations include questionnaire design, cross-sectional data, sampling, and possible response biases. CONCLUSIONS: Findings provide critical information about youth mental health and health behaviors following disasters, as well as how youth may differ in their responses. Findings provide guidance for early identification and resource allocation for youth at higher risk for post-disaster health issues.

The mediating role of self-regulation on the link between child maltreatment and later substance use among Latinx youth.

BACKGROUND: Children who experience maltreatment are at heightened risk for substance use initiation and mental health disorders later in life. Few studies have assessed the relationship between child maltreatment and substance use among Latinx youth. OBJECTIVE: The current study assessed the potential mediating effect of three aspects of self-regulation (emotional, behavioral, and cognitive) on the association between child maltreatment and substance use and examined whether effects varied depending on maltreatment type and severity. PARTICIPANTS AND SETTING: This study involved a random sample of 504 Latinx youth (52 % girls, 48 % boys) between the ages of 10-12 at the start of the study. METHODS: Study hypotheses were tested through structural equation modeling and bootstrapped random errors using the R programming language. RESULTS: Our results indicated that higher levels of child maltreatment predicted higher levels of later substance use, as mediated by emotional and behavioral dysregulation (ß = 0.09, p < 0.01), but not cognitive regulation. When separating maltreatment by subtype, we found the mediating effect was present for abuse (ß = 0.09, p < 0.01), but not neglect. CONCLUSIONS: Findings contribute to our understanding of potential causal mechanisms for the association between child maltreatment and substance use for Latinx youth.

Risk Factors for Intimate Partner Violence in the Context of Disasters: A Systematic Review.

Women are at increased risk for experiencing intimate partner violence (IPV) in the context of disasters. However, the factors that increase this risk are not well understood. The purpose of the current study was to systematically review the literature on IPV in the context of disasters. The first aim was to identify risk factors predicting women's exposure to IPV. The second aim was to identify disaster-specific risk factors for IPV. The third aim was to construct a social ecological framework of risk factors for IPV in disasters at the individual, relationship/household, community, and structural levels. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA; Moher et al., 2009). Articles were identified using keywords in seven ProQuest databases. Of the 67 articles identified for full-text review, 24 were eligible for inclusion. Studies were evaluated based on critical appraisal of methodology using an adapted version of the Mixed Methods Appraisals Tool (MMAT; Hong et al., 2018). Findings suggest that disasters give rise to unique risk factors across social ecologies which interact with pre-existing characteristics of social vulnerability to increase women's risk of IPV. Findings inform violence prevention strategies within the context of disaster response and therefore have implications for research, policy, and practice.

Child maltreatment, suicidal ideation, and in-home firearm availability in the U.S.: findings from the longitudinal studies of child abuse and neglect.

Suicide is the second leading cause of death among adolescents in the U.S., and risk factors include child maltreatment (CM), especially physical and emotional abuse, and in-home firearm availability ('availability'). However, research examining availability among adolescent populations at-risk for CM is limited. This study examines availability in this population, the association between CM and availability, and availability among adolescents experiencing suicidal ideation. A multivariable modified Poisson regression model assessed the relationship between CM by age 12 and availability at age 14 using data from the Longitudinal Studies of Child Abuse and Neglect (n = 1,354 families). Approximately 11.61% of adolescents reported availability, and physical abuse increased the risk of availability (aRR = 1.94; 95% CI [1.22, 3.08]). Over one-quarter (27.50%) of adolescents with suicidal ideation at age 16 reported availability. Child welfare-involved families are often referred to interventions. Future research and prevention efforts should explore augmentation of these programmes with firearm safe storage guidance.

Parent and Child Reports of Parenting Behaviors: Agreement Among a Longitudinal Study of Drug Court Participants.

Identifying ways to support children of parents with substance use disorder is a critical public health issue. This study focused on the parent-child relationship as a critical catalyst in child resilience. Using data from a longitudinal cohort study, the aims of this study were to: (1 ) examine the agreement between parent and child reports of parenting behaviors and (2 ) describe the association between agreement and child mental health. Participants were 50 parent-child dyads that included parents enrolled in an adult drug court and their children, aged 8-18. Overall, agreement (i.e., concordance) between parent and child reports of parenting was slight to fair. Parents reported their parenting behaviors to be slightly more positive than how children rated the same behaviors in the areas of: involvement, 0.53 (SD = 0.80); positive parenting, 0.66 (SD = 0.87), and monitoring behaviors, 0.46 (SD = 0.90). Parents also rated themselves, in comparison to their children's reports, as using less inconsistent discipline, -0.33 (SD = 1.00), and less corporal punishment, 0.13 (SD = 1.01). Agreement was related to some, but not all, child mental health outcomes. When parents rating their parenting as more positive than their child reported, that had a negative effect on child self-esteem and personal adjustment. Contrary to hypotheses, we did not find a significant relationship between positive parenting and internalizing problems. Findings have implications for obtaining parent and child reports of parenting within the drug court system, and for identifying children at higher risk for externalizing problems.

Trajectories of Posttraumatic Stress in Youths After Natural Disasters.

Importance: Disaster exposure is associated with the development of posttraumatic stress (PTS) symptoms in youths. However, little is known about how to predict which youths will develop chronic PTS symptoms after disaster exposure. Objective: To evaluate PTS symptom trajectories among youths after 4 major US hurricanes and assess factors associated with those trajectories. Design, Setting, and Participants: This cohort study used integrative data analysis to combine data from 4 studies of youths' responses to natural disasters (hurricanes Andrew [1992], Charley [2004], Ike [2005], and Katrina [2008]) at time points ranging from 3 to 26 months after the disasters. Those studies recruited and surveyed youths aged 6 to 16 years at schools via convenience sampling of schools near the path of destruction for each hurricane. This study was conducted from August 2017 to August 2020, and pooled data were analyzed from February 2019 to October 2020. Exposure: Experience of a natural disaster during the ages of 6 to 16 years. Main Outcomes and Measures: Posttraumatic stress symptoms were assessed using the University of California, Los Angeles, Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) and the UCLA PTSD-RI-Revised. Latent class growth analyses were used to evaluate the youths' PTS symptom trajectories and associated factors. Results: Among 1707 youths included in the study, the mean (SD) age was 9.61 (1.60) years, 922 (54%) were female, and 785 (46%) self-identified as White non-Hispanic. Four PTS symptom trajectories were identified: chronic (171 participants [10%]), recovery (393 [23%]), moderate-stable (563 [33%]), and low-decreasing (580 [34%]). Older youths were less likely to be in the chronic group; compared with the chronic group, each 1-year increase in age was associated with increased odds of being in the other groups (recovery: odds ratio [OR], 1.78 [95% CI, 1.29-2.48]; moderate-stable: OR, 1.94 [95% CI, 1.43-2.62]; and low-decreasing: OR, 2.71 [95% CI, 1.99-3.71]). Compared with males, females had higher odds of being in the chronic group than in any other group (recovery group: OR, 0.48 [95% CI, 0.26-0.91]; moderate-stable group: OR, 0.37 [95% CI, 0.21-0.64]; and low-decreasing group: OR, 0.25 [95% CI, 0.14-0.44]). Conclusions and Relevance: In this cohort study, few youths reported chronic distress, and trajectories among most youths reflected recovery or low-decreasing PTS symptoms. Older age and identification as male were factors associated with decreased odds of a chronic trajectory. Youths with chronic or moderate-stable trajectories may benefit from intervention.

Posttraumatic stress disorder symptom trajectories within the first year following emergency department admissions: pooled results from the International Consortium to predict PTSD.

BACKGROUND: Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics. METHODS: This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3083). Each study included at least three assessments of the clinician-administered PTSD scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course. RESULTS: Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (v. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (v. Remitting) trajectory. CONCLUSIONS: The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.

Sleep Problems and Posttraumatic Stress: Children Exposed to a Natural Disaster.

OBJECTIVE: Sleep plays a critical role in children's growth and development. This study examined the frequency and persistence of children's sleep problems following a natural disaster, risk factors for children's sleep problems, and the bidirectional relationship between children's sleep problems and posttraumatic stress symptoms (PTSS) over time. METHODS: This study assessed 269 children (53% female, M = 8.70 years, SD = 0.95) exposed to Hurricane Ike at 8 months (Time 1) and 15 months (Time 2) post-disaster. Children completed measures of hurricane exposure and related stressors, stressful life events, sleep problems, and PTSS. RESULTS: Children's sleep problems were significantly correlated from Time 1 to Time 2 (r = .28, p < .001). Risk factors for sleep problems at Time 2 were younger age, sleep problems at Time 1, and PTSS, not including sleep items, at Time 1. Examinations of the bidirectional relationship between sleep problems and PTSS indicated that PTSS significantly predicted later sleep problems, but sleep problems did not significantly predict later PTSS. CONCLUSIONS: Findings demonstrate that PTSS may contribute to the development and course of children's sleep problems post-disaster.

Correction to: Evaluating a screener to quantify PTSD risk using emergency care information: a proof of concept study.

An amendment to this paper has been published and can be accessed via the original article.

The Potential Unique Impacts of Hope and Resilience on Mental Health and Well-Being in the Wake of Hurricane Harvey.

Natural disasters can lead to mental health problems, such as posttraumatic stress disorder (PTSD). Higher levels of loss and/or disruption and prior trauma exposure constitute risk factors for mental illness, whereas protective factors, including hope and resilience, support positive functioning. The present cross-sectional study used structural equation modeling to examine the relative influence of resilience and hope on mental health and well-being 1-3 months after Hurricane Harvey made landfall in August 2017, among a sample of 829 adults in the Greater Houston, Texas area. Resilience was more strongly associated with reduced PTSD symptoms, ß = -.31, 95% CI [-.42, -.21], than was hope, ß = -.17, 95% CI [-;.30, -.04], whereas hope was more strongly associated with components of well-being, ßs = .47-.63. Hope was positively associated with posttraumatic growth, ß = .30, 95% CI [.19, .41], whereas resilience was negatively associated with posttraumatic growth, ß = -.24, 95% CI [-.35, -.12]. These associations remained consistent after considering risk factors, although more variance in trauma-related outcomes was risk factors were included in the model. The present results suggest that considering the influence of both risk and resilience factors provides an enhanced picture of postdisaster mental health.

Violence victimization and negative health correlates of youth in post-earthquake Haiti: Findings from the cross-sectional violence against children survey.

BACKGROUND: We examined the prevalence of and relationships between violence victimization and negative health correlates of Haitian youth exposed to the 2010 earthquake. METHODS: Participants were randomly selected 13-24 year-old youth (1457 females; 1459 males) living in Haiti following the 2010 earthquake. Data collected via Haiti's 2012 Violence against Children Survey (VACS) were analyzed. RESULTS: Participants reported violence victimization in the past 12 months (females: 49.93%; males: 41.68%), moderate-to-severe mental distress (females: 76.56%; males: 66.41%), and suicidal ideation (females: 26.79%; males: 8.05%). Compared to participants without experiences of violence, victims of violence had significantly higher mean number of sexual partners (females: 1.99, 95% CI: 1.81-2.16, p = .02; males: 4.33, 95% CI: 3.50-5.16, p = .03), mental distress (females: 80.39%, p = .01; males: 72.95%, p = .002), and suicidal ideation (females: 36.09%, p < .0001; males: 12.02%, p < .0001). Male victims of violence were more likely to have sex without a condom (26.02%, p = .01) and female victims of violence were more likely to report histories of STIs (28.04%, p = .01), when compared to participants without history of violence. LIMITATIONS: Data were collected via self-report. Disaster exposure experiences were not assessed. Analysis was correlational and did not control for potential confounding variables. CONCLUSIONS: Disaster-exposed youth endorsed high levels of violence victimization and negative health correlates. Earthquake survivors who experienced violence were more likely to report negative health correlates. Greater attention to downstream sequelae of natural disasters is needed.

Evaluating a screener to quantify PTSD risk using emergency care information: a proof of concept study.

BACKGROUND: Previous work has indicated that post-traumatic stress disorder (PTSD) symptoms, measured by the Clinician-Administered PTSD Scale (CAPS) within 60 days of trauma exposure, can reliably produce likelihood estimates of chronic PTSD among trauma survivors admitted to acute care centers. Administering the CAPS is burdensome, requires skilled professionals, and relies on symptoms that are not fully expressed upon acute care admission. Predicting chronic PTSD from peritraumatic responses, which are obtainable upon acute care admission, has yielded conflicting results, hence the rationale for a stepwise screening-and-prediction practice. This work explores the ability of peritraumatic responses to produce risk likelihood estimates of early CAPS-based PTSD symptoms indicative of chronic PTSD risk. It specifically evaluates the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) as a risk-likelihood estimator. METHODS: We used individual participant data (IPD) from five acute care studies that used both the PDEQ and the CAPS (n = 647). Logistic regression calculated the probability of having CAPS scores ≥ 40 between 30 and 60 days after trauma exposure across the range of initial PDEQ scores, and evaluated the added contribution of age, sex, trauma type, and prior trauma exposure. Brier scores, area under the receiver-operating characteristic curve (AUC), and the mean slope of the calibration line evaluated the accuracy and precision of the predicted probabilities. RESULTS: Twenty percent of the sample had CAPS ≥ 40. PDEQ severity significantly predicted having CAPS ≥ 40 symptoms (p < 0.001). Incremental PDEQ scores produced a reliable estimator of CAPS ≥ 40 likelihood. An individual risk estimation tool incorporating PDEQ and other significant risk indicators is provided. CONCLUSION: Peritraumatic reactions, measured here by the PDEQ, can reliably quantify the likelihood of acute PTSD symptoms predictive of chronic PTSD and requiring clinical attention. Using them as a screener in a stepwise chronic PTSD prediction strategy may reduce the burden of later CAPS-based assessments. Other peritraumatic metrics may perform similarly and their use requires similar validation. TRIAL REGISTRATION: Jerusalem Trauma Outreach and Prevention Study (J-TOPS): NCT00146900.

Modification to a systematically braided parent-support curriculum: Results from a feasibility pilot.

OBJECTIVES: There are a variety of parent-support programs designed to improve parenting and, thereby,the safety and well-being of children. Providers trained in multiple programs are likely to select components of interventions they feel will meet the needs of the families they serve leaving out aspects they deem unnecessary orredundant. In so doing, the fidelity of the evidence-based program is at risk. A potential solution is systematic braiding in which evidence-based programs are combined such that the fidelity to each original model and its implementation are maintained. METHODS: Drawing on qualitative feedback from a prior iteration, this paper discusses results of a feasibility and acceptability pilot of a modified version of the systematically braided Parents as Teachers and SafeCare at Home (PATSCH) curriculum This modification removed a provider-perceived "redundant" portion from the original PATSCH curriculum. A pre-post design (N=18) was used to evaluate the efficacy of the modified curriculum. RESULTS: Significant improvements were seen in trained parent behaviors surrounding home safety and child health. There was also improvement in self-reported parenting behaviors, the portion of the braided curriculum removed, suggesting that the PAT curriculum adequately teaches these skills. Providers and parents were highly satisfied with themodified curriculum. CONCLUSIONS: If a curriculum is modified to reflect provider and parent preferences, then the potential for delivery without fidelity is minimized.

Surviving the storm: Avoidant coping, helping behavior, resilience and affective symptoms around a major hurricane-flood.

BACKGROUND: As extreme weather events increasingly affect the global population, it is valuable to understand their impacts on mental health. Extending upon previous theory and research, the current study examined a hypothesized framework of direct and indirect pathways. Exposure and psychosocial resource factors at the time of the hurricane/flood were expected to help explain post-disaster behavioral responses, such as avoidant coping, positive coping, and helping behaviors, which, in turn, would help account for post-traumatic stress symptoms (PTSS) and depressive symptoms (DS). METHODS: Survey data were collected from adult survivors (n = 801) of Hurricane Harvey 1-3 months post-disaster. PTSS, DS, and needing help were common, and loss/disruption and helping behavior were widespread. Structural equation modeling was used to examine the hypothesized framework. RESULTS: Models accounted for substantial variance in PTSS (70%) and DS (61%), with immediate loss/disruption, low self-reported resilience, and avoidant coping showing the strongest associations with symptoms. As predicted, results provided support for several modeled indirect pathways through avoidant coping to PTSS and DS. Further, helping behavior was consistently associated with increased PTSS, but not DS. LIMITATIONS: Cross-sectional design and online data collection methods precluded testing of causal directionality and confirming clinical diagnoses. CONCLUSIONS: The current study represents a step toward elucidating potential mediators of avoidant coping and how helping behavior might relate to post-disaster psychopathology. Individuals in heavily hurricane/flood-exposed areas who have low psychosocial resources (social support and resilience) might be most vulnerable and most in need of intervention.

Estimating the risk of PTSD in recent trauma survivors: results of the International Consortium to Predict PTSD (ICPP).

A timely determination of the risk of post-traumatic stress disorder (PTSD) is a prerequisite for efficient service delivery and prevention. We provide a risk estimate tool allowing a calculation of individuals' PTSD likelihood from early predictors. Members of the International Consortium to Predict PTSD (ICPP) shared individual participants' item-level data from ten longitudinal studies of civilian trauma survivors admitted to acute care centers in six countries. Eligible participants (N=2,473) completed an initial clinical assessment within 60 days of trauma exposure, and at least one follow-up assessment 4-15 months later. The Clinician-Administered PTSD Scale for DSM-IV (CAPS) evaluated PTSD symptom severity and diagnostic status at each assessment. Participants' education, prior lifetime trauma exposure, marital status and socio-economic status were assessed and harmonized across studies. The study's main outcome was the likelihood of a follow-up PTSD given early predictors. The prevalence of follow-up PTSD was 11.8% (9.2% for male participants and 16.4% for females). A logistic model using early PTSD symptom severity (initial CAPS total score) as a predictor produced remarkably accurate estimates of follow-up PTSD (predicted vs. raw probabilities: r=0.976). Adding respondents' female gender, lower education, and exposure to prior interpersonal trauma to the model yielded higher PTSD likelihood estimates, with similar model accuracy (predicted vs. raw probabilities: r=0.941). The current model could be adjusted for other traumatic circumstances and accommodate risk factors not captured by the ICPP (e.g., biological, social). In line with their use in general medicine, risk estimate models can inform clinical choices in psychiatry. It is hoped that quantifying individuals' PTSD risk will be a first step towards systematic prevention of the disorder.

Patterns of Caregiver Factors Predicting Participation in Trauma-Focused Cognitive Behavioral Therapy.

This study examined patterns of caregiver factors associated with Trauma- Focused Cognitive Behavioral Therapy (TF-CBT) utilization among trauma-exposed youth. This study included 41 caregivers (caregiver age M = 36.1, SD = 9.88; 93% African American) of youth referred for TF-CBT, following a substantiated forensic assessment of youth trauma exposure. Prior to enrolling in TF-CBT, caregivers reported on measures for parenting stress, attitudes towards treatment, functional impairment, caregiver mental health diagnosis, and caregiver trauma experiences. Classification and regression tree methodology were used to address study aims. Predictors of enrollment and completion included: attitudes towards treatment, caregiver trauma experiences, and parenting stress. Several caregiver factors predicting youth service utilization were identified. Findings suggest screening for caregivers' attitudes towards therapy, parenting stress, and trauma history is warranted to guide providers in offering caregiver-youth dyads appropriate resources at intake that can lead to increased engagement in treatment services.

Understanding Open Access Data Using Visuals: Integrating Prospective Studies of Children's Responses to Natural Disasters.

BACKGROUND: As access to open data is increasing, researchers gain the opportunity to build integrated datasets and to conduct more powerful statistical analyses. However, using open access data presents challenges for researchers in understanding the data. Visuals allow researchers to address these challenges by facilitating a greater understanding of the information available. OBJECTIVES: This paper illustrates how visuals can address the challenges that researchers face when using open access data, such as: (1) becoming familiar with the data, (2) identifying patterns and trends within the data, and (3) determining how to integrate data from multiple studies. METHOD: This paper uses data from an integrative data analysis study that combined data from prospective studies of children's responses to four natural disasters: Hurricane Andrew, Hurricane Charley, Hurricane Katrina, and Hurricane Ike. The integrated dataset assessed hurricane exposure, posttraumatic stress symptoms, anxiety, social support, and life events among 1707 participants (53.61% female). The children's ages ranged from 7 to 16 years (M = 9.61, SD = 1.60). RESULTS: Visuals serve as an effective method for understanding new and unfamiliar datasets. CONCLUSIONS: In response to the growth of open access data, researchers must develop the skills necessary to create informative visuals. Most research-based graduate programs do not require programming-based courses for graduation. More opportunities for training in programming languages need to be offered so that future researchers are better prepared to understand new data. This paper discusses implications of current graduate course requirements and standard journal practices on how researchers visualize data.

Childhood Abuse and Adulthood IPV, Depression, and High-Risk Drinking in Latinas.

Little is known about relationships between child maltreatment and adulthood intimate partner violence (IPV), depression, and risky drinking in Latinas. 548 Latinas in a sexual health randomized control trial (RCT) self-reported childhood physical, sexual, and emotional abuse, IPV, depression, and risky drinking. Childhood abuse was related to adulthood IPV, OR = 1.27, depression, OR = 2.02, and high-risk drinking, OR = 2.16. Childhood emotional abuse was linked to depression, OR = 2.19; childhood physical abuse to risky drinking, OR = 2.62; and childhood sexual abuse to depression, OR = 2.78 and risky drinking, OR = 2.38. Results may inform prevention/intervention efforts for mental health nurses.

Evaluation of a Tool to Identify Child Sex Trafficking Victims in Multiple Healthcare Settings.

PURPOSE: Estimate the prevalence of child sex trafficking (CST) among patients seeking care in multiple healthcare settings; evaluate a short screening tool to identify victims in a healthcare setting. METHODS: This cross-sectional observational study involved patients from 16 sites throughout the U.S.: five pediatric emergency departments, six child advocacy centers, and five teen clinics. Participants included English-speaking youth ages 11-17 years. For emergency department sites, inclusion criteria included a chief complaint of sexual violence. Data on several domains were gathered through self-report questionnaires and examiner interview. Main outcomes included prevalence of CST among eligible youth; sensitivity, specificity, positive/negative predictive values, and positive/negative likelihood ratios for a CST screening tool. RESULTS: Eight hundred and ten participants included 91 (11.52%) youth from emergency departments, 395 (48.8%) from child advocacy centers, and 324 (40.0%) from teen clinics. Overall prevalence of CST was 11.1%: 13.2% among emergency department patients, 6.3% among child advocacy center patients, and 16.4% among teen clinic patients, respectively. The screen had a sensitivity, specificity, and positive likelihood ratio of 84.44% (75.28, 91.23), 57.50% (53.80, 61.11), and 1.99% (1.76, 2.25), respectively. CONCLUSIONS: This study demonstrates a significant rate of CST among patients presenting to emergency departments (for sexual violence complaints), child advocacy centers, and teen clinics. A six-item screen showed relatively good sensitivity and moderate specificity. Negative predictive value was high. Intervention for a "positive" screen may identify victims and help prevent high-risk youth from becoming victimized. This is one of the first CST screening tools specifically developed and evaluated in the healthcare setting.