Food Environment Index is Inversely Associated with Gastric Cancer Incidence in the United States.

The first epidemiologic study was conducted to prospectively examine the association between Food Environment Index (FEI) and gastric cancer (GC) risk in the US. Surveillance, Epidemiology, and End Results provided information on GC incident cases diagnosed between 2000 and 2015 from 16 population-based cancer registries across the US. The county-level food environment was assessed using the FEI, an indicator of access to healthy foods (0 is worst, 10 is best). Poisson regression was used to calculate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for the association between FEI and GC risk adjusting for individual-level and county-level covariates. Higher levels of FEI were associated with a statistically significant reduced risk for GC (n = 87,288 cases; adjusted IRR for every score increase = 0.50, 95% CI 0.35, 0.70; P < 0.001; adjusted IRR for the medium vs. low category = 0.87, 95% CI 0.81, 0.94; and adjusted IRR for the high vs. low category = 0.89, 95% CI 0.82, 0.95). These results suggest that a healthy food environment, as measured by FEI, may be a protective factor for GC in the US. To reduce the GC incidence, further strategies to improve food environment at the county level are warranted.

Open pilot trial of an interactive digital application for campus sexual violence prevention.

Digital applications, or "serious games" for health address learning goals in a cognitively active, interactive manner, with the potential for widespread dissemination. This study used a mixed methods approach to develop and conduct a formative evaluation of a digital application for sexual assault prevention. Make a change is a digital application that uses the principles of games for health to foster learning, engagement, and skill-building around risk and protective factors for sexual victimization, sexual aggression, and bystander intervention. The digital application includes four narrative chapters, six embedded activities, as well as a user-derived change plan in which individuals establish goals for behavior change following program completion. This multisite study at a 2- and a 4-year college utilized student interviews (n = 14), stakeholder interviews (n = 10), and focus groups with students (n = 40) to inform intervention development. A total of 41 college students then participated in an open trial and completed self-report surveys (pre, post, and 1-month follow-up) to evaluate the feasibility, acceptability, utility, and preliminary outcomes. Most of the sample reported enjoyment, usefulness, and perceived competence after completing the application. Data evidenced a trend to reduce the frequency of heavy drinking, and perceptions of social norms evidenced change over time. Findings support the feasibility and effectiveness of this novel format for the delivery of sexual assault prevention programming.

Associations of adverse childhood experiences and suicidal behaviors in adulthood in a U.S. nationally representative sample.

BACKGROUND: Suicide is a leading cause of death among adolescents and young adults. The current study extends the research linking adverse childhood experiences (ACEs) to suicidal behaviors by testing these associations using a nationally representative sample, assessing for suicide ideation and attempts in adulthood, controlling for established risk factors for suicidality, and measuring a broad array of ACEs. METHODS: The sample included 9,421 participants from the National Longitudinal Study of Adolescent Health who participated in four waves of assessments spanning 13 years. We examined longitudinal associations between eight different ACEs (physical, sexual, and emotional abuse, neglect, parental death, incarceration, alcoholism, and family suicidality) with suicidal ideation and suicide attempts in adulthood, while controlling for depression, problem alcohol use, drug use, delinquency, impulsivity, gender, race, age, and urbanicity. We also tested for cumulative associations of ACEs with suicide ideation and attempts. RESULTS: Logistic regression analyses indicated that physical, sexual, and emotional abuse, parental incarceration, and family history of suicidality each increased the risk by 1.4 to 2.7 times for suicidal ideation and suicide attempts in adulthood. The accumulation of ACEs increased the odds of suicide ideation and attempts. Compared with those with no ACEs, the odds of seriously considering suicide or attempting suicide in adulthood increased more than threefold among those with three or more ACEs. CONCLUSIONS: Intervention strategies need to prevent ACEs from occurring and, if they do occur, should take into account the impact of cumulative ACEs on suicide risk. Future research should focus on identifying mediating mechanisms for the ACEs-suicidality association using longitudinal research designs and determine which ACEs are most important to include in a cumulative ACE measure.

Trajectories of Dating Violence Victimization and Perpetration among Rural Adolescents.

Research is inconclusive about the trajectory of dating violence during adolescence and whether there are differences across gender and race/ethnicity. We examined dating victimization and perpetration trajectories among a diverse sample of rural youth (N = 580, 52.7% female, 49% Black, 39% White, 11% Hispanic or other minorities) in middle and high school who were surveyed annually across four years and explored the influences of gender and ethnicity. The results based on cohort-sequential latent growth modeling revealed that for boys, victimization peaked at 11th grade, and then declined. For girls, victimization was stable throughout adolescence. Perpetration was reported less frequently and increased steadily for males and females. For White youth, victimization peaked at grades 9 and 10, followed by a decline. For Black youth, victimization followed a linear increase. Perpetration trajectory followed a linear increase for White and Black but not Hispanic youth. The findings indicate that the developmental progression of dating violence during adolescence varies by demographics. The discussion focuses on future directions for research on teen dating violence among rural youth and implications for prevention and interventions initiatives.

Beliefs About Consent and Sexual Assault Perpetration in a Longitudinal Study of College Men.

This study examined the mediating role of beliefs about both active and passive consent in the prospective associations between sexual assault (SA) risk factors and coercive, incapacitated, and forcible attempted/completed SA among college men. Participants were 471 college men who completed self-report surveys at the end of each of their 4 years of college. SA risk factors (risky behavior, rape-supportive beliefs and peer norms, personality traits, childhood adversity) were assessed at Wave 1, beliefs about consent were assessed at Wave 2, and perpetration was assessed at Waves 3 and 4. Multivariate regression models with bias-corrected bootstrapping assessed longitudinal mediation. SA risk factors were negatively associated with endorsement of active consent (verbal approval required) and positively associated with passive consent (assume "yes" until you hear a "no"), with strongest effects observed for coercive SA. Both types of beliefs about consent served as mediators between risk factors and perpetration. Findings suggest that prevention programs should include a focus on reducing SA risk factors, clarifying definitions of consent, and improving sexual communication.

Epidemiology of Suicide Attempts among Youth Transitioning to Adulthood.

Suicide is the second leading cause of death for older adolescents and young adults. Although empirical literature has identified important risk factors of suicidal behavior, it is less understood if changes in risk factors correspond with changes in suicide risk. To address this knowledge gap, we assessed if there were different trajectories of suicidal behavior as youth transition into young adulthood and determined what time-varying risk factors predicted these trajectories. This study used four waves of data spanning approximately 13 years from the National Longitudinal Study of Adolescent Health. The sample included 9027 respondents who were 12-18 years old (M = 15.26; SD = 1.76) at Wave 1, 50% male, 17% Hispanic, and 58% White. The results indicated that 93.6% of the sample had a low likelihood for suicide attempts across time, 5.1% had an elevated likelihood of attempting suicide in adolescence but not young adulthood, and 1.3% had an elevated likelihood of attempting suicide during adolescence and adulthood. The likelihood of a suicide attempt corresponded with changes on depression, impulsivity, delinquency, alcohol problems, family and friend suicide history, and experience with partner violence. Determining how suicide risk changes as youth transition into young adulthood and what factors predict these changes can help prevent suicide. Interventions targeting these risk factors could lead to reductions in suicide attempts.

Religiosity Reduces Sexual Aggression and Coercion in a Longitudinal Cohort of College Men: Mediating Roles of Peer Norms, Promiscuity, and Pornography.

Extensive literature suggests that religiosity is a protective factor in reducing a number of deviant behaviors, including sexual aggression. Whereas previous research focused on the role of risky alcohol consumption in mediating the relationship between religiosity and sexual aggression, this study explores the hypothesized meditational paths from religiosity to sexual aggression and technology-based coercive behavior through peer norms, pornography consumption, and promiscuity. Findings from a four-year longitudinal study of male college students suggest that peer norms and promiscuity mediate the relationship between religiosity and both outcome measures, while pornography consumption mediates the relationship between religiosity and technology-based coercive behavior. These findings may inform ongoing practice and future research into possible mechanisms by which problematic sexual behaviors may be influenced.

A longitudinal study of risk factors for repeated sexual coercion and assault in U.S. College men.

The purpose of the current study was to understand the prevalence, severity, and predictors of repeated sexual coercion and assault (SCA) in a non-criminal sample. Participants were 795 college men who were surveyed at the end of each of their 4 years in college. Participants completed self-report inventories once per year for 4 years. Measures assessed demographics, adverse childhood experiences, offense characteristics, antisocial personality characteristics, attitudes towards women and forced sex, perceived social norms, sexual behavior, and substance use. Results indicated that, among the 238 participants who reported at least once incident of SCA, 68 % engaged in repeated SCA, with repeat offenders engaging in aggressive acts of higher severity that began at an earlier age. A multinomial logistic regression model compared single and repeat offenders to non-perpetrators. Both single and repeat offenders endorsed more risky behaviors and sexually aggressive beliefs than non-perpetrators. Single offenders were higher on childhood adversity than non-perpetrators and repeat offenders were higher on antisocial personality traits than non-perpetrators. A second multivariate model compared single offenders to repeat offenders. Repeat offenders scored higher than single offenders on risky behaviors, sexually aggressive beliefs, and antisocial traits. Findings highlight the high prevalence of repeated SCA in young adults, the need for interventions that decrease rape supportive attitudes and risky substance use, and the importance of expanding models of sexual recidivism to include multiple risk factors.

Factors associated with use of verbally coercive, incapacitated, and forcible sexual assault tactics in a longitudinal study of college men.

Although verbally coerced and incapacitated sexual assaults are common, less is known about perpetrators of these incidents in comparison to perpetrators of forcible assaults. Furthermore, few studies have investigated factors that differentiate perpetrators who employ different forms of sexual assault tactics. The current study included 526 men who completed self-report inventories at the end of each of their four years in college. Measures assessed sexual assault tactics, demographics, incident characteristics, risky behavior, rape supportive beliefs and peer norms, antisocial traits, and childhood adversity. Perpetrators were grouped based on the most severe tactics reported over the course of 7 assessed time periods, with 13% in the verbal coercion group, 16% in the incapacitation group, and 5% in the forcible group. ANOVAs determined that the forcible group scored significantly higher than incapacitation and verbal coercion groups on risky behavior, rape supportive beliefs/norms, antisocial traits, and childhood adversity. The incapacitation group scored higher than the verbal coercion group on risky behavior. In a multinomial logistic regression analysis comparing tactic groups to non-perpetrators, all tactic groups scored significantly higher on risky behavior and rape supportive beliefs/norms, and the forcible group scored higher on antisocial traits and childhood adversity. Perpetrators in the forcible group had engaged in more repeat offenses, and perpetrators of both the incapacitated and forcible assaults were more likely to use alcohol before the incident. Findings highlight the need for interventions that are tailored to offense trajectories, alter rape supportive attitudes and peer norms, and decrease campus substance use. Aggr. Behav. 41:34-43 2015. © 2014 Wiley Periodicals, Inc.

Associations between reasons for living and diminished suicide intent among African-American female suicide attempters.

African-American women are at high risk for suicide ideation and suicide attempts and use emergency psychiatric services at disproportionately high rates relative to men and other ethnic groups. However, suicide death rates are low for this population. Cultural variables in the African-American community may promote resilience and prevent fatal suicidal behavior among African-American women. The present study evaluated self-reported reasons for living as a protective factor against suicidal intent and suicide attempt lethality in a sample of African-American female suicide attempters (n = 150). Regression analyses revealed that reasons for living were negatively associated with suicidal intent, even after controlling for spiritual well-being and symptoms of depression. These results indicate that the ability to generate and contemplate reasons for valuing life may serve as a protective characteristic against life-threatening suicidal behavior among African-American women. Implications for research and clinical practice are further discussed.

Expanding the Sexual Experiences Survey to Include Technology Facilitated Sexual Exploitation.

The Sexual Experiences Survey is the most widely used measure of sexual assault victimization and perpetration among college students. To improve comprehensiveness and inclusiveness, the current revision of the victimization items of the SES (SES-V; Koss et al., 2024) included the addition of a module focusing on Technology Facilitated Sexual Exploitation (TFSE). The current paper outlines why the inclusion of items related to TFSE was necessary, and describes the development of the items making up this module of the SES-V. The module consists of 10 items that map onto seven domains: receipt of sexual materials, target of unwanted sexual comments, threatened sharing of sexually explicit images, actual sharing of sexually explicit images, target of sexual solicitation, threatened sharing of images of sexual exploitation, and actual sharing of images of sexual exploitation. Consistent with how the other types of sexual exploitation are assessed in the SES-V (Koss et al., 2024), respondents indicate how many times they have experienced these events since their 14th birthday and use an 11-point response format ranging from 0 to 10 or more times per experience. The addition of the new module on TFSE to the SES-V will ensure researchers assess both in-person and cyber modalities of sexual exploitation.

Long-term Impacts of Civic Engagement during Emerging Adulthood: A Nationally-representative Study.

PURPOSE: We examined if civic engagement during emerging adulthood positively impacted a broad array of outcomes in middle adulthood, and if associations varied based on race, gender, age, and urban-rural status. DESIGN: Prospective design used to determine if civic engagement during emerging adulthood (M age = 21.81) predicted outcomes 15 years later. SETTING: Restricted data from the National Longitudinal Study of Adolescent to Adult Health. SUBJECTS: Wave 1 participants who completed surveys 7 years (77% follow-up rate), 14 years (80% follow-up rate), and 22 years later (follow-up rate 72%) and who had valid sampling weight to ensure national representativeness (n = 9349). MEASURES: Predictor - civic engagement; Outcomes-mental health, substance use, criminal behaviors, and healthy behavior. ANALYSIS: Linear regression using MPLUS 7.2. RESULTS: Civic engagement predicted lower levels of depressive symptoms (b = -1.05, SE = .28), criminal behaviors (b = -.47, SE = .12), and substance use (b = -.66, SE = .13), and higher levels of healthy behaviors (b = 1.26, SE = .19), after controlling for demographics, family, peer, neighborhood, and school-related background variables. Moderation analyses revealed that civic engagement benefited females and white participants more. CONCLUSION: Civic engagement during emerging adulthood has a positive impact on a broad array of outcomes in middle adulthood. Implications and future research recommendations will be discussed.

Preliminary Evidence of Validity for the Verbally Pressured and Illegal Sexual Exploitation Modules of the Sexual Experiences Survey-Victimization.

The Sexual Experiences Survey-Victimization (SES-V; see Koss et al., 2024) revises the prior 2007 Sexual Experiences Survey-Short Form Victimization (SES-SFV) in many ways, including expanded measurement of verbally pressured and illegal sexual exploitation, as well as the addition of items that assess being made to perform a sexual act or to penetrate another person sexually. The current article describes two initial validity studies of the SES-V. Study 1 compared rates of self-reported verbal pressure and illegal sexual exploitation (e.g. rape) on a preliminary version of the SES-V and the SES-SFV in a sample of higher education students who completed both questionnaires online in a randomized order (N = 460). As expected, the preliminary SES-V produced higher rates than the SES-SFV, and continuous scores were strongly correlated. Responses to the made-to-penetrate (MTP) items suggested that some cisgender men and women may have misunderstood those items. Study 2 explored responses to the MTP items further by randomly assigning participants to complete items with either the Study 1 MTP language (n = 269) or revised language (n = 245). The revised language produced fewer implausible responses and was adopted in the final version of the SES-V. These findings provide initial support for the validity of the SES-V and the value of expanding the conceptualization of victimization to include a wider range of sexual exploitation. A research agenda for future validity research is suggested.

The Revised Sexual Experiences Survey Victimization Version (SES-V): Conceptualization, Modifications, Items and Scoring.

The Sexual Experiences Survey [SES] is considered the gold standard measure of non-consensual sexual experiences. This article introduces a new victimization version [SES-V] developed by a multidisciplinary collaboration, the first revision since 2007. The 2024 SES-V is designed to measure the construct of sexual exploitation since the 14th birthday. Notable revisions are adoption of a freely given permission standard for non-consent, introduction of new tactics and acts, including made to perform or to penetrate another person's body, tactics-first wording order, and emphasis on gender and sexual orientation inclusivity. The SES-V is modularized to allow whole or partial administration. Modules include Non-contact, Technology-facilitated, Illegal (largely penetrative), and Verbally pressured sexual exploitation. Tables provide item text, multiple scoring approaches, module follow-up, specific incident description and demographics. Future plans include developing a scoring algorithm based on weighting our hypothesized dimensions of sexual exploitation severity: invasiveness, pressure, and norm violation combined with frequency. This article is the first in a special issue on the SES-V. Subsequent articles focus on the taxonomies and literature that informed each module. The issue concludes with two empirical papers demonstrating the feasibility and validity of the SES-V: (1) psychometric comparison with the 2007 SES-SFV; and (2) prevalence data from a census-matched adult community sample.

COVID-related stress, risk for suicidal behavior, and protective factors in a national sample of college students.

Objective: This study's purpose was to determine if COVID-related stress predicted suicide risk among college students and if this risk was attenuated by higher levels of social and psychological resources. Participants: The sample included 65,142 college students who participated in the National College Health Assessment survey in Spring 2021. Methods: SPSS PROCESS was used to test the association between COVID-related stress and suicide risk while controlling for demographic covariates and to determine the potential stress-buffering roles of social connectedness, resiliency, and psychological well-being. Results: Higher levels of COVID-related stress predicted increased suicide risk yet this risk was attenuated when social connectedness, resiliency, and psychological flourishing were greater. Conclusions: Findings indicate that efforts to increase social connectedness, resiliency, and psychological flourishing could help reduce the risk of college students' suicidality under conditions of high COVID-related stress.

Physical activity is inversely associated with overall cancer risk among college students in the United States: Results from the National College Health Assessment.

To our knowledge, this is the first epidemiologic study to examine the association between physical activity (PA) and cancer using data from the American College Health Association-National College Health Assessment (ACHA-NCHA). The goal of the study was to understand the dose-response relation between PA and cancer, as well as the associations between meeting US PA guidelines and overall cancer risk in US college students. The ACHA-NCHA provided self-reported information on demographic characteristics, PA, body mass index, smoking status, and overall cancer during 2019-2022 (n = 293,682; 0.08% cancer cases). To illustrate the dose-response relationship, a restricted cubic spline logistic regression analysis was used to evaluate the association of overall cancer with moderate-to-vigorous PA (MVPA) on a continuous basis. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals for the associations between meeting the three U.S. PA guidelines and overall cancer risk. The cubic spline observed that MVPA was inversely associated with the odds of overall cancer risk after adjusting for covariates; a one hour/week increase in moderate and vigorous PA was associated with a 1% and 5% reduced overall cancer risk, respectively. Multivariable-adjusted logistic regression analyses showed that meeting the US guidelines for aerobic PA for adults (≥150 minutes/week of moderate aerobic PA or ≥75 minutes of vigorous PA) (OR: 0.85), for PA for adults (≥2 days of muscle strengthening activity in addition to aerobic MVPA) (OR: 0.90), and for highly active adults (≥2 days of muscle strengthening activity and ≥300 minutes/week of aerobic moderate PA or 150 minutes/week of vigorous PA) (OR: 0.89) were statistically significant and inversely associated with cancer risk. MVPA, especially meeting US guidelines, may be inversely associated with overall cancer among college students in the US. To reduce cancer risks, multilevel interventions to promote US physical activity guidelines among college students are warranted.

Effects of Campus Sexual Assault Prevention Programs on Attitudes and Behaviors Among American College Students: A Systematic Review and Meta-Analysis.

The US Campus Sexual Assault Violence Elimination (SaVE) Act of 2013 mandates that all higher education institutions receiving federal funds offer incoming students primary prevention and awareness programming addressing sexual violence. Yet, there is no thorough and up-to-date quantitative synthesis of the effects of campus sexual assault prevention programs on sexual assault attitudes/knowledge and behaviors. Thus, we conducted a systematic review of the literature and a meta-analysis of experimental and high-quality quasi-experimental research examining effects of college sexual assault prevention programs on sexual assault attitudes and behaviors. Our synthesis of 385 effect sizes from 80 eligible studies disseminated between 1991 and 2021 indicates campus sexual assault programs have a more pronounced effect on attitudes/knowledge than on violence. Effects on sexual assault victimization were significant but small (g = 0.15) and effects on sexual assault perpetration were nonsignificant. Moderator analyses indicate programs that use a risk reduction framework are associated with less favorable outcomes than programs that do not use a risk reduction framework. Considering the limited effect of campus sexual assault prevention programs on violence, we recommend programming efforts move beyond a focus on individuals and, instead, adopt an ecological perspective targeting individuals, social relationships, community factors, and societal factors.

Crisis Response and Suicidal Behaviors of Essential Workers and Children of Essential Workers During the COVID-19 Pandemic.

OBJECTIVE: The COVID-19 pandemic has put unprecedented stress on essential workers and their children. Limited cross-sectional research has found increases in mental health conditions from workload, reduced income, and isolation among essential workers. Less research has been conducted on children of essential workers. We examined trends in the crisis response of essential workers and their children from April 2020 through August 2021. METHODS: We investigated the impact during 3 periods of the pandemic on workers and their children using anonymized data from the Crisis Text Line on crisis help-seeking texts for thoughts of suicide or active suicidal ideation (desire, intent, capability, time frame), abuse (emotional, physical, sexual, unspecified), anxiety/stress, grief, depression, isolation, bullying, eating or body image, gender/sexual identity, self-harm, and substance use. We used generalized estimating equations to study the longitudinal change in crisis response across the later stages of the pandemic using adjusted odds ratios (aORs) for worker status and crisis outcomes. RESULTS: Results demonstrated higher odds of crisis outcomes for thoughts of suicide (aOR = 1.06; 95% CI, 1.00-1.12) and suicide capability (aOR = 1.14; 95% CI, 1.02-1.27) among essential workers than among nonessential workers. Children of essential workers had higher odds of substance use than children of nonessential workers (aOR = 1.33; 95% CI, 1.08-1.65), particularly for Indigenous American children (aOR = 2.76; 95% CI, 1.35-5.36). Essential workers (aOR = 1.17; 95% CI, 1.07-1.27) and their children (aOR = 1.18; 95% CI, 1.07-1.30) had higher odds of grief than nonessential workers and their children. CONCLUSION: Essential workers and their children had elevated crisis outcomes. Immediate and low-cost psychologically supportive interventions are needed to mitigate the mental health impacts of the COVID-19 pandemic on these populations.

Intimate Partner Violence, Legal Systems and Barriers for African American Women.

Although many African American IPV survivors need services, they often do not access care. Hopelessness may partially explain low rates in help-seeking for this population and serve as a significant barrier to care for African American IPV survivors particularly those who have had prior legal system involvement. In a sample of 185 African American women, we first examined whether hopelessness mediated the relation between IPV and barriers to services. If such a mediation effect was found, we then would explore whether legal system involvement moderated the mediated effect of hopelessness on the relation between IPV and barriers to services. As anticipated, hopelessness partially served to explain (i.e., mediated) the relation between IPV and barriers to services. Further, this mediated effect was moderated by legal system involvement such that when legal system involvement was included as a moderator, hopelessness mediated the association between IPV and barriers to services only for those survivors who had been involved with the legal system. These results underscore the critical role of hopelessness as a barrier to accessing services for African American IPV survivors, especially those with prior involvement with the legal system. Recommendations are offered that underscore the importance of interventions that empower African American women who have survived violence instead of penalizing them.

Women's Behavioral Coping Responses During Sexual Assault: Association With Posttraumatic Stress Disorder Symptoms and the Moderating Role of Alexithymia.

We examined the associations between women's behavioral coping responses during sexual assault and posttraumatic stress disorder (PTSD) symptoms, and the moderating role of alexithymia in college women (N = 152). Immobilized responses (b = 0.52, p < .001), childhood SA (b = 0.18, p = .01), and alexithymia (b = 0.34, p < .001) significantly predicted PTSD. The interaction between immobilized responses and alexithymia was significant (b = 0.39, p = .002), indicating a stronger association for those higher in alexithymia. Immobilized responses are associated with PTSD, particularly for those with difficulty identifying and labeling emotions.