Substance use and mental health predictors of patterns of non-partner youth violence among high-risk urban youth.

OBJECTIVE: This study examined the association between baseline substance use and mental health, and non-partner violence trajectories among youth presenting to an urban emergency department who screened positive for drug use. Non-partner violence is physically violent victimization or aggression involving someone other than a dating partner. METHODS: Group-based trajectory modeling was used to identify longitudinal trajectories of non-partner violence in N = 599 youth (14-24 years old) at baseline, 6, 12, 18 and 24 month follow-ups. Multinomial logistic regression analyses were used to examine associations between baseline substance use and mental health conditions (i.e., anxiety, depression, and post-traumatic stress disorder [PTSD]), and non-partner violence trajectories. RESULTS: Six trajectory groups were identified for non-partner violence. Binge drinking and cannabis, illicit drug, nonmedical prescription stimulant, and polysubstance use in the 30 days leading up to their initial ED visit were associated with the likelihood of medium to high non-partner violence group membership during the two years following their ED visit. Post-traumatic stress disorder (PTSD) and depression/anxiety at baseline were also associated with greater risk of belonging to medium to high non-partner violence trajectory groups. CONCLUSIONS: Our findings highlight distinct trajectories of violent behavior, with roughly 60 % of young adults belonging to one of the non-partner violence groups. Although general trajectory trends were of decreasing violent behavior, the constellation of baseline risk factors differentially predicted group membership. These findings indicate that violence does not operate in a vacuum; interventions to reduce violence should also address previous trauma, substance use, and mental health issues.

Violent firearm-related conflicts among high-risk youth: An event-level and daily calendar analysis.

Firearm homicide is the leading cause of violence-related youth mortality. To inform prevention efforts, we analyzed event-level data to identify unique precursors to firearm conflicts. Youth (ages:14-24) seeking Emergency Department (ED) treatment for assault or for other reasons and reporting past 6-month drug use were enrolled in a 2-year longitudinal study. Time-line follow-back substance use/aggression modules were administered at baseline and each 6-month follow-up. Violent non-partner conflicts were combined across time-points. Regression analyzed: a)antecedents of firearm-related conflicts (i.e., threats/use) as compared to non-firearm conflicts; and b)substance use on conflict (vs. non-conflict) days for those engaged in firearm conflict. During the 24-months, we found that 421-youth reported involvement in violent non-partner conflict (n=829-conflicts;197-firearm/632-non-firearm). Among firearm conflicts, 24.9% involved aggression and 92.9% involved victimization. Retaliation was the most common motivation for firearm-aggression (51.0%), while "shot for no reason" (29.5%) and conflicts motivated by arguments over "personal belongings" (24.0%) were most common for firearm-victimization. Male sex (AOR=5.14), Black race (AOR=2.75), a ED visit for assault (AOR=3.46), marijuana use before the conflict (AOR=2.02), and conflicts motivated by retaliation (AOR=4.57) or personal belongings (AOR=2.28) increased the odds that a conflict involved firearms. Alcohol (AOR=2.80), marijuana (AOR=1.63), and prescription drugs (AOR=4.06) had a higher association with conflict (vs. non-conflict) days among youth reporting firearm conflict. Overall, we found that firearm conflicts are differentially associated with substance use and violence motivations. Addressing substance use, interrupting the cycle of retaliatory violence, and developing conflict resolution strategies that address escalation over infringement on personal belongings may aid in decreasing and preventing adolescent firearm violence.

A Latent Profile Analysis of Aggression and Victimization Across Relationship Types Among Veterans Who Use Substances.

OBJECTIVE: This study examined patterns of violence victimization and aggression in both intimate partner and nonpartner relationships among U.S. military veterans using latent profile analysis to identify subtypes of violence involvement. METHOD: Participants were 839 substance use treatment-seeking veterans (93% male) from a large Veterans Affairs Medical Center who completed screening measures for a randomized controlled trial. RESULTS: Past-year violence involvement, including both intimate partner violence (IPV) and nonpartner violence (NPV), was common in the sample, although NPV occurred at somewhat higher rates. When we included either IPV or NPV aggression or victimization, more than 40% reported involvement with physical violence, 30% with violence involving injury, and 86% with psychological aggression. Latent profile analysis including both aggression and victimization in partner and nonpartner relationships indicated a four-profile solution: no/low violence (NLV; n = 377), predominantly IPV (n = 219), predominantly NPV (n = 134), and high general violence (HGV; n = 109). Multinomial logistic regression analyses revealed that, compared with the NLV group, the remaining three groups differed in age, cocaine use, posttraumatic stress disorder (PTSD) symptoms, and legal involvement. Legal issues appeared to differentiate the profiles most, with the predominantly NPV and HGV profiles reporting more instances of driving under the influence and the HGV profile reporting legal problems related to aggression. CONCLUSIONS: IPV and NPV are fairly common among veterans seeking substance use treatment. The clinical characteristics of violence profiles indicate that cocaine use, PTSD symptoms, and legal involvement are treatment needs that vary with violence profile and may be useful for clinical decision making.

Marijuana use trajectories among drug-using youth presenting to an urban emergency department: Violence and social influences.

AIMS: This paper examined longitudinal marijuana use trajectories among drug-using youth presenting to the ED to inform intervention development. METHODS: Given interest in substance use and violence, this study oversampled those presenting with assault injuries. Assault-injured youth (ages 14-24) endorsing past 6-month drug use (n=349), and a sex and age proportionally-sampled comparison group (n=250) endorsing drug use, completed a baseline assessment and follow-ups at 6, 12, 18, and 24 months. Latent class trajectory analyses examined days of marijuana use over 2 years. Multinomial regression analyses examined baseline, 12-month and 24-month factors associated with substance use trajectory groups. RESULTS: Trajectory analyses identified 5 groups: Low (Low; 28.2%; n=169); Intermittent (INT; 16.2%; n=97); Moderate Decline (MD; 12.0%; n=72); High decline (HD, 13.2%; n=79) and Chronic (C; 30.4%; n=182). At baseline, as compared to the Low group, the other trajectory groups were more likely to be male and have greater levels of physical aggression. At 12- and 24-months, negative and positive peer influences, incarceration and community violence were additional characteristics associated with the greater marijuana use trajectories (as compared to the Low group). CONCLUSIONS: Interventions for drug-using youth presenting to the urban ED should address peer influences, physical aggression and community violence exposure, given the association between these characteristics and greater marijuana use trajectories.

Two-Year Trajectories of Sexual Risk Behaviors Among Drug-Using Adolescents and Emerging Adults in an Urban Community.

Among 14-24 year-olds who used drugs and were recruited from an emergency department, we examined 2-year trajectories of sexual risk behaviors. We hypothesized that those in higher risk trajectories would have more severe substance use, mental health concerns, and dating violence involvement at baseline. Analyses identified three behavioral trajectories. Individuals in the highest risk trajectory had a more severe profile of baseline alcohol use, marijuana use, dating violence involvement, and mental health problems. Future research will examine longitudinal differences in risk factors across trajectories. Understanding risk factors for sexual risk behavior trajectories can inform the delivery and tailoring of prevention interventions.

Associations between PTSD and intimate partner and non-partner aggression among substance using veterans in specialty mental health.

BACKGROUND: Risk factors of violence perpetration in veterans include substance use and posttraumatic stress disorder (PTSD); however, it is unknown whether these factors are associated with greater risk for partner or non-partner violence. This study investigated the associations between probable PTSD, heavy drinking, marijuana use, cocaine use, and partner and non-partner violence perpetration. METHODS: Self-report questionnaires assessing past-year partner and non-partner aggression (CTS2) as well as past-month substance use (SAOM), probable PTSD (PCL-C), and probable depression (PHQ-9) were administered to 810 substance using veterans entering VA mental health treatment. RESULTS: In bivariate analyses, probable PTSD in substance using veterans was associated with violence perpetration (partner physical, χ2=11.46, p=0.001, φ=0.12; non-partner physical, χ2=50.64, p<0.001, φ=0.25; partner injury, χ2=6.41, p=0.011, φ=0.09; non-partner injury, χ2=42.71, p<0.001, φ=0.23). In multiple logistic regression analyses that adjusted for sociodemographic characteristics, probable PTSD was independently associated with non-partner physical (odds ratio [OR], 2.82; 95% confidence interval [CI], 1.97-4.05) and injury aggression (OR, 3.96; CI, 2.56-6.13). Cocaine and heavy drinking were independently associated with non-partner physical and injury aggression and non-partner injury aggression respectively. CONCLUSIONS: The results provide evidence that probable PTSD, heavy drinking, and cocaine use are associated with increased risk of non-partner violence perpetration in substance using veterans. These results underscore the importance of screening for PTSD symptoms and violence perpetration towards non-partners in substance using veterans presenting for treatment.

Substance Use as a Risk Factor for Sleep Problems Among Adolescents Presenting to the Emergency Department.

OBJECTIVES: To determine correlates of sleep problems among adolescents. Specifically, to assess the relative strength of associations between sleep problems and dating victimization, reasons for emergency department (ED) visit, depression, unhealthy alcohol use, and other drug use (marijuana, nonmedical use of prescription opioids, stimulants, and tranquilizers). METHODS: A total of 1852 adolescents aged 14 to 20 years presenting for care to the University of Michigan Emergency Department, Ann Arbor, Michigan, during 2011-2012, self-administered a computerized health survey. Sleep problems were identified if any of the 4 items on the Sleep Problems Questionnaire were rated by a patient as greater than 3 on a 0 to 5 scale. Adolescents who were too sick to be screened in the ED were eligible to participate in the study during their inpatient stay. Exclusion criteria for baseline included insufficient cognitive orientation precluding informed consent, not having parent/guardian present if younger than 18 years, medical severity precluding participation, active suicidal/homicidal ideation, non-English-speaking, deaf/visually impaired, or already participated in this study on a prior visit. RESULTS: 23.5% of adolescents reported clinically significant sleep problems. Female gender, depression, dating victimization, tobacco use, nonmedical use of prescription medication, and an ED visit for medical reasons were each associated with sleep problems among adolescents, even while controlling for age, other types of drug use, receiving public assistance, and dropping out of school. CONCLUSIONS: These exploratory findings indicate that ED-based screening and brief intervention approaches addressing substance use and/or dating victimization may need to account for previously undiagnosed sleep problems.

Reasons for Fighting among Violent Female Adolescents: A Qualitative Investigation from an Urban, Midwestern Community.

This qualitative study examines the self-reported reasons for fighting among female adolescents (N = 72). Data are drawn from brief intervention sessions addressing violent behavior and alcohol use. Young women age 14 to 18 (Mean = 16) were recruited in an urban emergency department (58.3% African American/Black, 31.9% White, and 9.7% other races/ethnicities). Participants identified multiple reasons that they engage in fights including self-protection/self-defense, enhancing social status and respect, safety (e.g., preventing future fights or sexual assaults), revenge/retaliation, social motivations (e.g., defending family or friends, fighting over romantic interests), coping, and enjoyment. Results provide insight into opportunities and challenges in developing interventions addressing aggression among female adolescents.

Substance Use Among Sexual Minority Collegiate Athletes: A National Study.

BACKGROUND: The empirical research examining substance use among sexual minority collegiate athletes is sparse. Problematically, this group may be at a greater risk of substance use due to their marginalized status within the context of sport. OBJECTIVES: We examined different types of substance use during the past 30 days, and diagnosis of substance use disorders during the past 12 months, among sexual minority collegiate athletes. METHODS: This study uses data from college students for the fall semester between 2008 and 2012 from the American College Health Association-National College Health Assessment. RESULTS: Sexual minority collegiate athletes had greater odds of past 30-day cigarette use, past 30-day alcohol use, past 30-day marijuana use, and indicating being diagnosed or treated for a substance use disorder during the past 12 months when compared to either heterosexual collegiate athletes or heterosexual nonathletes, but had similar odds on these outcomes when compared to sexual minority nonathletes. Sexual minority collegiate athletes also had greater odds of binge drinking during the past 2 weeks when compared to either heterosexual nonathletes or sexual minority nonathletes, but had similar odds on this outcome when compared to heterosexual collegiate athletes. Additional analyses by gender reveal that male sexual minority athletes are at the greatest risk of being diagnosed or treated for a substance use disorder. CONCLUSIONS: Possible explanations as to why sexual minority collegiate athletes (particularly males) may be at a greater risk of substance use disorders could include the difficulty of trying to maintain an athletic identity within a social environment that is traditionally homophobic.

Diversion of ADHD Stimulants and Victimization Among Adolescents.

OBJECTIVE: To examine whether a recent prescription for stimulant medication is associated with peer victimization among youth with attention deficit/hyperactivity disorder (ADHD). METHODS: Data from 4,965 adolescents attending five public schools who completed an annual web survey over 4 years were used to examine recent stimulant medication prescription and self-reported frequent victimization. RESULTS: Adolescents with ADHD and recent stimulant prescription reported more victimization than those without ADHD, but similar to adolescents with ADHD and no recent prescription. Adolescents with ADHD and past 12-month diversion of their prescribed stimulants were at greatest risk of 12-month frequent victimization compared with adolescents without ADHD and adolescents with ADHD but no recent prescription. Youth approached to divert reported more victimization than youth not approached. Youth who diverted reported more victimization than those who did not divert. CONCLUSIONS: Close parent-prescriber collaboration is needed to ensure effective medical treatment for ADHD without greater risk for victimization and treatment failure.

Physical dating violence among adolescents and young adults with alcohol misuse.

BACKGROUND: This study determined prevalence and correlates of physical dating violence (victimization or aggression) among male and female youth with alcohol misuse and seeking emergency department (ED) care. METHODS: Patients age 14-20 seeking care at a single large university-based ED completed a computerized, self-administered, cross-sectional survey. Measures included demographics, alcohol and substance use, mental health problems, health service use, peer influences, parent support, and community involvement. Bivariate and multivariate regression assessed physical dating violence correlates. RESULTS: Among 842 male and female youth seeking ED care who screened positive for alcohol misuse, 22.3% (n=188) reported dating violence in the past year. Multivariate analyses showed variables associated with dating violence were female gender (AOR 2.17, CI 1.46-3.22), Caucasian race (AOR 0.59, CI 0.37-0.93), receipt of public assistance (AOR 1.82, CI 1.16-2.87), AUDIT Score (AOR 1.06, CI 1.02-1.10), older age of drinking onset (AOR 0.86, CI 0.77-0.96), suicidal ideation or attempt (AOR 1.95, CI 1.13-3.37), frequency of ED visits (AOR 1.22, CI 1.05-1.46), negative peer influences (AOR 1.05, CI 1.01-1.10), and positive peer influences (AOR 0.86, CI 0.80-0.93). CONCLUSIONS: Nearly 1 in 4 youth with alcohol misuse seeking ED care report dating violence. Key correlates of dating violence included alcohol use severity, suicidal ideation, ED services, and peer influences. Evidence-based dating violence interventions addressing these correlates are needed for youth with alcohol misuse seeking ED care.

A prospective study of adolescents' nonmedical use of anxiolytic and sleep medication.

The purpose of this longitudinal study (N = 2,745) was to determine whether adolescents' recent medical use of anxiolytic or sleep medication was associated with increased incidence of using someone else's prescription for these classes of medication (nonmedical use). Data were collected from adolescents attending 5 Detroit area secondary schools between December and April in 3 consecutive academic years between 2009 and 2012. Respondents were assigned to the following 3 mutually exclusive groups for the analyses: (1) never prescribed anxiolytic or sleep medication (in their lifetime); (2) prescribed anxiolytic or sleep medication in their lifetime, but not during the study period; or (3) prescribed anxiolytic or sleep medication during the study period. Almost 9% of the sample had received a prescription for anxiolytic or sleep medication during their lifetime, and 3.4% had received at least 1 prescription during the 3-year study period. Compared with adolescents never prescribed anxiolytic or sleep medication, adolescents prescribed these medicines during the study period were 10 times more likely to engage in nonmedical use for reasons such as "to get high" or "to experiment" (adjusted odds ratio [ORadj.] = 10.15; 95% CI [3.97-25.91]), and 3 times more likely to engage in nonmedical use to self-treat anxiety or to sleep (ORadj. = 3.24; 95% CI [1.67-6.29]). Adolescents prescribed anxiolytics during their lifetime but not during the 3-year study were 12 times more likely to use another's anxiolytic medication, compared with adolescents never prescribed anxiolytics (ORadj. = 12.17; 95% CI [3.98-37.18]). These risk factors have significant implications for later substance use problems.

Opioid use among interscholastic sports participants: an exploratory study from a sample of college students.

PURPOSE: Involvement in sports increases the risk for injury and the risk for prescription opioid use and misuse. This was an exploratory retrospective study to examine if previous involvement in interscholastic sports was associated with a greater lifetime prevalence of medical prescription opioid use, lifetime risk for diverting prescribed opioids, and lifetime risk for nonmedical prescription opioid use. METHOD: A Web-based survey was self-administered to a sample of 4,187 full-time undergraduate students at a large public university located in the Midwest. Student demographics, involvement in interscholastic sports during high school, lifetime medical prescription opioid use, lifetime risk for diverting prescribed opioids, and lifetime risk for nonmedical prescription opioid use were measured and analyzed for this study. RESULTS: Multiple logistic regression analyses indicated that those who participated in at least 1 interscholastic sport during high school had greater odds for lifetime medical prescription opioid use on multiple occasions and greater odds for being approached to divert their prescribed opioid medications on multiple occasions when compared with their peers who did not participate in interscholastic sports during high school. CONCLUSIONS: The findings indicate some association between previous involvement in interscholastic sports and prescription opioid use and misuse. These findings further suggest that greater awareness should be instilled in parents and coaches regarding this form of substance misuse.

Substance use and violence among youth: a daily calendar analysis.

BACKGROUND: While researchers have identified factors that contribute to youth violence, less is known about the details of violent incidents. In addition, substance use has been linked to youth violence; however, little is known about actual substance use on days in which violence occurs. OBJECTIVE: This study examined reasons for peer violence and the association between substance use and violence using daily calendar-based analyses among at-risk urban youth. METHODS: Data were collected from Emergency Department (ED) patients (ages 14-24; n = 599; 59% male, 65% African American) who screened positive for substance use in the past 6 months. Daily data regarding past 30-day substance use and violence and reasons for violent incidents were obtained via semi-structured interviews. Multi-level multinomial regression models were conducted to test the associations between substance use and peer violence incidents (i.e., none, moderate and severe). RESULTS: Conflict over 'personal belongings' was a common reason for violence among males; 'jealousy'/'rumors' were common reasons among females. Moderate victimization was more likely to be reported on days in which participants reported alcohol and cocaine use. Severe victimization was more likely to be reported on days in which participants reported alcohol use. Moderate or severe aggression was more likely to be reported on days in which participants reported alcohol and non-medical sedative use. CONCLUSIONS: RESULTS suggest that youth violence prevention that addresses differential reasons for violence among males and females as well as substance use would be beneficial.

Distal and proximal factors associated with aggression towards partners and non-partners among patients in substance abuse treatment.

Studies of violence in substance use disorder (SUD) treatment settings typically focus on partner aggression (PA) although non-partner aggression (NPA) is also a common problem. This study examines potentially distinct paths of distal and proximal risk factors related to aggression towards non-partners (NPA) and partners (PA) among a SUD treatment sample. The sample included 176 adults reporting past-year violence. Bivariate analyses indicated several distal and proximal factors were associated with NPA and PA. According to multivariate, multiple mediation analyses youth aggression history was a factor for both NPA and PA. Alcohol and cocaine use and psychological distress were associated with NPA; marijuana use was associated with PA. There also was evidence of indirect effects of distal factors on NPA and PA. The results suggest that there may be substantially different dynamics associated with NPA and PA, and have implications for developing screening, assessment and treatment protocols targeting violence among individuals in SUD treatment.

Dating violence among male and female youth seeking emergency department care.

STUDY OBJECTIVE: We determine prevalence and correlates of dating violence, dating victimization, and dating aggression among male and female patients aged 14 to 20 years seeking emergency department (ED) care. METHODS: This was a systematic sampling of subjects aged 14 to 20 years seeking care at a single large academic ED between September 2010 and March 2013. Participants completed a computerized, self-administered, cross-sectional survey of demographics, dating violence from physical abuse measures of the Conflict in Adolescent Dating Relationships Inventory, associated behaviors, and ED health service use. Separate analyses were conducted for male and female patients. RESULTS: Four thousand three hundred eighty-nine youths (86.1% participation rate) were screened, and 4,089 (mean age 17.5 years; 58% female patients) were eligible for analysis. Almost 1 in 5 female patients (n=215; 18.4%) and 1 in 8 male patients (n=212; 12.5%) reported past-year dating violence. Of female patients, 10.6% reported dating victimization and 14.6% dating aggression, whereas of male patients, 11.7% reported dating victimization and 4.9% reported dating aggression. Multivariate analyses showed that variables associated with any male dating violence were black race (adjusted odds ratio [AOR] 2.26; 95% CI 1.54 to 3.32), alcohol misuse (AOR 1.03; 95% CI 1.00 to 1.06), illicit drug use (AOR 2.38; 95% CI 1.68 to 3.38), and depression (AOR 2.13; 95% CI 1.46 to 3.10); any female dating violence was associated with black race (AOR 1.68; 95% CI 1.25 to 2.25), public assistance (AOR 1.64; 95% CI 1.28 to 2.09), grades D and below (AOR 1.62; 95% CI 1.07 to 2.43), alcohol misuse (AOR 1.04; 95% CI 1.02 to 1.07), illicit drug use (AOR 2.85; 95% CI 2.22 to 3.66), depression (AOR 1.86; 95% CI 1.42 to 2.44), and any past year ED visit for intentional injury (AOR 2.64; 95% CI 1.30 to 5.40). CONCLUSION: Nearly 1 of 6 male and female patients aged 14 to 20 years and seeking ED care report recent dating violence, and health disparities remain among this population. Dating violence was strongly associated with alcohol, illicit drug use, and depression and correlated with previous ED service use among female youths. ED interventions should consider addressing these associated health conditions, as well as improving screening protocols to address dating violence among male and female youths.

Event-level analysis of antecedents for youth violence: comparison of dating violence with non-dating violence.

BACKGROUND: Dating violence (DV) has emerged as a major concern among youth with links to substance use, injuries, and death. The emergency department (ED) provides an opportunity for violence screening and prevention interventions. Additional data are needed regarding antecedents of DV versus non-dating violence (NDV; e.g., acquaintance, stranger) to develop ED-based violence interventions for youth. METHODS: Participants were 575 patients screening positive for past 6-month drug use in an urban ED who completed timeline follow-back aggression modules at baseline and 6- and 12-months, indicating event-specific antecedents of violence. Multi-level logistic regressions using event-level data, nested by individual and time (i.e. baseline, 6- and 12-month assessment intervals), were used to examine antecedents of DV vs. NDV. Post-hoc analyses examined substance use×reasons and gender interactions. RESULTS: Prescription sedative/opioid misuse was more likely to be reported prior to DV whereas alcohol only, and co-ingested alcohol and marijuana only, were more likely to be reported prior to NDV. Reasons for DV included: "personal belongings", "angry/bad mood," "jealousy," "drunk/high on drugs" and "arguing about sex". Reasons for NDV included: "rumors," "retaliation," "personal space" and "aid (someone) due to physical attack". Substance use before/during conflicts and reasons for conflicts were both uniquely associated with DV versus NDV. Two gender interactions were found. CONCLUSIONS: ED based interventions for urban youth need to be tailored by gender, substance use (alcohol, cocaine, sedatives), reasons for violence, and type of violence (DV vs. NDV).

Painfully obvious: a longitudinal examination of medical use and misuse of opioid medication among adolescent sports participants.

PURPOSE: The objective of this longitudinal study was to assess the prevalence of medical use, medical misuse, and non-medical use of opioid medication among adolescents who participate in organized sports. METHODS: Data for this study were taken from the Secondary Student Life Survey. A total of 1,540 adolescents participated in three waves of data collection occurring between the 2009-2010 and 2011-2012 school years, with 82% of the baseline sample completing all three waves. RESULTS: Using generalized estimating equation models to analyze the longitudinal data, it was found that male adolescents who participated in organized sports during each wave of the Secondary Student Life Survey had higher odds of being prescribed an opioid medication (i.e., medical use) during the past year (adjusted odds ratio [AOR], 1.86; 95% confidence interval [CI], 1.23-2.82), higher odds of past-year medical misuse of opioid medication as a result of taking too much (AOR, 10.5; 95% CI, 2.42-45.5), and higher odds of past-year medical misuse of opioid medication to get high (AOR, 4.01; 95% CI, 1.13-14.2) compared with males who did not participate in organized sports during the study period. Among females, no association was found between participation in organized sports and medical use, medical misuse, and non-medical use of opioid medication. CONCLUSIONS: The results of this study indicate that adolescent males who participate in sports may have greater access to opioid medication, which puts them at greater risk to misuse these controlled substances.

Technology-Delivered Dating Aggression: Risk and Promotive Factors and Patterns of Associations Across Violence Types Among High-Risk Youth.

Increasingly, technology (text, e-mail, and social media) is being used in dating relationships to stalk, control, threaten, and harass dating partners. This study examines risk and promotive factors associated with technology-delivered dating aggression (TDA) and relations between types of violence (physical dating/nondating, community violence, and TDA). Participants (14-20 years old) self-administered a computerized survey as part of a larger study at an urban emergency department. The study includes 210 youth who reported having a dating partner in the past 2 months. About 48.1% of participants reported TDA in the past 2 months. Mindfulness was negatively associated with TDA. Youth reporting TDA were more likely to report physical dating violence and community violence exposure. TDA is not an isolated occurrence and is positively associated with in-person violence among adolescents. Associations between TDA, risk and promotive factors, and other forms of violence can help identify avenues for targeting interventions.