Resilience and Sub-optimal Social Determinants of Health: Fostering Organizational Resilience in the Medical Profession.

The relationship between social determinants of health (SDOH) and resilience has been investigated at the individual level and, to some extent, at the community level. The aftermath of the COVID-19 pandemic further highlighted the necessity for organizational resilience in the United States. The US public health and health care system began the lengthy process of identifying the resiliency needs of its workforce that expand beyond disaster preparedness. The purpose of this article is to describe the relationship between resilience and SDOH and how medical training can infuse resiliency within the curriculum and clinical practice.

Adverse childhood experiences and adult diet quality.

Childhood trauma is strongly associated with poor health outcomes. Although many studies have found associations between adverse childhood experiences (ACEs), a well-established indicator of childhood trauma and diet-related health outcomes, few have explored the relationship between ACEs and diet quality, despite growing literature in epidemiology and neurobiology suggesting that childhood trauma has an important but poorly understood relationship with diet. Thus, we performed a cross-sectional study of the association of ACEs and adult diet quality in the Southern Community Cohort Study, a largely low-income and racially diverse population in the southeastern United States. We used ordinal logistic regression to estimate the association of ACEs with the Healthy Eating Index-2010 (HEI-10) score among 30 854 adults aged 40-79 enrolled from 2002 to 2009. Having experienced any ACE was associated with higher odds of worse HEI-10 among all (odds ratio (OR) 1⋅22; 95 % confidence interval (CI) 1⋅17, 1⋅27), and for all race-sex groups, and remained significant after adjustment for adult income. The increasing number of ACEs was also associated with increasing odds of a worse HEI-10 (OR for 4+ ACEs: 1⋅34; 95 % CI 1⋅27, 1⋅42). The association with worse HEI-10 score was especially strong for ACEs in the household dysfunction category, including having a family member in prison (OR 1⋅34; 95 % CI 1⋅25, 1⋅42) and parents divorced (OR 1⋅25; 95 % CI 1⋅20, 1⋅31). In summary, ACEs are associated with poor adult diet quality, independent of race, sex and adult income. Research is needed to explore whether trauma intervention strategies can impact adult diet quality.

A longitudinal study of justice characteristics among girls participating in a sex trafficking court program.

BACKGROUND: Sex trafficking is a public health and social justice issue that has traditionally been addressed with criminal justice solutions. Because many sex trafficking survivors are incarcerated for crimes related to their exploitation, specialty, human trafficking courts were developed to offer resources and assistance to labor and sex trafficking survivors. This study assessed justice-involved youth participating in a specialty, anti-trafficking court program. The purpose of this study was to investigate justice-related outcomes of participants in a specialty court program. We examined: (1) the relationship between age at first citation and justice characteristics (number of bench warrants, number of citations, number placements, and number of times ran away); and (2) the number of months between first citation and enrollment into the program with the aforementioned justice characteristics. We used negative binomial models to estimate the relationships between age at first citation, number of months between first citation and program enrollment, with the four justice characteristics (n = 181). RESULTS: Adjusted models showed that younger age at first citation was associated with significantly more bench warrants and citations while in the program. Likewise, fewer months between first citation and program entry was related to more bench warrants and citations. CONCLUSIONS: There is a need to evaluate the appropriateness of specialty, trafficking court programs in reducing continued justice involvement and these programs ability to meet the evolving needs of sex trafficking survivors over time. We recommend universal screening for trafficking indicators for all systems-involved youth and relocating trafficking specialty courts out of juvenile courts to dependency courts.

Justice involvement and girls' sexual health: Directions for policy and practice.

Arrested girls in the United States (US) are often diverted from detention through referrals to juvenile specialty courts (e.g., juvenile drug court), community-based diversion programs, or pre-adjudicated probation services. Limited research suggests that sexual and reproductive health needs for diverted, or court-involved, non-incarcerated (CINI) girls are similar to that of their detained counterparts. Despite the US justice system's emphasis on diverting youth from detention, research and programmatic efforts to improve sexual and reproductive health outcomes has primarily focused on detained girls. Policy and programming for CINI girls is scant and thus warrants further attention. This report details the immediate sexual and reproductive health needs of CINI girls. We discuss implications of current health care policies and practices for this population and conclude with recommendations for research focused on improving access to sexual and reproductive health care.

Exploring Mental Health and Substance use Treatment Needs of Commercially Sexually Exploited Youth Participating in a Specialty Juvenile Court.

The study sought to: (1) describe the mental health and substance use profiles among participants of a specialty trafficking court program (the Succeed Though Achievement and Resilience Court); (2) describe youths' mental health and substance use treatment prior to participating in the program; and (3) examine whether abuse influences report of mental health problems and/or substance use. Retrospective case review of court files was performed on commercially sexually exploited youth who volunteered to participate in the court from 2012 to 2014 (N = 184). All participants were female. Mental health problems and report of substance use was high among this population. Substance use differed at statistically significant levels between youth with a documented abuse history compared to those with no abuse history. Substance use also differed by report of mental health problems. Unexpected findings included the high rate of hospitalization for mental health problems and relatively low substance use treatment prior to STAR Court participation. Opportunities for improvement in critical points of contact to identify commercially sexually exploited youth and address their health needs are discussed.

Sexual Risk Behaviors and Substance Use Among Men Sexually Victimized by Women.

OBJECTIVES: To investigate whether forced sex of men by women was associated with sexual risk behaviors, and whether this association was mediated by substance use. METHODS: Data from US men aged 18 years or older at interview in the National Survey of Family Growth 2006-2010 (n = 8108) who reported sexual behavior history. Outcome variables were condom use at most recent sex and number of lifetime sexual partners. Sexual activity covariates included age at first consensual sex and treatment of sexually transmitted infections. Alcohol and drug use were the mediating factors. RESULTS: Six percent of men reported forced sex by a woman at a mean age of 18 years. On average, victimized men had 3 more lifetime sexual partners than nonvictimized men (P < .01). Furthermore, victimized men who reported drug use had, on average, 4 more female sexual partners (P < .01) than nonvictimized men. Marijuana (P < .05) and crack cocaine use (P < .05) partially mediated the association between forced sex and number of female partners. Neither condom use nor number of male partners differed between victimized and nonvictimized men. CONCLUSIONS: A nontrivial fraction of men experience forced sex by women; some of them have elevated sexual risk behaviors.