Help-Seeking Patterns Among Students Experiencing Sexual Harassment: A Latent Class Analysis.

Sexual harassment continues to be a pervasive problem in institutes of higher education. Despite this, there are significant gaps in research and our understanding related to students' help-seeking associated with sexual harassment. Understanding students' help-seeking patterns is critical in improving and streamlining campus-wide resources. The following study uses a latent class analysis to examine whether unique patterns of help-seeking exist among students experiencing sexual harassment and whether there are meaningful differences between help-seeking groups with respect to incident characteristics, campus climate, and demographic profiles. Data used in this analysis are from an anonymous, web-based campus climate survey across a university system that included 7,318 undergraduate and 3,484 graduate students. Of these, 704 undergraduates and 229 graduate students reported experiencing sexual harassment. Our results indicated four help-seeking groups: Comprehensive help-seeking group (engaged in multiple types of formal and informal help-seeking), Informal help-seeking group (relied exclusively on friends as sources of support), Low help-seeking group (individuals in this group told virtually no one about their experience, including friends or family), and Unsure group (reached out to friends in large numbers but universally characterized themselves as not knowing what to do). Across classes, findings highlight significant differences related to incident characteristics (offender identity and incident location), student status, and racial identity. Our results point to the heterogeneity of patterns and responses in help-seeking for students experiencing sexual harassment. Variations in help-seeking across different classes highlight that students' perceptions and preferences for formal and informal support depend on their specific type. Our study is a reminder that survivors access support through diverse ways; understanding these distinct patterns in help-seeking behaviors based on specific subgroups will help universities tailor programs that better align with students' contextual needs and realities.

Early Discharge to Clinic-Based Therapy of Patients Presenting With Decompensated Heart Failure (EDICT-HF): Study Protocol for a Multi-Centre Randomised Controlled Trial.

BACKGROUND: Acute decompensated heart failure involves a high rate of mortality and complications. Management typically involves a multi-day hospital admission. However, patients often lose part of their function with each successive admission, and are at a high risk for hospital-associated complications such as nosocomial infection. This study aims to determine the safety and efficacy of the management of patients presenting with acute decompensated heart failure to clinic-based therapy vs usual inpatient care using a reproducible management pathway. METHOD: An investigator-initiated, prospective, non-inferiority, 1:1 randomised-controlled trial, stratified by left ventricular ejection fraction including 460 patients with a minimum follow-up of 7 days. This is a multi-centre study to be performed in centres across Victoria, Australia. Participants will be patients with either heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF), admitted for acute decompensation of heart failure. INTERVENTION: Early discharge to an outpatient-based Heart Failure Rapid Access Clinical Review (RACER) in addition to frequent medical/nursing at-home review for patients admitted with decompensated heart failure. RESULTS: The primary endpoint will be a non-inferiority assessment of re-hospitalisation at 30 days. Secondary outcomes include superiority assessment of hospitalisation at 30 days, a composite clinical endpoint of major adverse cardiac and cerebrovascular event (MACCE), hospital re-admission or mortality at 3 months, achievement of guideline-directed medical therapy, patient assessment of symptoms (visual-analogue scale quantified as area under curve and Kansas City Cardiomyopathy Questionnaire-12 [KCCQ-12]), attendance at 3-month outpatient follow-up, number of bed stays/clinics attended, proportion of patients free from congestion, change in serum creatinine level, treatment for electrolyte disturbances, time to transition from intravenous to oral diuretics, and health economics analysis (cost-benefit analysis, cost-utility analysis, incremental cost-effectiveness ratio). CONCLUSIONS: The Early Discharge to Clinic-Based Therapy of Patients Presenting with Decompensated Heart Failure (EDICT-HF) trial will help determine whether earlier discharge to out-of-hospital care is non-inferior to the usual practice of inpatient care, in patients with heart failure admitted to hospital for acute decompensation, as an alternative model of care.

A Longitudinal Exploration of How Connections to Staff Facilitate Efficacy and Service Use in Drop-in Centers Serving Youth Experiencing Homelessness.

INTRODUCTION: Youth experiencing homelessness (YEH) benefit from a variety of services to meet their immediate and long-term needs. Drop-in centers are a popular service venue used by YEH. However, the mechanisms responsible for engaging youth in drop-in services are not clear. The current study uses longitudinal data to explore the role of positive staff relationships in increasing youths' knowledge and efficacy to access and subsequently use drop-in center services. METHODS: 731 youth (Mage = 21.8, SD = 2.2, 25.1% female) accessing services at three drop-in centers in Los Angeles, California participated in the study. Surveys were completed at baseline, 1-month, and 3-months later. Path models examined the direct effect of positive relationships with adult staff on service use at the 3-month follow-up, and the indirect effect of service knowledge (assessed at the 1-month follow-up). RESULTS: The direct effect model showed that positive staff relationships at baseline were significantly associated with number of services used at the 3-month follow-up (aIRR = 1.24, 95% CI: 1.00, 1.54). Positive staff relationships were also associated with greater service knowledge at 1-month (b = 0.93, p < 0.001), which in turn was associated with greater service use at 3-months (IRR = 1.15, 95% CI: 1.04, 1.28). The indirect effect of service knowledge was significant (b = 0.13, p = 0.02), suggesting that the association between positive staff relationships and service use was completely mediated by service knowledge. CONCLUSIONS: The current study adds to the literature by demonstrating that positive relationships with staff lead to increased service use by increasing youths' knowledge and efficacy to access services. Efforts should be made to develop positive relationships with YEH in order to engage them in essential services needed to exit homelessness.

Patterns of Gender Equitable Attitudes and Behaviors Among Young Men: Relationships With Violence Perpetration and Masculinity Ideologies.

This study used latent profile analysis with data from 481 U.S. men to examine patterns of men's attitudes toward gender equity and their engagement in gender-equitable (GE) behaviors. Five resulting profiles included groups with (a) high endorsement of both GE attitudes and behaviors, (b) low endorsement of both, (c) mid-range endorsement of both, (d) strong endorsement of GE attitudes, but low engagement in action, and (e) low endorsement of GE attitudes but high participation in GE behavior. Worryingly, this last group reported higher rates of violence perpetration than other groups, while simultaneously reporting higher rates of participation in gender-based violence prevention actions.

Sexual assault and harassment victimization and post-assault help-seeking among undergraduate students: Comparing residential and nonresidential campuses.

In the United States, campus sexual violence research has mostly focused on 4-year residential campuses. The experiences of students on nonresidential campuses are less well understood. Using data from a Web-based campus climate survey, this study explores sexual assault and sexual harassment victimization rates, victimization characteristics, and post-assault help-seeking across nonresidential and residential students in a campus system that contains both residential and nonresidential campuses. Our analyses highlight that sexual victimization rates, characteristics, and post-assault help-seeking patterns vary by campus type. Interestingly, while nonresidential students on nonresidential campuses reported lower rates of victimization, they accessed formal support resources at higher rates than students on a residential campus. Findings underscore the importance of accounting for campus type in campus sexual violence research and programming and to center nonresidential campuses to learn more about the strategies they adopt to address their students' unique victimization needs and experiences.

Patterns of Intimate Partner Violence and the Harsh Parenting of Children.

While research shows that adult intimate partner violence (IPV) and harsh parenting of children co-occur, less information is available about whether specific types or patterns of IPV create greater risk for harsh parenting, and whether these patterns vary by gender. This study used latent class analysis (LCA) to examine unique patterns of IPV perpetration and victimization among men and women, and variation across patterns by gender, parenting status, and harsh parenting of children. Data are from the Lehigh Longitudinal study (n = 332). LCA produced four classes of IPV perpetration and victimization (Minor Psychological; None; Moderate; and Severe), which were invariant by gender. Although any level of IPV was associated with an increase in harsh parenting, patterns of IPV characterized by a greater number of and more severe types, were particularly associated with the use of harsh parenting toward their children for both mothers and fathers. Parents were overrepresented in all IPV classes compared to the No-IPV class. Results suggest the need for more broad screening and increased supports for parents that are tailored to different levels of need.

Life Course and Socioecological Influences on Gender-Equitable Attitudes Among Men: A Scoping Review.

Emerging research suggests that holding gender-equitable attitudes (GEA) is associated with decreased risk of gender-based violence perpetration and increased willingness to engage in violence preventative actions among men. GEA, defined here as support for political, economic, and social equity across gender in both public and private spheres, may therefore constitute a protective factor against perpetration and a promotive factor in fostering healthy relationships and communities. Forces that shape GEA throughout boys' and young men's lives are less well articulated. The purpose of this exploratory, scoping review was to synthesize cross-disciplinary research to distill life-course influences on the development of GEA among men. Three databases and Google Scholar were searched to locate peer-reviewed studies that empirically examined GEA as an outcome of childhood, adolescent, or young adulthood factors. Sixty-nine articles were located that, collectively, used data from 97 different countries and identified 22 potential life-course influences on men's GEA. Across studies, facilitators of equitable attitudes included higher levels of education, exposure to gender transformative prevention programming, and having parents who held, modeled, and communicated gender-equitable beliefs. Hindrances to equitable attitudes included but were not limited to religiosity, the transition to fatherhood, and having mostly male peer groups. Findings suggest that opportunities to foster equitable attitudes exist across the life course and both inside and outside of formal prevention or education interventions.

Sexual and Relationship Violence Prevention Programming on Commuter Campuses: Wisdom From Students and Campus Personnel.

Responding to the dearth of literature regarding sexual and relationship violence prevention programming on nonresidential university campuses, this study investigates how students and staff conceptualize prevention on commuter campuses. We use qualitative analysis of data from interviews with personnel, and focus groups with students on three commuter campuses and describe (a) the unique considerations associated with implementing prevention in commuter contexts and (b) core elements of comprehensive prevention approaches on these campuses. Results suggest that comprehensive prevention programming is desired by commuter campus stakeholders, but requires policy revision, creative delivery strategies, and student involvement, among other factors, to be realized.

How Research Evidence is Defined, Acquired, and Shared Across Systems That Address Intimate Partner Violence.

This exploratory study examined the flow of research evidence through systems that address intimate partner violence (IPV), including victim services, law enforcement, and criminal justice organizations. Qualitative interviews with representatives of these disciplines assessed how respondents define, acquire, and share research evidence. Findings suggest that research evidence is defined more broadly in the field than in academic settings, and is accessed primarily from trusted intermediaries within professional networks. State IPV coalitions and victim service providers are key intermediaries across sectors. Findings suggest the need for more tangible supports to support sharing of research information within and across service sectors.

Disjunctures in Experiences of Support During the Transition to Fatherhood of Men Who Have Used Intimate Partner Violence.

The transition to fatherhood has been shown to be a stressful time for men, and their experiences of identifying and accessing formal and informal support are mixed. However, research on the experience of men who use intimate partner violence (IPV) during the transition to fatherhood is limited. The evidence documenting the prevalence and short- and long-term impact of violence perpetrated by men against women during pregnancy and postpartum demonstrates the seriousness of this public health issue. To understand the mechanisms of interrupting IPV by engaging men, the gap between what is known about experiences of identifying the need for and access to support during the transition to fatherhood of men with past and current histories of using IPV must be bridged. The study described explores experiences of support during the transition to fatherhood of men who have used IPV. Descriptive findings revealed that men had a range of types of supports from multiple sources; however, most also identified crucial unmet instrumental and socioemotional needs. Four themes surfaced disjunctures in how participants described resources they needed, accessed, and desired. Specifically, these disjunctures were related to men's adherence to a self-reliant identity, a lack of male-specific peer or role model support, the tendency for childbirth classes to be geared toward mothers and not seen by fathers as sources of support, and a gap between men's goals for themselves as fathers, and the actual tools, resources, and modeling that were accessible and "acceptable." The implications include suggestions for group-based programmatic efforts, and three initial steps for organizations to assess and build current capacity to engage-with safety and accountability at the forefront-fathers who use IPV.

Sexual and Relationship Violence Prevention and Response: What Drives the Commuter Campus Student Experience?

This exploratory study brings together two lines of inquiry on (a) college campus-based responses to sexual and intimate partner violence among students, and (b) the characteristics, experiences, and challenges unique to commuter students and commuter institutions of higher education. Using qualitative analysis of 14 in-depth interviews with campus personnel and focus groups with a total of 71 students on three commuter campuses in the Pacific Northwest, we offer a detailed description of the experiences and characteristics of commuter students as they pertain to sexual and relationship violence programming and prevention, the associated nature of commuter campus communities, and the resulting lack of visibility of the issue of sexual and relationship violence on commuter campuses. We conclude that creative, tailored approaches to prevention and response services on commuter campuses are needed to address the unique circumstances and challenges facing commuter campus students.

A Quality Improvement Project to Delay Umbilical Cord Clamping Time.

Delayed cord clamping (DCC) has numerous benefits to the neonate, including increased hemoglobin levels, decreased need for red blood cell transfusions, and decreased incidence of necrotizing enterocolitis and intraventricular hemorrhage. A preliminary observational study at our institution demonstrated 12% of the observed deliveries met the DCC standard, defined as umbilical cord clamping at least 30-60 seconds after birth. Therefore, we designed a quality improvement project to increase the percentage of deliveries using DCC. METHODS: We planned a quality improvement project aiming to increase DCC rates on the university obstetrics service. Our interventions included provider education, installation of timers in the delivery suites, and modification to documentation in the electronic health record. We measured our results through the documented status of cord clamping, either: (1) greater than or equal to 30 seconds or (2) less than 30 seconds. We analyzed the DCC rates weekly and compared those results to the DCC goal of 80% of all deliveries. RESULTS: Postintervention DCC rates were 96% overall. Rates of DCC met our aim of 80% or greater each of the 6 weeks we collected data. CONCLUSION: Simple and inexpensive interventions quickly led to improvements in DCC rates on our university obstetrics service. Our interventions including, provider education, installation of timers in delivery suites, and modification to cord clamping documentation in the electronic health record can be easily instituted at other hospitals. Additionally, the simplicity of this system can produce long-term sustainability of DCC.

Gender Matters: Infusing a Gender Analysis into the "Healthy Development of All Youth" Grand Challenge.

The social work grand challenge to ensure healthy youth development necessarily involves a focus on violence prevention, including the prevention of sexual and dating violence during adolescence. The experience of sexual and dating violence is associated with numerous and often long-lasting detrimental mental, physical, and social outcomes, many of which this grand challenge seeks to prevent. Although evidence shows that gender is a critical axis of identity to consider in violence prevention research and practice efforts, gender is not a central lens applied in the field's approach to such issues within this grand challenge. First, this article articulates a rationale for infusing a gender analysis into understanding sexual and dating violence and conceptualizing effective violence prevention strategies. Second, authors describe gender-transformative (GT) approaches to sexual and dating violence prevention, a promising practice for both ensuring the healthy development of youths and reducing violence perpetration by focusing on engaging boys and young men. Third, authors discuss the potential for GT strategies to be used in prevention efforts targeting adolescent social issues more broadly. Last, authors call for practitioners and researchers focused on healthy youth development to apply a gender analysis in their efforts and articulate concrete ways to do so.

Social Norms: Are Sexually Aggressive Men More Likely to Misperceive Other Men's Sexual Desires and Behavior?

Separate lines of research show that men overestimate the extent of male peers' sexual activity, and independently, that sexually aggressive men believe that other men approve of coercive behavior. This study examined the intersection of these lines of inquiry, testing whether the degree of male participants' misperception of other men's sexual behavior differs as a function of perpetrator status. In a national sample, we presented heterosexually active men (n=497) with sexual scenarios varying in sexual acts, partner types, and circumstances. Results showed that participants significantly overestimated the typicality of all types of sexual situations for other men. Participants also misjudged the desirability of scenarios consistent with a traditional masculinity sexual script to other men; these scenarios reflected an adversarial perspective on relationships and an impersonal approach to sexuality - a known risk factor for sexual aggression. Further, sexually aggressive men overestimated the desirability of these traditional masculinity scenarios to a greater extent than non-aggressive peers. Findings suggest that interventions that provide accurate knowledge about social norms, or "typical" sexual desires and behaviors among other men, may reduce pressure to live up to perceived but perhaps inaccurate masculine ideals, as well as reduce social norm-related risks for sexually aggressive behavior.

A Global Exploratory Analysis of Men Participating in Gender-Based Violence Prevention.

Organizations addressing gender-based violence (GBV) increasingly include men as partners in prevention efforts. However, little is known about men who get involved in those efforts and what specific actions they take. We present analyses of data from an international sample of men involved in gender-based prevention work that aimed to describe (a) the nature of participants' involvement in prevention efforts, in both formal programming and in their daily lives; (b) characteristics of engaged men, including gender and bystander-related attitudes and beliefs, and social networks; and (c) factors that sustain men's involvement in GBV movements over time. Comparisons across global regions for these variables were also conducted. A total of 379 male-identified participants above 18 who had attended a GBV event in the past year completed an online survey (available in English, French, and Spanish). Respondents represented all continents except Antarctica, although North America was over-represented in the sample. Overall, respondents scored well above North American norms for men on support for gender equality and recognition of male privilege, and this was true across all geographic regions. Men in all regions reported moderate support from friends and somewhat less support from male relatives for their involvement in GBV prevention. Respondents in all regions reported high levels of active bystander and violence-preventive behavior. The most commonly reported motivations for involvement in GBV prevention included concern for related social justice issues, exposure to the issue of violence through work, hearing a moving story, or disclosures about domestic or sexual violence. Results were mainly similar across regions, but when regional differences emerge, they tended to be contrasts between the global north and global south, highlighting the importance of cross-fertilization across regions and a willingness to adapt critical learnings in new geographic settings.

Examining Men's Perceptions of GBV Prevention Programming Content.

As global efforts to engage men in preventing gender-based violence (GBV) continue to grow, understanding male participants' perceptions of prevention events is needed. Data from a global sample of 319 men who had attended GBV prevention events were used to (a) assess men's perceptions of what topics were covered, (b) determine whether profiles of these perceptions could be identified, and (c) describe the degree to which content prerception profiles are associated with levels of men's motivation and confidence related to antiviolence action. Latent class analysis identified four perception profiles of prevention topics. Implications for GBV prevention programming are discussed.

How Childhood Maltreatment Profiles of Male Victims Predict Adult Perpetration and Psychosocial Functioning.

This study used latent class analysis to empirically identify subgroups of men based on their exposure to childhood maltreatment (i.e., emotional neglect and abuse, physical neglect and abuse, and sexual abuse). It then examined subgroups' differential perpetration of adult intimate partner violence (IPV; both psychological and physical), violence against peers, and sexual assault. Finally, we compared sociodemographic variables and psychosocial functioning across profiles to characterize the adult experiences of men in different maltreatment groups. The community sample consisted of 626 heterosexually active 21- to 30-year-old men. We identified four subgroups: Low Maltreatment (80% of the sample), Emotional and Physical Maltreatment (12%), Emotional and Sexual Maltreatment (4%), and Poly-Victimized (4%). The Low Maltreatment group had significantly lower IPV perpetration rates than the Emotional and Physical Maltreatment group, but groups did not significantly differ on peer violence or sexual assault perpetration rates. Overall, Poly-Victimized men were significantly worse off than the Low Maltreatment group regarding income, education level, and incarceration history. Their rates of recent anxiety and depression symptoms were also higher than those of Low Maltreatment men. Findings support the use of person-oriented techniques for deriving patterns of childhood maltreatment and how these patterns relate to psychological, behavioral, and social factors in adulthood.

Gender Transformative Approaches to Engaging Men in Gender-Based Violence Prevention: A Review and Conceptual Model.

Engaging men and boys as participants and stakeholders in gender-based violence (GBV) prevention initiatives is an increasingly institutionalized component of global efforts to end GBV. Accordingly, evidence of the impact of men's engagement endeavors is beginning to emerge, particularly regarding interventions aimed at fostering gender equitable and nonviolent attitudes and behaviors among men. This developing evidence base suggests that prevention programs with a "gender transformative" approach, or an explicit focus on questioning gender norms and expectations, show particular promise in achieving GBV prevention outcomes. Interventions targeting attitude and behavior change, however, represent just one kind of approach within a heterogeneous collection of prevention efforts around the globe, which can also include community mobilization, policy change, and social activism. The degree to which gender transformative principles inform this broader spectrum of men's engagement work is unclear. The goals of this article are twofold. First, we offer a conceptual model that captures and organizes a broader array of men's antiviolence activities in three distinct but interrelated domains: (1) initial outreach and recruitment of previously unengaged males, (2) interventions intended to promote gender-equitable attitudes and behavior among men, and (3) gender equity-related social action aimed at eradicating GBV, inclusive of all genders' contributions. Second, we review empirical literature in each of these domains. Across these two goals, we critically assess the degree to which gender transformative principles inform efforts within each domain, and we offer implications for the continuing conceptualization and assessment of efforts to increase men's participation in ending GBV.

Mapping a continuum of adolescent helping and bystander behavior within the context of dating violence and bullying.

Although research has identified factors that support and hinder proactive bystander behaviors among adolescents, less is known about the more specific bystander responses viewed by youth as feasible, or whether these responses are likely to be ultimately helpful in the context of bullying and teen dating violence (TDV). Goals of this exploratory study were to describe specific bystander behaviors that adolescents perceive as possible for addressing bullying and TDV among peers, to assess the potential impact of these behaviors, and to examine similarities and differences in bystander behaviors across these forms of aggression. In focus groups with 113 14- to 18-year-old youth, participants identified more possible responses to bullying than to TDV, and more options for supporting victims of aggression than for interrupting perpetrators. Although many bystander responses identified by youth are promising for lessening the impact of bullying and TDV, some, such as "advising" victims of TDV and physically confronting perpetrators are likely not safe or helpful and may cause more harm than good. Findings point to the importance of better understanding how youth perceive their options as bystanders, and providing coaching to respond to peer aggression in specific ways that maximize their own and others' safety and well-being. (PsycINFO Database Record

Quality Improvement Initiative to Increase the Use of Nasogastric Hydration in Infants With Bronchiolitis.

BACKGROUND AND OBJECTIVES: Intravenous (IV) hydration is used primarily in children with bronchiolitis at our institution. Because nasogastric (NG) hydration can provide better nutrition, the goal of our quality improvement (QI) initiative was to increase the rate of NG hydration in eligible children 1 to 23 months old with bronchiolitis by 20% over 6 months. METHODS: We used Plan-Do-Study-Act cycles to increase the use of NG hydration in eligible children. Interventions included educational and system-based changes and sharing parental feedback with providers. Chart reviews were performed to identify the rates of NG hydration, which were plotted over time in a statistical process control p chart. The balancing measure was the rate of complications in children with NG versus IV hydration. RESULTS: Two hundred and ninety-three children who were hospitalized with bronchiolitis needed supplemental hydration during the QI initiative (January 2016-April 2016). Ninety-one children were candidates for NG hydration, and 53 (58%) received NG hydration. The rates of NG hydration increased from a baseline of 0% pre-QI bronchiolitis season (January 2015-April 2015) to 58% during the initiative. There was no aspiration and no accidental placement of the NG tube into a child's airway. Nine patients (17%) in the NG group had a progression of disease requiring nil per os status, and 6 of these were transferred to the PICU whereas none of those in the IV group were transferred to the PICU. Post-QI initiative, the majority of nurses (63%) and physicians (95%) stated that they are more likely to consider NG hydration in children with bronchiolitis. CONCLUSIONS: We successfully increased the rates of NG hydration in eligible children with bronchiolitis by using educational and system-based interventions.