Exploring adolescent-adult connections, coping, and safety among minoritized youth in neighborhoods impacted by community violence.

Dyadic interviews were conducted with 32 youth ages 13-21 and their self-identified key adult supports to illuminate how adult supports help protect youth in communities impacted by high levels of violence. Interview transcripts were analyzed using thematic content analysis. Youth described choosing social interactions carefully, avoiding high-violence areas, and keeping busy with activities. Many youths discussed the necessity of minimizing contact with peers to avoid violence, resulting in isolation from friends and increased engagement with family at home. Adult supports reflected upon an intergenerational transfer of violence avoidance, safety planning, and coping strategies through sharing their own lived experiences. Dyads highlighted the need for intergenerational programming to address social isolation and build supportive social networks.

Examining Associations Between School Connectedness, Social Support, Violence, and Firearm Carrying.

Firearms are the leading cause of pediatric deaths. Few studies have identified protective factors that reduce the risk of firearm violence. Interpersonal factors, including school connectedness and social support, protect against multiple health-affecting risk behaviors. Therefore, this study examines associations of school connectedness and social support with firearm and weapon violence involvement. Data were gathered through an anonymous survey conducted across 13 high schools within an urban school district in 2018 (n = 2,604) modeled on the Centers for Disease Control and Prevention Youth Risk Behavior Surveillance Survey. Separate hierarchical logistic regression models examined associations between school connectedness and social support, and the outcomes of firearm carrying and engaging in violence with a weapon on school property in the past 12 months. Models were adjusted for age, race, and covariates representing basic needs, education, and mental health. The mean age was 15.7 years, and 57.5% of youth were female. 5.8% of youth had carried firearms and 5.5% engaged in violence with a weapon on school property in the past 12 months. School connectedness was significantly inversely associated with engaging in violence with a weapon on school property (odds ratio [OR] 0.225, 95% confidence interval [CI] [0.080, 0.632] and high levels of social support were significantly inversely associated with firearm carrying (OR 0.522, 95% CI [0.313, 0.870]). School connectedness and social support may be important in protecting youth from firearm and weapon-related violence. Interventions that strengthen safe and supportive interpersonal relationships within school environments and broader support systems across contexts may help reduce firearm and weapon violence involvement.

Violence Prevention in Pediatrics: Advocacy and Legislation.

Given the complexities of youth violence prevention and longstanding violence inequities, advocacy by pediatric clinicians provides a critical voice to represent youth at multiple levels to address the myriad contributors and effects of youth violence. Institutional, community, state, and federal programs, policies, and legislation are required to support a public health approach to the amelioration of youth violence. This article focuses on the role of pediatric clinicians in advocating for youth and families, promoting change within clinical and hospital systems, partnering with communities to advance evidence-informed prevention and intervention, and legislative advocacy to advance violence prevention policy, research, and practice.

Primary Versus Secondary Prevention Effects of a Gender-Transformative Sexual Violence Prevention Program Among Male Youth: A Planned Secondary Analysis of a Randomized Clinical Trial.

Engaging adolescent males is a promising violence prevention strategy. This study explored primary versus secondary prevention effects of a gender-transformative program (i.e., Manhood 2.0) versus job-readiness training on multiple forms of violence perpetration. Adolescent males, ages 13 to 19 years, were recruited through youth-serving organizations in Pittsburgh, PA, between July 27, 2015, and June 5, 2017, to participate in an unblinded community-based cluster-randomized trial in 20 neighborhoods. The intervention curriculum, Manhood 2.0, focused on challenging norms that foster gender-based violence and building bystander skills. The control program was job-readiness training. We completed a planned secondary analysis of surveys from baseline and 9 months post intervention (follow-up), wherein we stratified participants based on any sexual violence/adolescent relationship abuse (SV/ARA) at baseline and examined risk of perpetration of SV/ARA, incapacitated sex, sexual harassment, cyber sexual abuse, peer violence, bullying, and homophobic teasing at follow-up. Among 866 participants, mean age was 15.6 years, 70% identified as Black, 6% as Hispanic, and 6% as multiracial. In both the Manhood 2.0 intervention group and job-readiness control groups, youth who reported SV/ARA at baseline were significantly more likely to report any form of SV/ARA, incapacitated sex, sexual harassment, cyber sexual abuse, bullying, and homophobic teasing at follow-up. Among participants who reported no SV/ARA perpetration at baseline, participating in the Manhood 2.0 intervention program was associated with increased risk of SV/ARA at follow-up compared to participating in the job-readiness control program. Among participants who reported SV/ARA perpetration at baseline, participating in the Manhood 2.0 intervention group was associated with lower risk of peer violence at follow-up. Synergizing gender-transformative approaches with job-readiness training may offer opportunities for crosscutting prevention programming to address multiple forms of violence.

Examining Longitudinal Associations Between Future Orientation and Multiple Forms of Youth Violence Perpetration.

PURPOSE: Future orientation, defined as hopes and aspirations for the future, is gaining promise as a cross-cutting protective factor against youth violence. This study assessed how future orientation longitudinally predicted multiple forms of violence perpetration among minoritized male youth in neighborhoods made vulnerable by concentrated disadvantage. METHODS: Data were drawn from a sexual violence (SV) prevention trial among 817 predominately African American male youth, ages 13 to 19, residing in neighborhoods disproportionately impacted by community violence. We used latent class analysis to create baseline future orientation profiles of participants. Mixed effects models examined how future orientation classes predicted multiple forms of violence perpetration (i.e., weapon violence, bullying, sexual harassment, non-partner SV, and intimate partner SV) at 9-month follow-up. RESULTS: Latent class analysis yielded four classes, with nearly 80% of youth belonging to moderately high and high future orientation classes. We found significant overall associations between latent class and weapon violence, bullying, sexual harassment, non-partner SV, and SV (all p < .01). While patterns of association differed across each type of violence, violence perpetration was consistently highest among youth in the low-moderate future orientation class. Compared to youth in the low future orientation class, youth in the low-moderate class had higher odds of bullying (odds ratio 3.51, 95% confidence interval: 1.56-7.91) and sexual harassment perpetration (odds ratio 3.44, 95% confidence interval: 1.49-7.94). DISCUSSION: The longitudinal relationship between future orientation and youth violence may not be linear. Greater attention to nuanced patterns of future orientation may better inform interventions seeking to harness this protective factor to reduce youth violence.

Exploring the Impact of Racism on Black Youth: A Multidimensional Examination of Discriminatory Experiences Across Place and Time.

PURPOSE: Community violence disproportionally impacts Black youth. Experiences of racism and discrimination may create additional challenges for youth recovering from violence exposure. This study used ecological momentary assessment to elucidate how perceptions of racism and social support influence health and safety outcomes among Black youth following violence exposure. METHODS: Twenty-five Black youth (14-19 years old, 60% female) who had witnessed violence within the past three months completed a baseline survey that assessed discrimination experiences, social support, post-traumatic stress symptoms (PTS), and perceived safety. Youth completed ecological momentary assessments three times daily for two weeks about the place they were in, people they were with, their current emotional state, and in-the-moment racism perceptions. Multilevel models estimated the relationship between overall and time-varying perceptions of racism and social support, PTS symptoms, and perceived safety. RESULTS: Overall, 76% of youth reported at least one discrimination experience at baseline. Prior discrimination was associated with higher PTS (B = 1.86, p = .001) and depressive symptoms (B = 0.13, p = .013) at baseline. Youth who reported higher overall perceptions of racism in-the-moment reported higher PTS (B = 0.50, p = .002) and lower perceived safety (B = -0.53, p = .001). In-the-moment perceptions of racism were associated with lower perceived safety in that place (B = -0.09, p < .01). Emotional and instrumental support were associated with lower PTS and higher perceived safety (p < .05). DISCUSSION: Experiences of racism and being in discriminatory places impacted youth's depressive symptoms, PTS symptoms, and perceived safety. Interventions attuned to in-the-moment experiences of racism, and that leverage social support, are needed to support Black youth exposed to violence and discrimination.

Psychological empowerment and future orientation among adolescents in a youth participatory action research program.

Youth participatory action research (YPAR) empowers youth to address challenges in their environment. Empowerment is associated with prosocial behaviors; however, understanding of how empowerment may serve as a protective factor and promote emotional health remains limited. We sought to characterize protective factors (future orientation and resilience) and emotional health (difficulties regulating emotion and psychological distress) among youth engaged in YPAR and examine associations with psychological empowerment. We administered cross-sectional surveys to 63 youth in YPAR programming. Multivariable linear regression examined relationships between psychological empowerment, protective factors, and emotional health. Participants had high future orientation and resilience with high psychological distress. Empowerment was significantly associated with higher future orientation. There was no significant relationship between empowerment and measures of emotional health. We demonstrate the importance of evaluating protective factors and emotional health constructs in empowerment frameworks, calling for strategies that incorporate such protective factors and more directly address emotional health.

Adolescent-Adult Social Networks and Experiences of Violence Among Black Youth in Neighborhoods With High Levels of Community Violence.

PURPOSE: Adult support is inversely linked to health-affecting risk behaviors. This study aimed to describe adolescent-adult support network structure and quality, and to analyze associations among network properties, strength of emotional and instrumental support, and violence involvement among predominantly Black youth residing in neighborhoods with high levels of community violence. METHODS: One hundred six youth from urban neighborhoods with high levels of community violence in Pittsburgh, PA completed egocentric social network surveys describing adult supports, measures of support across contexts, and past 30-day violence perpetration, victimization, and witnessing. Forty youth-identified adults completed complementary social network surveys. Poisson regression examined associations among strength of social support, adults' violence experiences, and youths' violence experiences. RESULTS: Mean youth participant age was 16.7 years, 56% self-identified as female, and 84% as Black or African-American. Youth and adult participants reported high levels of violence exposure and involvement. Youth identified a mean of 4.8 adult supports. Identifying at least one immediate family member in their network was inversely related to violence perpetration (adjusted incidence rate ratio [aIRR] 0.44, 95% confidence interval [CI] 0.22-0.89), victimization (aIRR 0.42, 95% CI 0.25-0.72), and witnessing (aIRR 0.48, 95% CI 0.35-0.64). The percent of adult supports involved in violence was directly associated with violence perpetration (aIRR 1.81, 95% CI 1.07-3.07), victimization (aIRR 1.95, 95% CI 1.09-3.45), and witnessing (aIRR 1.85, 95% CI 1.25-2.73). Few associations emerged between the structure of youth-reported adolescent-adult social networks and violence. DISCUSSION: Network-based interventions combined with healing-centered services attuned to violence experiences among Black youth and their adult supports may offer opportunities to leverage youths' existing adult support network and reduce violence.

Associations Between Parental Monitoring and Multiple Types of Youth Violence Victimization: A Brief Report.

Youth violence victimization continues to be pervasive and a significant cause of adolescent mortality. Since their 2014 "Connecting the Dots" report, the Centers for Disease Control and Prevention have encouraged researchers to identify shared protective factors that prevent multiple forms of youth violence. Parental monitoring, a bidirectional construct encompassing parental knowledge and regulation of their child's activities with children's concurrent perception of their parent's awareness of such activities, could be such a cross-cutting protective factor. In this study, we examined associations between parental monitoring and multiple types of violence victimization among a school-based sample of adolescents. We conducted a cross-sectional analysis of an anonymous survey of health risk and protective behaviors completed by students across Pittsburgh Public Schools (N = 2,426). In separate analyses, we used logistic regression to examine associations between youth-reported parental monitoring and multiple experiences of youth violence victimization, ranging from school- and electronic-based bullying to different forms of sexual and physical violence. We found that many experiences of youth violence victimization were consistent with nationally representative data. In addition, we determined that higher parental monitoring was significantly and inversely associated with all violence victimization outcomes examined (school-based bullying, electronic-based bullying, threatening someone with a weapon, adolescent relationship abuse, sexual assault, and exchange sex) at the p < .05 threshold. Overall, this study is one of the first that examines how parental monitoring relates to multiple forms of youth violence victimization, including exchange sex, which is a critical but less-studied violence experience. This work adds to the growing literature on how parental monitoring may serve as a shared protective factor for multiple forms of violence victimization.

Exploration of Experiences and Perpetration of Identity-Based Bullying Among Adolescents by Race/Ethnicity and Other Marginalized Identities.

Importance: Race-based discrimination represents an ongoing public health crisis in the US, manifested by wide-ranging disparities in youth health, mental health, and violence exposure. However, studies of racial discrimination often neglect experiences of identity-based bullying (IBB) stemming from other marginalized identities, such as gender identity and sexual orientation. Objective: To examine associations between experiences of IBB based on race/ethnicity/national origin and other social identities and youth health, mental health, and violence outcomes. Design, Setting, and Participants: This cross-sectional study analyzed responses from an anonymous survey conducted at 13 public high schools in Pittsburgh, Pennsylvania, between October 15, 2018, and October 19, 2018. Participants included in the study were in the 9th through 12th grades. Data were analyzed from October 15, 2020, to February 14, 2021. Exposures: Experiences of bullying and bullying perpetration based on race/ethnicity/national origin and other social identities (ie, gender identity, sexual orientation, religion, physical or mental disability, immigration status, other unspecified reason). Main Outcomes and Measures: Youth health (delayed well care; forgone medical care; physical, mental, or emotional limitations), mental health (nonsuicidal self-injury, suicidal ideation), and violence involvement (weapon perpetration or survivorship, fighting, sexual assault, adolescent relationship abuse, experiencing homicide of friend or family member) were assessed using self-reported items modeled on the Centers for Disease Control and Prevention Youth Risk Behavior Survey. Results: Among 3939 participants, the mean (SD) age was 15.7 (1.3) years; 1380 students (36.3%) identified as Black/African American, 2086 (53.7%) as assigned female at birth, 1021 (32.6%) as belonging to a sexual minority group, and 313 (10.0%) as gender diverse. Among reported social identities, race/ethnicity-based experiences of bullying (375 students [9.5%]) and bullying perpetration (209 students [5.8%]) were the most common. Youth with multiple stigmatized identities experienced even higher rates of experiences of IBB and IBB perpetration. Specifically, the highest rates of IBB were reported by gender diverse Black and Hispanic youth. Experiencing IBB based on multiple stigmatized identities was associated with all outcomes, including delayed well care (aOR, 1.41; 95% CI, 1.20-1.65), forgone medical care (aOR, 1.64; 95% CI, 1.44-1.87), nonsuicidal self-injury (aOR, 2.86; 95% CI, 2.53-3.24), suicidal ideation (aOR, 2.49; 95% CI, 2.20-2.83), and greater violence involvement (experiencing violence: aOR, 2.90; 95% CI, 2.45-3.43; homicide survivorship: aOR, 1.19; 95% CI, 1.06-1.33). Conclusions and Relevance: These results further encourage the development of youth health, mental health, and violence prevention programs that address experiences of bullying based on multiple marginalized identities.

Protective Factors Against Vaping and Other Tobacco Use.

BACKGROUND AND OBJECTIVES: Vaping has gained popularity among adolescents despite negative health consequences. Few studies have focused on factors that may protect against vaping. We sought to determine if future orientation, parental monitoring, school connectedness, and social support are associated with decreased risk of vaping and other forms of tobacco use. METHODS: Data were obtained via anonymous school-based health behavior surveys among ninth- through 12th-graders in Pittsburgh, PA (n = 2487). Protective factors were assessed through validated Likert scale instruments. The primary outcome was recent (past 30-day) vaping. Additional outcomes included other forms of tobacco use and intention to quit tobacco products. Poisson regression models examined associations between protective factors and vaping and tobacco use outcomes. RESULTS: Mean age was 15.7 years, 1446 (58.1%) respondents were female, and 671 youth (27.0%) reported recent vaping. Positive future orientation and high parental monitoring were associated with significantly lower prevalence of recent vaping (adjusted prevalence ratio: 0.84 [95% confidence interval: 0.73-0.97] and adjusted prevalence ratio: 0.73 [95% confidence interval: 0.62-0.85], respectively). There were no significant relationships between social support or school connectedness and vaping. All 4 protective factors were inversely associated with other forms of tobacco use. No factors were significantly associated with intent to quit tobacco products. CONCLUSIONS: Findings reveal significant inverse associations between future orientation, parental monitoring, and vaping but no relationship between protective factors and intent to quit tobacco products. Developing interventions to foster protective factors in youth and their parental supports may inform primary prevention efforts to reduce vaping and other tobacco use.

Racial Diversity Among American Cardiologists: Implications for the Past, Present, and Future.

In the United States, race-based disparities in cardiovascular disease care have proven to be pervasive, deadly, and expensive. African American/Black, Hispanic/Latinx, and Native/Indigenous American individuals are at an increased risk of cardiovascular disease and are less likely to receive high-quality, evidence-based medical care as compared with their White American counterparts. Although the United States population is diverse, the cardiovascular workforce that provides its much-needed care lacks diversity. The available data show that care provided by physicians from racially diverse backgrounds is associated with better quality, both for minoritized patients and for majority patients. Not only is cardiovascular workforce diversity associated with improvements in health care quality, but racial diversity among academic teams and research scientists is linked with research quality. We outline documented barriers to achieving workforce diversity and suggest evidence-based strategies to overcome these barriers. Key strategies to enhance racial diversity in cardiology include improving recruitment and retention of racially diverse members of the cardiology workforce and focusing on cardiovascular health equity for patients. This review draws attention to academic institutions, but the implications should be considered relevant for nonacademic and community settings as well.

Future Orientation as a Cross-Cutting Protective Factor Against Multiple Forms of Violence.

Among 9th-to 12th-grade students who completed an anonymous health risk and protective behavior survey (n = 2346), positive future orientation was significantly and inversely associated with multiple forms of interpersonal violence including youth, community, and sexual/relationship violence. Designing interventions to promote future orientation holds promise as a cross-cutting violence prevention strategy.

Best Practices for Modeling Egocentric Social Network Data and Health Outcomes.

OBJECTIVE/AIM: We describe best practices for modeling egocentric networks and health outcomes using a five-step guide. BACKGROUND: Social network analysis (SNA) is common in social science fields and has more recently been used to study health-related topics including obesity, violence, substance use, health organizational behavior, and healthcare utilization. SNA, alone or in conjunction with spatial analysis, can be used to uniquely evaluate the impact of the physical or built environment on health. The environment can shape the presence, quality, and function of social relationships with spatial and network processes interacting to affect health outcomes. While there are some common measures frequently used in modeling the impact of social networks on health outcomes, there is no standard approach to social network modeling in health research, which impacts rigor and reproducibility. METHODS: We provide an overview of social network concepts and terminology focused on egocentric network data. Egocentric, or personal networks, take the perspective of an individual who identifies their own connections (alters) and also the relationships between alters. RESULTS: We describe best practices for modeling egocentric networks and health outcomes according to the following five-step guide: (1) model selection, (2) social network exposure variable and selection considerations, (3) covariate selection related to sociodemographic and health characteristics, (4) covariate selection related to social network characteristics, and (5) analytic considerations. We also present an example of SNA. CONCLUSIONS: SNA provides a powerful repertoire of techniques to examine how relationships impact attitudes, experiences, and behaviors-and subsequently health.

Understanding Variation In Nonurgent Pediatric Emergency Department Use In Communities With Concentrated Disadvantage.

Children in communities with concentrated socioeconomic and structural disadvantage tend to have elevated rates of nonurgent visits to emergency departments (EDs). Using a spatial regression model of 264 census block groups in Pittsburgh, Pennsylvania, we investigated sociodemographic and structural factors associated with lower-than-expected ("low utilization") versus higher-than-expected ("high utilization") nonurgent ED visit rates among children in block groups with concentrated disadvantage. Compared with high-utilization block groups, low-utilization block groups had higher percentages of households with two adults, high school graduates, access to vehicles, sound housing quality, and owner-occupied housing. Notably, low-utilization block groups did not differ significantly from high-utilization block groups either in the percentage of households located within very close proximity to public transit or primary care or in children's health insurance coverage rates. Stakeholders wishing to reduce pediatric nonurgent ED visits among families in communities of concentrated disadvantage should consider strategies to mitigate financial, time, transportation, and health literacy constraints that may affect families' access to primary care.

Route Choices and Adolescent-Adult Connections in Mitigating Exposure to Environmental Risk Factors During Daily Activities.

While adolescent-adult connections have been shown to be protective against violence perpetration and victimization, mechanisms through which these connections confer protection from violence are poorly understood. We assessed whether adolescent-adult connections protected youth in lower resource urban neighborhoods from exposure to environmental risk factors for violence during daily activities. We overlaid on the city landscape minute-by-minute activity paths from 274 randomly sampled predominantly African American male youth, ages 10 to 24, enrolled in a population-based study of daily activities in Philadelphia, PA, to calculate environmental exposures and to compare exposures along actual versus shortest potential travel routes. Adolescent-adult connections were defined using brief survey questions and detailed family genograms. Analyses demonstrated that youth's selected travel routes resulted in significantly lower exposure to several types of crime, including vandalism, narcotics arrests, and disorderly conduct, than would have occurred on shortest potential routes. On average, youth with adolescent-adult connections spent less time outdoors than youth without connections, although these differences did not reach statistical significance (p = .06). There were no significant differences in environmental risk factors encountered by youth with versus without adolescent-adult connections. Future mixed-methods research combining qualitative and geographic information systems (GIS) approaches should investigate which factors shape travel decisions during daily activities to guide multimodal violence prevention interventions.