Firearm suicide risk beliefs and prevention: The role of fear of community violence and firearm ownership for protection.

INTRODUCTION: Household firearm availability is a risk factor for firearm suicide when a household member at-risk for suicide. Firearm ownership for protection and perceptions of community violence may reduce the likelihood of limiting access to firearms as a way to prevent suicide. The association between a firearm suicide risk belief and the intention to reduce firearm access as a means of preventing suicide, with fear of community violence and firearm ownership for protection as moderators, was examined. MATERIALS AND METHODS: The analytic sample consisted of 388 Missouri firearm owners from a cross-sectional, statewide survey of Missouri adults. Logistic regression models were estimated. RESULTS: Among Missouri firearm owners, firearm suicide risk belief was positively associated with the intention of reducing firearm access for firearm owners who were not afraid of community violence and owned a firearm for non-protection reasons (e.g., hunting). DISCUSSION: Findings suggest that firearm suicide prevention efforts must be tailored to address the underlying beliefs about their violence risk among firearm owners who indicate they principally own for protection.

Firearm homicides among hispanics and white non-hispanics: measuring disparities.

Firearm homicides are increasing in the United States, and firearm homicides are a critical driver of racial health disparities. One such disparity that has received limited attention is excess firearm homicides among Hispanics, relative to White Non-Hispanics; comprehensively characterising this disparity is the purpose of this brief report. Using data from CDC WONDER, we examined temporal trends (2012-2021) in firearm homicide rate disparities between Hispanics and White Non-Hispanics in the U.S. Focusing on recently elevated rates (2018-2021), we estimated this disparity across demographics (gender, age, urbanicity, and race), and across U.S. states. These data clearly show nearly universal excess firearm homicide among Hispanics, relative to White Non-Hispanics, with larger differences among men, younger age groups, and in metropolitan areas. Similarly, nearly all states show higher rates of firearm homicide among Hispanics, relative to White Non-Hispanics, though the magnitude of the difference varies substantially.

Diversifying Clinical Child and Adolescent Psychology: A Change Gonna Come.

OBJECTIVES: Workforce diversity is an ongoing challenge in the field of clinical child and adolescent psychology. This article discusses individual, institutional, and nonspecific factors that contribute to a lack of diversity among clinical child and adolescent psychologists and offers suggestions to diversify and advance the field of clinical child and adolescent mental health. METHOD: Seventeen professors, licensed psychologists, faculty, and clinicians in the field of clinical child and adolescent psychology answered questions about workforce diversity and who is permitted access to the field. No formal research was conducted. RESULTS: Individual factors included: racial discrimination and microaggressions, feelings of isolation, otherness, and not belonging. Institutional factors included: racism in academia, racial underrepresentation, ethnocentric and culturally-biased training, biased admissions selection processes, financial barriers, and lack of institutional commitment. Nonspecific factors were: values misalignment, hidden expectations, suboptimal mentoring, and limited research opportunities. CONCLUSIONS: Drawing on recent scholarship and the Contexts, Actions, and Outcomes (CAO) Model, we recommend institutional changes in programs, policies, practices, resources, climate, partnerships, and inquiry to improve diversity in the field of clinical child and adolescent psychology.

School Prejudice and Substance Use from Adolescence to Emerging Adulthood in the United States: Variation across Race and Ethnicity.

BACKGROUND: Racial and ethnic disparities in health outcomes have been consistently documented in the health literature. Until recently, many studies have evidenced associations between prejudice and health behaviors using cross-sectional data. However, studies assessing the link between school prejudice and health behaviors from adolescence to adulthood are limited. METHODS: To address this gap, we use data from Waves I, II, and III of the National Longitudinal Study of Adolescent to Adult Health (1994-2002) to examine how perceptions of school prejudice over time influence cigarette smoking, alcohol use, and marijuana use from adolescence to emerging adulthood. We also examine variation across race and ethnicity. RESULTS: Results indicate that school prejudice in adolescence (Wave I) is associated with higher cigarette use, alcohol use, and marijuana use in later adolescence (Wave II). White and Asian adolescents who perceived school prejudice were more likely to use alcohol, while Hispanic adolescents were more likely to use marijuana. CONCLUSIONS: Efforts to reduce school prejudice among adolescents may have implications in reducing substance use.

Parental Childhood Adversity and Pediatric Emergency Department Utilization: A Pilot Study.

OBJECTIVES: Adverse childhood experiences (ACEs) including physical, emotional, or sexual abuse; neglect; and/or exposure to household instability have been associated with adult emergency department utilization, but the impact of parental ACEs on pediatric emergency department (PED) utilization has not been studied. The primary aim was to determine if parental ACEs impact resource utilization as measured by (1) frequency of PED utilization, (2) acuity of PED visits, and (3) 72-hour PED return rates. The secondary aim was to determine if resilience interacts with the impact of parental ACEs on PED utilization. METHODS: This study is a cross-sectional survey using previously validated measures of ACEs, resiliency, and social determinants of health screening. Surveys were administered from October 17, 2019, to November 27, 2019, via iPad by research assistants in our institution's PEDs. Survey responses were linked to data abstracted from the electronic health record. Descriptive statistics were used to characterize our study population. Pearson correlation was used to identify correlation between ACEs, social determinants of health, and PED utilization measures. RESULTS: A total of 251 parents had complete data. Parental ACEs were positively associated with frequency of PED visits (incidence rate ratio, 1.013). In addition, high levels of parental resilience attenuated the association between parental ACEs and the number of severe acuity visits and were associated with fewer 72-hour return visits (incidence rate ratio, 0.49). CONCLUSIONS: Parental ACEs appear to be positively associated with frequency of PED utilization and inversely associated with higher-acuity PED visits and parental resiliency.

Retaliatory attitudes as mediator of exposure to violence and firearm aggression among youth: The protective role of organized activity involvement.

Firearm injury is a significant public health concern among youth living in the United States. Youth with exposure to violence (ETV) are more susceptible to carrying and using a firearm. Few researchers, however, have examined psychological mechanisms undergirding the association between ETV and firearm aggression. Retaliatory attitudes have been discussed as a potential mediator linking ETV with firearm aggression. Moreover, organized activity participation may disrupt direct and indirect pathways connecting ETV to firearm aggression. We tested: (a) the mediating role of retaliatory attitudes in the ETV-firearm aggression link, and (b) the moderating role of organized activity participation among 570 youth with past year illicit drug use and seeking emerging department care in an urban emergency department (ages 14-24; 58.8% males). Using multigroup path analysis, ETV indirectly influenced firearm aggression through retaliatory attitudes for youth not involved organized activities. Organized activities also buffered the association between retaliatory attitudes (mediator) and firearm aggression (outcome). Organized activities may, therefore, prevent firearm aggression by reducing retaliatory attitudes among youth contending with ETV. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Nitrous Oxide Use for Intrauterine System Placement in Adolescents.

STUDY OBJECTIVE: To evaluate the impact of nitrous oxide on patient-reported pain for placement of intrauterine systems (IUSs) in adolescents STUDY DESIGN: : Prospective observational study SETTING: : IUS placement in an ambulatory clinic compared with placement with nitrous oxide in a hospital-based sedation unit PARTICIPANTS: : English-speaking adolescents aged 12 to 20 presenting to a pediatric and adolescent gynecologist with a medical indication for IUS placement MAIN OUTCOME MEASURES: : Patient-reported procedural pain measured on a visual analog scale 2 minutes post IUS insertion procedure. Secondary outcome measurement of likelihood of recommending an IUS to a peer. RESULTS: Seventy-four patients agreed to participate. Forty-five patients underwent IUS placement in the clinic. Controlling for age, history of dysmenorrhea, and body mass index, a significant time (change in reported pain scores pre- vs post IUS insertion) by treatment (nitrous oxide vs standard of care) interaction was observed for patient-reported pain (b = -29.32 mm, P < 0.01). Patients receiving nitrous oxide were more likely to recommend an intrauterine placement than patients who received the current standard of care for pain management (b = 0.47, P = 0.02) after controlling for age, baseline pain score, and dysmenorrhea history. CONCLUSION: Patient-reported pain was attenuated for patients who received nitrous oxide relative to those who received standard IUS placement. Patient-reported satisfaction was higher for patients who received nitrous oxide relative to those who received standard IUS placement.

Demographic Risk Factors for Malnutrition in Patients With Cleft Lip and Palate.

OBJECTIVES/HYPOTHESIS: Patients with cleft lip and/or palate (CLP) are at increased risk of malnutrition. Acute and chronic malnutrition have been associated with elevated risk of postsurgical wound complications, adding morbidity and cost to patients and their families. To study the association between demographic factors, including insurance type, race, and median neighborhood income (MNI), and malnutrition in patients with CLP. STUDY DESIGN: Retrospective cohort study. METHODS: Retrospective review was performed in patients undergoing their first cleft-related surgery at a large tertiary pediatric hospital from 2006 to 2018. Demographic data, weight and height at surgery, type of insurance, race, and primary residential address were collected. Geocoded information on MNI was generated using patient address. World Health Organization Z-scores for weight-for-age (WFA) and height-for-age (HFA) were used as proxies for acute and chronic malnutrition, respectively. Linear regression models were generated to analyze the relationship of insurance type, race, and MNI on WFA and HFA Z-scores. RESULTS: About 313 patients met inclusion criteria. Increasing MNI predicted increasing WFA Z-score (0.05 increase in WFA per $1,000 increase, P = .047) as well as HFA Z-score (0.09 increase in HFA per $1,000 increase, P = .011). The effect of MNI was not independently modified by race for either WFA (P = .841) nor HFA (P = .404). Race and insurance type did not predict WFA or HFA. CONCLUSIONS: Lower MNI is a significant independent risk factor for acute and chronic malnutrition in children with CLP. Combined with previous investigation linking malnutrition to surgical outcomes in this population, this offers a target area for intervention to improve patient outcomes. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:1482-1486, 2022.

Racial Discrimination and Trajectories of Problematic Alcohol Use Among African American Emerging Adults: The Role of Organizational Religious Involvement.

Racial discrimination jeopardizes a wide range of health behaviors for African Americans. Numerous studies demonstrate significant negative associations between racial discrimination and problematic alcohol use among African Americans. Culturally specific contexts (e.g., organized religious involvement) often function protectively against racial discrimination's adverse effects for many African Americans. Yet organized religious involvement may affect the degree to which racial discrimination increases problematic alcohol use resulting in various alcohol use trajectories. These links remain understudied in emerging adulthood marked by when individuals transition from adolescence to early adult roles and responsibilities. We use data from 496 African American emerging adults from the Flint Adolescent Study (FAS) to (a) identify multiple and distinct alcohol use trajectories and (b) examine organizational religious involvement's protective role. Three trajectory classes were identified: the high/stable, (20.76% of sample; n = 103); moderate/stable, (39.52% of sample; n = 196); and low/rising, (39.72% of the sample; n = 197). After controlling for sex, educational attainment, and general stress, the interaction between racial discrimination and organized religious involvement did not influence the likelihood of classifying into the moderate/stable class or the low/rising class, compared with the high/stable class. These results suggest organized religious involvement counteracts, but does not buffer racial discrimination's effects on problematic alcohol use. Findings emphasize the critical need for culturally sensitive prevention efforts incorporating organized religious involvement for African American emerging adults exposed to racial discrimination. These prevention efforts may lessen the role of racial discrimination on health disparities related to alcohol use.

Parents' Perceived Neighborhood Safety and Children's Cognitive Performance: Complexities by Race, Ethnicity, and Cognitive Domain.

BACKGROUND AIM: To examine racial/ethnic variations in the effect of parents' subjective neighborhood safety on children's cognitive performance. METHODS: This cross-sectional study included 10,027 children from the Adolescent Brain Cognitive Development (ABCD) study. The exposure variable was parents' subjective neighborhood safety. The outcomes were three domains of children's cognitive performance: general cognitive performance, executive functioning, and learning/memory. We used mixed-effects regression models for data analysis. RESULTS: Overall, parents' subjective neighborhood safety was positively associated with children's executive functioning, but not general cognitive performance or learning/memory. Higher parents' subjective neighborhood safety had a more positive influence on the executive functioning of non-Hispanic White than Asian American children. Higher parents' subjective neighborhood safety was associated with higher general cognitive performance and learning/memory for non-White children relative to non-Hispanic White children. CONCLUSION: The race/ethnicity of children moderates the association between neighborhood safety and cognitive performance. This becomes more complicated, as the patterns seem to differ across race/ethnicity and cognitive domains. It is unknown whether the observed racial/ethnic variations in the effect of neighborhood safety on cognitive performance are due to neighborhood characteristics such as residential segregation. Addressing neighborhood inequalities is needed if we wish to reduce racial/ethnic inequities in the cognitive development of children.

The Longitudinal Association Between Exposure to Violence and Patterns of Health Risk Behaviors Among African American Youth.

PURPOSE: We investigate whether exposure to violence (ETV) during adolescence and emerging adulthood predicts engagement in chronic disease-related health risk behaviors years later among African Americans. DESIGN: A longitudinal study following youth from mid-adolescence (mean age = 14.8 years) to young adulthood (mean age = 32.0 years). SETTING: Flint, Michigan. SAMPLE: Four hundred forty-two African American (96.2%) and mixed African American and White (3.8%) participants. MEASURES: Outcomes were diet, smoking, drinking, and physical inactivity. Covariates were ETV, sex, mother's educational attainment, and substance use by siblings, peers, and parents. ANALYSIS: Latent profile analysis was conducted to identify distinct patterns of adult health risk behaviors and assess the association of youth ETV and identified patterns. RESULTS: Four latent profiles were identified: high substance use (n = 46; 10.41%), high overall risk (n = 71; 16.06%), low overall risk (n = 140; 31.67%) and inactive (n = 185, 41.86%). Relative to the low overall risk profile, ETV was associated with being in the high overall risk profile (b = 0.37, p = 0.04), but not other profiles. Female gender and higher maternal education were associated with being in the inactive profile compared to the low overall risk profile. Peer alcohol and tobacco use were associated with being in the high substance use profile. CONCLUSION: ETV during adolescence and emerging adulthood increased the risk of engagement in multiple health risk behaviors later in life.

Pathways from racial discrimination to cortisol/DHEA imbalance: protective role of religious involvement.

Objective: Racial discrimination (RD) is hypothesized to dysregulate the production of stress reactive hormones among African Americans. Psychological processes that may mediate the association between RD and such dysregulation (e.g. cortisol/DHEA ratio) are not well articulated. Organizational religious involvement (ORI) has been discussed as a psychological protective factor within the context of RD, but our understanding of ORI as a physiological protective factor remains limited. We evaluated whether RD was directly and indirectly (through depressive symptoms) associated with an imbalance of cortisol and DHEA hormones, and whether ORI buffered these direct and/or indirect pathways.Design: Data were drawn from the Flint Adolescent Study, an ongoing interview study of youth that began in 1994. Participants were 188 African American emerging adults (47.3% Female, ages 20-22). We used mediation and moderated-mediation analyses, as outlined by Hayes [2012. PROCESS SPSS Macro. [Computer Software and Manual]. http://www.afhayes.com/public/process.pdf], to evaluate the study aims.Results: We found that depressive symptoms mediated the association between RD and the cortisol/DHEA ratio. We also found that depressive symptoms mediated the association between RD and the cortisol/DHEA ratio for individuals reporting low and moderate levels of ORI, but not at high levels.Conclusions: Our findings support the socio-psychobiological model of racism and health [Chae et al. 2011. "Conceptualizing Racial Disparities in Health: Advancement of a Socio-Psychobiological Approach." Du Bois Review: Social Science Research on Race 8 (1): 63-77. doi:10.1017/S1742058X11000166] and suggest that the psychological toll of RD can confer physiological consequences. Moreover, ORI may disrupt pathways from RD to cortisol/DHEA ratio by buffering the psychological toll of RD.

Longitudinal pathway from violence exposure to firearm carriage among adolescents: The role of future expectation.

INTRODUCTION: Exposure to violence is a risk factor for firearm carriage. Youth exposed to violence also have difficulty envisioning positive future outcomes (e.g., educational outcomes), which can increase the likelihood of firearm carriage over time. Researchers, however, have not yet examined whether changes in exposure to violence over time can influence the developmental trajectories of firearm carriage. To address this gap, we (1) examined the longitudinal association between exposure to violence and firearm carriage (grades 9 to 12) and then (2) examined whether changes in future expectations mediated this longitudinal association. METHOD: The longitudinal association between exposure to violence and firearm carriage through future expectations was examined among 850 adolescents from the Flint Adolescent Study. Participants were recruited from four high schools in a midwestern city in the United States. Parallel latent growth models and latent growth mediation models were estimated. RESULTS: A positive association was observed between the rate of change in exposure to violence and firearm carriage. Exposure to violence also indirectly increased the risk for firearm carriage over time by decreasing future expectation in the 9th grade. CONCLUSIONS: Our results support the idea that helping youth develop positive attitude about educational success may help reduce firearm carriage. Increasing positive expectations about future may help prevent firearm carriage within the context of violence exposure.

Racial discrimination trajectories predicting psychological well-being: From emerging adulthood to adulthood.

Perceived racial discrimination (PRD) has been documented as a risk factor for worse psychological well-being among African Americans. Yet, most researchers have not examined how trajectories of PRD during emerging adulthood shape psychological well-being in adulthood. Moreover, less is known about whether demographic factors and components of racial identity shape PRD over time. We identified trajectories of PRD among 605 African American emerging adults and examined whether PRD trajectories were associated with depressive symptoms, anxiety symptoms, and perceived lack of control in adulthood. Four trajectories of PRD were identified (i.e., high-stable, moderate-declining, low-rising, and low-stable), and demographic factors and racial identity indicators influenced the likelihood of trajectory classification. In addition, members of the moderate-declining trajectory exhibited higher levels of depressive symptoms, anxiety symptoms, and perceived lack of control than members in the low-stable trajectory. Our findings suggest that changes in PRD in emerging adulthood can extend our understanding of psychological well-being in adulthood. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Disrupting the Behavioral Health Consequences of Racial Discrimination: A Longitudinal Investigation of Racial Identity Profiles and Alcohol-Related Problems.

Researchers have documented the negative associations between racial discrimination and alcohol use for young Black people, yet fewer researchers have examined these associations longitudinally and with racial identity as a protective factor. We use data from the Flint Adolescent Study (465 Black/African Americans) to investigate the relationship between discrimination and alcohol-related problems over time, and how that relationship differs with varying trajectories of racial identity (i.e., private and public regard). Among those reporting persistently moderate levels of private regard and high levels of public regard in late adolescence through emerging adulthood, increases in racial discrimination were associated with increases in alcohol-related problems over time. Findings suggest that regard for one's racial group may function protectively in the health strategies employed in response to discriminatory events. More longitudinal research is needed to delineate how varying racial pride operates with regard to long-term discrimination and behavioral health.

Risk and protective family factors during childhood on youth violence among African American males: The role of mothers and nonresident fathers.

African American male youth experience disproportionately higher levels of violence. We examined parental depression among African American mothers and nonresident fathers on parenting stress and school involvement in their adolescent sons' school connectedness and violent behaviors. Using a longitudinal study design, parent factors were assessed when sons were 9 years old on youth outcomes at age 15. We found that maternal depression was associated with maternal stress, and maternal stress was indirectly associated with sons' violent behaviors through school connectedness. School involvement among nonresident fathers was positively associated with sons' school connectedness, which was linked to less youth violent behaviors. Maternal stress and nonresident fathers' school involvement are influential for understanding youth violence. Future interventions should incorporate a more nuanced approach when including family factors.

Psychological pathway from racial discrimination to the physical consequences of alcohol consumption: Religious coping as a protective factor.

While racial discrimination (RD) is associated with increased alcohol-related problems among African Americans (AAs), researchers have not examined how RD contributes to the physical consequences of alcohol consumption over time. In addition, the protective role of religious coping has been discussed but not formally tested in pathways connecting RD to the physical consequences of alcohol consumption. To address this gap, we estimated latent growth mediation models in a sample of 465 AA emerging adults. We found that RD increased physical consequences of alcohol consumption over time through psychological distress. After identifying two profiles of religious coping (i.e., low and high religious coping), RD indirectly influenced the physical consequences of alcohol consumption through psychological distress among AAs in the low religious coping group. Our results signal the importance of developing alcohol-misuse prevention programs that address the psychological consequences of RD. Integrating culturally tailored coping strategies (e.g., religious coping) may bolster the efficacy of these prevention programs.

Positive Parenting Moderates the Effect of Socioeconomic Status on Executive Functioning: A Three-Generation Approach.

OBJECTIVE: While low parental socioeconomic status (SES) has been associated with lower levels of child executive functioning (EF), few have examined the intergenerational effect of SES on child EF across three generations. We adopt a resilience framework to investigate positive parenting as a protective factor in the intergenerational effect of low SES on child EF. METHODS: In a sample of 50 parents (70% female) and their oldest child (56% female, M age = 12.38) from the Flint Adolescent Study, we estimated the effect of grandparent SES on child EF (i.e., Animal Sorting, Inhibition, Inhibition Switching) and examined the protective role of positive parenting using a multivariate regression model. RESULTS: Lower levels of grandparent SES was associated with lower levels of cognitive flexibility (i.e., Animal Sorting), but not inhibition (i.e., Inhibition, Inhibition Switching), at low levels of positive parenting. CONCLUSION: These findings indicate the varied ways by which intergenerational SES may shape child EF. Further, positive parenting may offset the intergenerational influence of SES on child EF outcomes.

Risk and protective factors related to youth firearm violence: a scoping review and directions for future research.

To conduct our scoping review of risk and protective factors for firearm violence among youth, we searched PubMed, Scopus, EMBASE, and Criminal Justice Abstracts for English-language research articles published between January 1985 and May 2018. We included studies of modifiable risk or protective factors associated with intentional (including suicide) or unintentional firearm victimization or perpetration with samples that included youth ≤ 17. Among the 28 included studies, 15 explored risk/protective factors for victimization, five focused on perpetration, five did not differentiate between victimization and perpetration, and five focused on suicide. Most studies examined individual-level risk factors. The few that explored factors beyond the individual were limited by methodological weaknesses and inconsistent findings. Protective factors for youth firearm outcomes were understudied. We need more research on youth firearm violence using longitudinal data and robust statistical methods. Future research is needed to understand the underlying mechanisms by which risk/protective factors influence firearm violence.

Violence Exposure and Sexual Risk Behaviors for African American Adolescent Girls: The Protective Role of Natural Mentorship and Organizational Religious Involvement.

African American adolescent girls are at increased risk of being exposed to community violence and being diagnosed with a sexually transmitted infection. Fewer studies, however, have examined the protective roles of natural mentorship and organizational religious involvement as potential moderators that could lessen the effects of violence exposure on health risk behavior. Data from 273 African American ninth grade girls were used to test hypothesized independent and moderated-moderation models. Results suggest that natural mentorship and religious involvement were protective for girls who reported at least one mentor and moderate to high levels of religious involvement. Our findings may be relevant for community stakeholders and organizations that directly interact with religious institutions and community programs that focus on outreach to African American adolescent girls.