Developing and implementing survivor-centred approaches for college student-athletes: perspectives from athletic department, Title IX, and campus advocacy personnel.

ABSTRACTBackground: Sexual violence (SV) is a persistent issue on US college campuses, particularly among college student-athletes. Strategies to address SV are urgently needed. Yet, prior research shows that many university practices can be more harmful than helpful to SV survivors and necessitates a reimagination of how institutions support SV survivors. Survivor-centred approaches may be one way to effectively address SV for students, including student-athletes, across college campuses.Objective: This qualitative study explored campus personnel experiences with and perceptions of survivor-centred SV prevention and intervention policies and practices on college campuses and examined how these approaches serve SV survivors, including college student-athletes.Methods: As part of a larger study on campus SV and student-athletes across four institutions, semi-structured interviews with 22 representatives from athletic departments, campus advocacy, and Title IX were conducted. Guided by phenomenology, a thematic analysis approach was used to identify key patterns in survivor-centred SV prevention and intervention policies and practices. Participant demographic data were analysed descriptively.Results: Most participants identified as white (72.2%), heterosexual (63.6%), women (68.2%), and were an average of 41.8 years old (SD = 10.2). The majority were in positions associated with athletic departments (63.6%), and they had been in their role for an average of 5.6 years (SD = 6.6). Through thematic analysis, three main themes were identified: (1) education & accessibility; (2) interpersonal relationships & individual well-being; and (3) campus and societal norms.Conclusions: The findings from this study highlight clear policy and practice recommendations for survivor-centred SV prevention and intervention on college campuses, such as accessible, applicable SV training and the implementation of survivor-centred approaches. Further research is needed to understand existing survivor-centred practices and the facilitators and barriers to their implementation across institutions and within athletic departments.

Sexual violence is a persistent issue on US college campuses, particularly among college student-athletes. Strategies to address SV are urgently needed. Survivor-centred approaches may offer solutions to better serve survivors of sexual violence, including student-athletes.Through interviews with athletic department, Title IX, and campus advocacy personnel, three themes were identified related to developing and implementing survivor-centred approaches: (1) education & accessibility; (2) interpersonal relationships & individual well-being; and (3) campus and societal norms.Further research is needed to understand existing survivor-centred practices and the facilitators and barriers to their implementation across institutions, particularly for college student-athletes.

State laws addressing teen dating violence in US high schools: A difference-in-differences study.

OBJECTIVE: Teen dating violence (TDV) is prevalent with lifelong adverse consequences, and strategies to reduce its burden are needed. Many U.S. states have enacted laws to address TDV in schools, but few studies have examined their effectiveness. This study aimed to assess whether state TDV laws were associated with changes in physical TDV victimization among high school students. METHODS: We used repeated cross-sectional data of high school students from the Youth Risk Behavior Survey across 41 states from 1999 to 2019. Using a difference-in-differences approach with an event study design, we compared changes in past-year physical TDV in states that enacted TDV laws (n = 21) compared to states with no required laws (n = 20). Analyses accounted for clustering at the state-level and state and year-fixed effects. We conducted sensitivity analyses to assess the robustness of our findings. RESULTS: In our sample of 1,240,211 students, the prevalence of past-year physical TDV was 9.2% across all state-years. In 1999, the prevalence of TDV at the state-level ranged from 7.5 to 13.0%; in 2019, the prevalence ranged from 3.7 to 10.5%. There was no significant association between TDV laws and past-year physical TDV. Six or more waves after enactment, we observed a non-significant 1.7% percentage point reduction in TDV in states with TDV laws (95% CI: -3.6 to 0.3 percentage points; p = 0.10). CONCLUSIONS: We found no significant association between enactment of TDV laws and physical TDV among high school students. Further research is needed to understand how TDV laws are implemented and components of TDV laws that may influence effectiveness.

Threats, Violence, and Weapon Use Against Children in Domestic Violence Protection Orders.

BACKGROUND AND OBJECTIVES: Childhood exposure to domestic violence is common, but the overlap between threats and violence against children and weapon/firearm use has not been well studied. The objectives of this study were to: assess differences in respondent firearm access and the use of weapons in granted domestic violence protection orders (DVPOs) with and without minors (individuals <18 years of age); and characterize the frequency and characteristics of threats and acts of violence against minors. METHODS: We conducted a cross-sectional study of a random sample of granted DVPOs from 2014-2020 in King County, Washington. We examined the use of threats, violence, and weapons by restrained individuals (ie, respondents) by reviewing and abstracting information from DVPO case files. RESULTS: Respondent weapon use and firearm possession were more common among DVPOs including minors than DVPOs not including minors (weapon use: 38.2% and 33.0%; firearm possession: 23.1% and 19.1%, respectively). Almost 2 in 3 DVPOs including minors (1338 of 2029) involved threats or violence directed at a minor perpetrated by the DVPO respondent. About 1 in 3 (32.5%) DVPOs documented explicit threats, and 1 in 2 (48.9%) documented violence. Over two-thirds (680 of 993, 68.5%) of acts of violence directed at minors included a weapon. CONCLUSIONS: We found higher lethality risk (weapon use and respondent firearm access/ownership) among DVPOs including minors. Many minors experienced threats and acts of violence involving weapons and firearms by DVPO respondents. Evidence-based safety planning strategies and training of judicial officers are needed.

Improving School Environments for Preventing Sexual Violence Among LGBTQ+ Youth.

BACKGROUND: Sexual violence (SV) is a serious public health concern, and lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ+) youth report higher rates than their heterosexual and cisgender peers. This qualitative study aimed to understand LGBTQ+ students' perspectives on how middle and high school environments can better prevent and address SV. METHODS: In partnership with a school-based LGBTQ+ support group in Washington State, we recruited 31 LGTBQ+ students ages 13-18 for virtual interviews (n = 24) and for providing text-based answers to interview questions (n = 7). We used inductive thematic analysis to analyze data and identify themes. RESULTS: To prevent and respond to SV, students highlighted schools having: (1) access to gender-neutral spaces; (2) LGBTQ+ competency training for staff; (3) enforcement of school policies (eg, SV, anti-bullying) and accountability; (4) LGBTQ+-competent mental health support; and (5) comprehensive sexual health education that addresses LGBTQ+ relationships and SV. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Students expressed the need for changes in school physical and social environments to address SV among LGBTQ+ youth. CONCLUSIONS: Incorporating youth perspectives, particularly LGBTQ+ youth at high risk of SV, can help schools implement strategies that are supported by youth and thus potentially more sustainable and effective.

Using Cognitive Interviews to Adapt Interpersonal Violence Measures for Use With Middle School Youth.

Experiences of interpersonal violence are common among youth. Starting prevention programming early (e.g., middle school) may be beneficial for primary prevention. Evaluating whether such programs are effective often requires collecting self-report data from youth, but many existing measures have been developed for high school and college-aged youth. This study aimed to assess adolescents' comprehension of self-report survey items on interpersonal violence with middle school youth. We conducted virtual cognitive interviews with 15 youth in grades 6 to 8. A content analysis was used to identify patterns and to classify the nature and type of comprehension issues youth experienced. Nearly all students found most questions clear and understandable. We identified the following comprehension issues: (1) uncertainty with how the intent of a perpetrator factored into a victim's experience (e.g., distinguishing the difference between joking and bullying, or intentional versus unintentional behavior); (2) lack of familiarity with certain expressions of sexualized violence (e.g., "sexual looks") or sex-related terminology (e.g., intercourse); and (3) narrow interpretations of question prompts (e.g., interpreting "forced" as physically forced, not psychologically coerced). Students suggested including language describing dating relationships, types of social media platforms where cyber abuse takes place, and additional examples alongside items to enhance relevance and clarity. Survey questions to measure interpersonal violence may need to be adapted for use among middle school youth. Our findings highlight potential considerations for improving the measurement of interpersonal violence in this age group.

Use of immigration status for coercive control in domestic violence protection orders.

In the context of domestic violence (DV), immigration-related circumstances can be exploited by an abuser to coerce and manipulate their partner. Using an intersectional structural framework, we examine how social structures overlaid with immigration-specific experiences operate to further enhance opportunities for abuse against immigrant women. We conducted a textual analysis to identify how socially constructed systems interact with a victim-survivor's immigration status to introduce more tools for abusers to engage in coercive control and/or acts of violence in a random sample of petitioners (i.e., victim-survivors) who were granted a Domestic Violence Protection Order (DVPO) in King County, WA (n = 3,579) from 2014-2016 and 2018-2020. We hand-reviewed textual petitioner narratives and identified n = 39 cases that discussed immigration-related circumstances and related acts of violence and coercion. These narratives included threats to contact authorities to interfere with an ongoing immigration process, deportation threats, and threats that would separate families. In many cases, petitioners indicated that immigration-related threats prevented them from leaving the violent partner, seeking help, or reporting the abuse. We also found mention of barriers for victims to receive protection and gain autonomy from further abuse including a lack of familiarity with US protections and laws, and restrictions on authorizations to work. These findings demonstrate that structurally created immigration-specific circumstances provide opportunities for threats and retaliation against victim-survivors by abusers and create barriers to seeking help initially. Policy should respond to anticipate these threats in the immigrant community and engage early responders (e.g., healthcare providers, law enforcement) to support victim-survivors from immigrant communities.

Lessons Learned From Integrating Anti-Oppression Pedagogy in a Graduate-Level Course in Epidemiology.

Despite the high burden of injury and violence globally and disproportionate burden on marginalized communities, few US schools of public health and departments of epidemiology offer classes focused on injury and violence, and even fewer are taught with an antiracist or anti-oppression framework. Recent years have brought renewed focus to incorporating antiracist and anti-oppression principles to pedagogy. Public health professionals have increasingly grappled with how we teach, conduct research, and advocate for just policies, which are shaped by interlocking systems of oppression. Although all areas of epidemiology are shaped by these structures, motivations for those who study injury and violence ought to be especially keen. In this commentary, we illustrate how anti-oppression can be integrated into course development and delivery with a case study of a graduate-level course at the University of Washington School of Public Health on injury and violence epidemiology. We include feedback from an epidemiology faculty reviewer, as well as narratives from students describing what worked and what did not. We offer our reflections and lessons learned, hoping to encourage others within public health and epidemiology to adopt an anti-oppression framework in developing classes and programs, particularly those related to injury and violence.

Prevalence and Formal Reporting of Sexual Violence among Undergraduate Student-Athletes: A Multi-State Study.

Sexual violence (SV) is a serious problem on college campuses, and student-athletes are one group of college students at risk for experiencing SV. The administrative context and close-knit bonds of college teams introduce opportunities and structures for responding to SV and delivering uniquely tailored prevention programming, but there is limited research about formal reporting of SV among student-athletes. The current study examines the prevalence of SV and SV reporting history and perceptions among a multi-state sample of undergraduate student-athletes. Student-athletes at 10 National Collegiate Athletic Association (NCAA) Division I institutions across the US participated in an online survey about their experiences of SV victimization, formal reporting of SV, knowledge of resources, and perceptions of responses to SV at their institutions. Among 1004 student-athletes who completed the survey, 29% experienced some type of SV since enrolling at their university, with higher prevalence of SV among student-athletes on women's teams (36%) compared to men's teams (13%). About one fifth of student-athletes felt very or extremely knowledgeable about where to make a report of SV, and only about 10% felt very or extremely knowledgeable about what happens when a student reports SV. Only 9% of participants who experienced SV filed a formal report at their institution. Perceptions about whether campus officials would take the report seriously or would conduct a fair investigation were most positive for students who experienced and formally reported SV. Further research with student-athletes about their decision to formally report and barriers to reporting is needed to build a more comprehensive understanding of the unique experiences of SV among student-athletes. Our results highlight the importance of including and targeting student-athletes in campus SV prevention efforts to build knowledge and trust in hopes of ultimately decreasing the prevalence and adverse consequences of SV.

The Measurement of Intimate Partner Violence Using International Classification of Diseases Diagnostic Codes: A Systematic Review.

Intimate partner violence (IPV) is challenging to measure yet systematic surveillance of IPV is critical to informing public health prevention and response efforts. Administrative medical data provide opportunities for such surveillance, and often use the International Classification of Diseases (ICD). The primary purpose of this systematic review was to document which ICD codes have been used in empirical literature to identify IPV, understand the justification used to select specific codes to develop IPV case definitions, and identify the data sources and types of research questions addressed by the existing literature. We searched 11 databases and of the initial 2182 results, 21 empirical studies from 2000 to 2020 met the study inclusion criteria including using ICD codes to measure IPV. The majority of these studies (90.5%) used either national samples of data or population-based administrative data from emergency departments (52.4%) or inpatient hospitalizations (38.1%). We found wide variation of ICD diagnostic codes to measure IPV and categorized the sets of codes used based on the number of codes. The most commonly used ICD-9 codes were E967.3, 995.81, 995.80, 995.85 and the most common ICD-10 codes were T74.1 and Z63.0. Few studies validated the ICD codes used to measure IPV. Most included studies (81.0%) answered epidemiological research questions. The current study provides suggestions for future research, including justifying the selection of ICD codes and providing a range of estimates based on narrow and broad sets of codes. Implications for policy and practice, including enhanced training for healthcare professionals in documenting IPV, are discussed.

Intimate Partner Violence-Related Emergency Department and Hospital Visits in California Following the ICD-10-CM Transition, 2016-2018.

With the transition to the International Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10-CM), additional research is needed to understand which diagnostic codes for intimate partner violence (IPV) are being used. The current study examined characteristics of IPV visits and frequency of diagnostic codes to identify IPV in all emergency department (ED) and inpatient hospital visits for adults in California from 2016-2018, after ICD-10-CM implementation. Five ICD-10-CM codes outlined in the Uniform Data System Reporting Instructions were used to identify IPV. Fewer than 0.1% of visits (17,347 ED visits and 1,430 hospitalizations) included documentation of IPV. Visits with documented IPV were more common among patients who were younger, female, Black, primarily English-speaking, and publicly insured compared to visits with no documented IPV. There were fairly consistent patterns over time in the specific ICD-10-CM codes used for IPV between 2016 and 2018. Physical and sexual abuse were the most common codes for types of abuse. Among the 15 EDs and 15 hospitals in California with the highest volume of IPV visits, there was variability in the use of ICD-10-CM codes for IPV visits. Accurate documentation of IPV in administrative data may improve patient care and increase understanding of the burden and effects of IPV on individuals and communities.

Race, structural racism and racial disparities in firearm homicide victimisation.

OBJECTIVES: To identify an approach in measuring the association between structural racism and racial disparities in firearm homicide victimisation focusing on racism, rather than race. METHODS: We examined associations of six measures of structural racism (Black/white disparity ratios in poverty, education, labour force participation, rental housing, single-parent households and index crime arrests) with state-level Black-white disparities in US age-adjusted firearm homicide victimisation rates 2010-2019. We regressed firearm homicide victimisation disparities on four specifications of independent variables: (1) absolute measure only; (2) absolute measure and per cent Black; (3) absolute measure and Black-white disparity ratio and (4) absolute measure, per cent Black and disparity ratio. RESULTS: For all six measures of structural racism the optimal specification included the absolute measure and Black-white disparity ratio and did not include per cent Black. Coefficients for the Black-white disparity were statistically significant, while per cent Black was not. CONCLUSIONS: In the presence of structural racism measures, the inclusion of per cent Black did not contribute to the explanation of firearm homicide disparities in this study. Findings provide empiric evidence for the preferred use of structural racism measures instead of race.

Student-Athlete Preferences for Sexual Violence Reporting: A Discrete Choice Experiment.

BACKGROUND: Sexual violence (SV) is prevalent among US college athletes, but formal reports are rare. Little is known about adaptations to institution-level reporting policies and procedures that could facilitate reporting. METHODS: We conducted a discrete choice experiment (DCE) survey with 1004 student-athletes at ten Division I NCAA member institutions to examine how attributes of the reporting system influence the decision to formally report SV to their institution. Changes in utility values were estimated using multinomial logistic regression and mixed multinomial logistic regression. Importance scores were compared to understand student-athlete preferences. RESULTS: In order of relative importance, the two attributes most preferred by student-athletes were higher probabilities of students perpetrating SV being found in violation of code of conduct policies (relative importance score = 33), and the availability of substance use amnesty policies (relative importance score = 24). Student-athletes with prior SV experiences were more likely to opt out of formally reporting in the DCE paired choice, had lower estimated utility values for all attributes, and had less between-person heterogeneity. While anonymous reporting and survivor-initiated investigations were preferred by student-athletes on average, there was considerable valuation heterogeneity between student-athletes (sizeable deviations from mean estimated utilities). These two attributes also varied in relative importance; anonymous reporting had higher relative importance after interacting levels with prior SV experiences and competitive status, but lower relative importance after interacting levels with whether a student-athlete played on men's or women's sports teams. CONCLUSIONS: Changes to reporting policies and procedures (e.g., transparency about SV reporting outcomes, implementing substance use amnesty policies) may be promising institution-level interventions to increase formal reporting of SV among student-athletes. More research is needed to understand preference heterogeneity between students and generalize these findings to broader student populations.

Assessment of Variation in US State Laws Addressing the Prevention of and Response to Teen Dating Violence in Secondary Schools.

Importance: Teen dating violence (TDV) is widespread and has adverse consequences across the life course. Many US states are actively seeking strategies to prevent and address TDV in schools, including enactment and implementation of TDV laws. These state laws are upstream, system-level interventions that lay the foundation for an array of downstream targeted interventions to be deployed in schools. Despite these laws gaining momentum in the past decade, there has been minimal research examining their content and variability. Objective: To assess the content and comprehensiveness of US state laws addressing prevention of and response to TDV in secondary schools. Design, Setting, and Participants: A team of public health and legal researchers used systematic policy surveillance methods to develop a comprehensive database of state laws addressing TDV in schools in all 50 US states and the District of Columbia (referred to hereinafter as "states") in effect as of September 30, 2020. Using LexisNexis and state legislature websites, state laws (statutes and administrative codes) were identified. Main Outcomes and Measures: Components for each law were coded within 5 categories: scope, prevention education, policy, response, and implementation. Results: Overall, 38 states (74.5%) had at least 1 law addressing TDV in secondary schools and 13 states (25.5%) did not. Fewer than half of states with a law (15 of 38 [39.5%]) defined TDV. All 38 states addressed prevention education, with 29 (76.3%) requiring and 9 (23.7%) encouraging these efforts. Prevention education was largely for students in most states (35 [92.1%]), but some states also required school staff (18 [47.4%]) and parents (8 [21.1%]) to receive prevention education. Fewer than half of states required (14 [36.8%]) or encouraged (3 [7.9%]) school districts to develop a policy addressing TDV. Very few states included requirements for how schools must respond to TDV incidents. Fewer than a third of states designated an individual to coordinate TDV efforts (12 [31.6%]), included a funding provision in their laws for TDV programs and policies (10 [26.3%]), and included explicit consequences for noncompliance with TDV laws (12 [31.6%]). Conclusions and Relevance: This cross-sectional study found that most US states had laws addressing TDV in schools, but there was significant variation in the content and comprehensiveness of the laws. These findings can inform the development of more comprehensive laws on TDV that may ultimately reduce such incidents.

Trends in Secondary School Practices Related to Violence Prevention, 2012-2018.

BACKGROUND: Schools are important venues for addressing interpersonal violence among youth. However, it is unclear to what extent school violence prevention practices have been implemented across states and over time. This study examined trends in the percentage of US secondary schools that engaged in practices related to violence prevention (eg, bullying, fighting, dating violence) across 33 states. METHODS: With representative data from 4 waves (2012-2018) of School Health Profiles, we used logistic regression to examine change over time of 5 practices related to violence prevention in school-based settings: professional development for health education teachers (received and would like to receive); increasing student knowledge; and teaching healthy and respectful relationships in grades 6-8 and grades 9-12. RESULTS: Two practices had rates of adoption >90% across years (tried to increase student knowledge on violence prevention and taught healthy and respectful relationship in grades 9-12). Adoption of professional development on violence prevention for health education teachers was lowest (53%-61% across years). For all practices, most states experienced no change in the percentage of schools implementing violence prevention practices from 2012 to 2018. CONCLUSION: Education about healthy relationships in middle school and professional development on violence prevention for health education teachers are needed.

The Earned Income Tax Credit and Intimate Partner Violence.

Intimate partner violence (IPV) is a serious public health problem in the United States with adverse consequences for affected individuals and families. Recent reviews of the literature suggest that economic policies should be further investigated as part of comprehensive strategies to address IPV. The Earned Income Tax Credit (EITC) is the nation's largest anti-poverty program for working parents, and especially benefits low-income women with children, who experience an elevated risk of IPV. The EITC may prevent IPV by offering financial resources; such resources may help individuals experiencing IPV leave abusive relationships or address IPV risk factors, thereby preventing entry into abusive relationships. However, the association between EITC generosity and IPV has not been previously examined. We used state-level and individual-level datasets to examine the association between EITC generosity and IPV. Our state-level data source was the nationally representative National Crime Victimization Survey (NCVS; N = ~ 95,000 households per year). For NCVS, we used a difference-in-difference approach to investigate the relationship between state EITC generosity and IPV rates. We also used individual-level longitudinal data from the Fragile Families and Child Well-being Study (n = 13,422 person-waves). Using this cohort of US families at higher risk for IPV, we evaluated associations between estimated EITC benefits based on the mother's state of residence and number of children and self-reported IPV. In both state- and individual-level analyses, no significant association between state EITC benefits and IPV was found. Factors that may account for these null findings include program ineligibility for individuals who separate from abusive spouses. Future research efforts should more closely examine EITC policy implementation processes and the lived experience of participating in anti-poverty programs for people experiencing IPV.

Firearms and protective orders in intimate partner homicides.

PURPOSE: To determine differences among intimate partner homicides (IPH) by whether or not a firearm was used in and whether a protective order (PO) was filed prior to IPH. METHOD: We identified all incidents of IPH recorded in the National Violent Death Reporting System from 2003-2018, based on the relationship between victim and perpetrator. We characterized incidents, perpetrators and victims in IPH cases by whether or not a firearm was used, and whether a PO had been sought or issued prior to the IPH. RESULTS: We identified 8,375 IPH incidents with a total of 9,130 victims. Overall 306 (3.3%) victims were killed in a firearm IPH with PO, 4,519 (53.9%) in a firearm IPH without PO, 176 (2.1%) in a non-firearm IPH with PO and 3,416 (40.7%) in a non-firearm IPH without PO. Based on review of incident narratives, 5.4% (n=451) of incidents involved a previously-granted or sought PO, and none of which had explicitly mentioned firearm removal as a part of the PO. CONCLUSIONS: The majority of victims were killed with a firearm. Prior literature suggests that POs with firearm removal may be effective strategies for reducing risk of IPH, but we found no documentation in the narratives that firearm removal was a condition in the POs identified. As very few IPH narratives included documentation of a PO, it is likely that ascertainment of PO status is incomplete and could be an area for improvement in NVDRS data collection efforts.

Adolescent and Young Women's Daily Reports of Emotional Context and Episodes of Dating Violence.

PURPOSE: To investigate same day, previous day, and next day associations between trust, closeness, commitment, jealousy and provision of instrumental support with dating violence victimization and perpetration. METHOD: A convenience sample of young women, 16-19 years, in a heterosexual dating relationship with at least one act (past month) of physical or psychological victimization or perpetration, were recruited from urban public locations. Participants answered questions daily via text continuously for four months on dating violence and partner-specific emotions. Daily surveys asked about trust, closeness, commitment for their partner, jealousy, perceptions of partner's jealousy and provision of instrumental support to and from partner, and dating violence victimization and perpetration. Multilevel modeling examined within-relationship associations over time. RESULTS: Mean (sd) age for the full sample was 18.1 (1.1) years. Same-day emotional context (trust, closeness, commitment, jealousy and provision of instrumental support) was more strongly associated with victimization and perpetration compared to previous day emotions. Strongest same-day positive associations were with partner's perpetration, both partner's jealousy, and females' instrumental support. Partner's jealousy and increased trust were best predictors of next day victimization. Closeness, commitment and trust went down on the day of violence. Perpetration was positively associated with next day commitment. Victimization was positively associated with next day trust. CONCLUSIONS: This event-level analysis demonstrates the role and timing that emotional aspects of adolescent relationships - including positive feelings - have surrounding episodes of dating violence. This granular understanding of the emotional context of dating violence has the potential to facilitate development of effective, developmentally appropriate interventions.

From fathers to peers: Association between paternal violence victimization and peer violence perpetration among youth in Malawi, Nigeria, and Zambia.

Interpersonal violence against children and youth, including parental violence and peer violence, are major global health concerns. However, the majority of the parental violence and peer violence literature examines each separately from one another. In this study, we specifically investigate the role of fathers and whether paternal violence victimization is associated with peer violence perpetration, above and beyond maternal violence victimization. We used nationally-representative data from three sub-Saharan African country surveys of the Violence Against Children Surveys, which comprised a pooled sample of 8184 youth aged 13-24 years in Malawi (conducted in 2013), Nigeria (2014), and Zambia (2014). We used multivariable logistic regression models to estimate the association between paternal violence victimization and peer violence perpetration, controlling for maternal violence victimization, witnessing violence, and other covariates. We also tested a structural equation model to determine whether the direct association between paternal violence victimization and peer violence perpetration was mediated through youth mental distress or alcohol use, controlling for other violence exposures and covariates. In the pooled sample, 22.8% of youth reported paternal violence victimization, and 18.8% of youth reported peer violence perpetration in their lifetime. Youth who experienced paternal violence had a greater odds of perpetrating peer violence (OR = 1.74, 95% CI: 1.50-2.02), compared with youth who did not experience paternal violence and after controlling for maternal violence victimization and other covariates. Structural equation model results revealed that approximately a quarter of the total association between paternal violence victimization and peer violence perpetration was mediated by youth mental distress and alcohol use. Our study underscores the role of fathers in the context of parental violence against youth and highlights the need for multicomponent and two-generation violence prevention interventions that address paternal violence and support youth psychosocial wellbeing to prevent cycles of violence perpetration against youth in sub-Saharan Africa.

Prevalence, age of initiation, and patterns of co-occurrence of digital dating abuse behaviors nationwide.

INTRODUCTION: Little is known about the patterns of adolescent and young adult digital dating abuse (DDA) nationwide. This study characterizes (1) the lifetime prevalence, (2) the age of initiation, and (3) the patterns of co-occurrence of both using and experiencing DDA behaviors in dating relationships. METHODS: A cross-sectional online survey was conducted among a sample of 696 U.S. young adults recruited from Prolific, an online research platform. The sample was 50.7% female, 43.7% male, and 5.6% gender non-binary or transgender. The average age was 18.7 years (SD = 0.63, range: 16-22). RESULTS & CONCLUSIONS: Among those with dating experience, 76.1% (n = 530) reported either using or experiencing at least one DDA behavior in their lifetime. Overall, 42.9% of respondents reported using and 58.3% experiencing digital monitoring and control behaviors, 25.0% reported using and 49.2% experiencing digital direct aggression, and 12.4% reported using and 36.4% experiencing digital sexual coercion. The average age of initiation for most DDA behaviors was 16 years with respondents reporting experiencing these behaviors at 11 years of age at the earliest. Of those with any involvement with DDA, 59.2% report both using at least one DDA behavior and experiencing at least one DDA behavior (n = 314), 32.5% report experiencing at least one DDA behavior but not using any (n = 172), and 8.3% report using at least one DDA behavior but not experiencing any (n = 44). DDA behaviors are common, can occur at young ages. Our findings highlight crossover between those who use and those who experience DDA behaviors and suggest prevention should focus on underlying issues that drive both the use and experience of these behaviors.

Co-Reporting of Child Maltreatment and Intimate Partner Violence: The Likelihood of Substantiations and Foster Care Placements.

Intimate partner violence (IPV) negatively affects children. Although IPV-related reports frequently come to the attention of child protective services (CPS), there is neither a unified standard for how CPS systems should respond, nor sufficient research documenting that reaction. The current study used population-based administrative records from California to assess how CPS responds to reported allegations of IPV, with and without physical abuse and/or neglect allegations. We used multinomial regression to model the likelihood of investigation outcomes. Results indicate that 20.7% of CPS reports had IPV alleged during hotline screening, and of those, just 3.2% were screened out compared to 20.2% for reports where IPV was not alleged. Almost half (45.5%) of IPV-alleged reports came from law enforcement, in contrast to 15.2% of reports that did not allege IPV. IPV-alleged reports were more likely to have allegations substantiated without a case opened for services, but less likely to result in foster care placements. Several statistically significant differences were identified by the type of alleged maltreatment co-reported with IPV. This study contributes to an understanding of how CPS responds to IPV-alleged reports.