Emerging Trends of Self-Harm Using Sodium Nitrite in an Online Suicide Community: Observational Study Using Natural Language Processing Analysis.

Background: There is growing concern around the use of sodium nitrite (SN) as an emerging means of suicide, particularly among younger people. Given the limited information on the topic from traditional public health surveillance sources, we studied posts made to an online suicide discussion forum, "Sanctioned Suicide," which is a primary source of information on the use and procurement of SN. Objective: This study aims to determine the trends in SN purchase and use, as obtained via data mining from subscriber posts on the forum. We also aim to determine the substances and topics commonly co-occurring with SN, as well as the geographical distribution of users and sources of SN. Methods: We collected all publicly available from the site's inception in March 2018 to October 2022. Using data-driven methods, including natural language processing and machine learning, we analyzed the trends in SN mentions over time, including the locations of SN consumers and the sources from which SN is procured. We developed a transformer-based source and location classifier to determine the geographical distribution of the sources of SN. Results: Posts pertaining to SN show a rise in popularity, and there were statistically significant correlations between real-life use of SN and suicidal intent when compared to data from the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (⍴=0.727; P<.001) and the National Poison Data System (⍴=0.866; P=.001). We observed frequent co-mentions of antiemetics, benzodiazepines, and acid regulators with SN. Our proposed machine learning-based source and location classifier can detect potential sources of SN with an accuracy of 72.92% and showed consumption in the United States and elsewhere. Conclusions: Vital information about SN and other emerging mechanisms of suicide can be obtained from online forums.

Mask On, Mask Off: Risk Perceptions for COVID-19 and Compliance with COVID-19 Safety Measures.

Since early 2020, COVID-19 has spread throughout the United States (US), killing more than 700,000. Mask-wearing, social-distancing, and hand hygiene can curb the spread of COVID-19 and other infectious diseases. However, the adherence to COVID-19 safety measures varies considerably among the US public, likely due to disparate perceptions of COVID-19's risk. The current study examines risk perceptions for COVID-19 (RP-C) in a nationally representative sample of US residents (N = 512), as well as their political preferences, news media consumption, COVID-19 safety attitudes (SA-C) and reported COVID-19 safety behaviors (SB-C; e.g., mask-wearing and social-distancing). Using structural equation modeling, we tested a comprehensive measure for RP-C with a single latent factor, finding good model fit. We found that higher RP-C was associated with being more liberal, consuming more traditional news media, having attitudes that supported compliance with COVID-19 safety measures, and having greater reported compliance with COVID-19 safety measures. In addition, factor loadings for RP-C items indicate that people's RP-C was more strongly determined by personal and family, rather than collective or societal risk, which suggests risk communication may be improved by focusing on personal and family risk. Public health efforts to combat COVID-19 are only as good as compliance allows, and RP-C's strong relationship with SB-C indicates a potential means for risk communicators to increase compliance with COVID-19 safety measures. This finding will remain important as new COVID-19 variants, such as the Delta variant, emerge.

Associations between Adverse Childhood Experiences and Pandemic-Related Stress and the Impact on Adolescent Mental Health during the COVID-19 Pandemic.

Vulnerabilities of adolescents during times of crisis have been previously identified, but little research has investigated the compounding effects of lifetime adversities and pandemic-related stress on adolescent mental health. This study uses adolescent self-report data to model relationships between stress exposures and indicators of poor mental health from the longitudinal COVID Experiences (CovEx) Surveys. These surveys were administered online in English to U.S. adolescents ages 13-19 using the NORC AmeriSpeak® panel, a probability-based panel designed to be representative of the U.S. household population. Two waves of data were collected (Wave 1: October-November 2020, n = 727; Wave 2: March-May 2021, n = 569). Measures included demographics, adverse childhood experiences (ACEs, 8 items), pandemic-related stress (Pandemic-Related Stress Index [PRSI], 7 items), and depression symptoms (Patient Health Questionnaire for Adolescents [PHQ-A], 9 items). Path analyses were conducted to examine pathways between Wave 1 ACEs, Wave 1 PRSI, and Wave 2 PHQ with covariates of sex and race/ethnicity. Females had higher ACEs, PRSI, and PHQ scores than males. The PRSI score at Wave 1 was positively associated with the PHQ at Wave 2 (b = 0.29, SE = 0.14, p < 0.001). ACEs at Wave 1 were positively associated with PRSI at Wave 1 (b = 0.31, SE = 0.03, p < 0.001) and with PHQ at Wave 2 (b = 0.32, SE = 0.12, p < 0.001). The direct effect of ACEs on PHQ (b = 0.23, SE = 0.12, p < 0.001) remained significant even after accounting for the indirect effect of pandemic-related stress (b = 0.09, SE = 0.05, p < 0.001). Pandemic-related stress had a direct, adverse impact on adolescent depressive symptoms and demonstrates a compounding effect of childhood adversity and pandemic-related stress on depression. Findings can aid the design of interventions that promote mental health and support adolescent coping and recovery. Supplementary Information: The online version contains supplementary material available at 10.1007/s40653-022-00502-0.

Associations of a Multilevel School Health Program and Health Outcomes Among Lesbian, Gay, and Bisexual Youth.

Lesbian, gay, and bisexual (LGB) adolescents are often at higher risk than their heterosexual peers for adverse sexual health, violence, mental health, and substance use outcomes. Schools are a vital resource for enhancing protective behaviors and reducing risk behaviors. Sixteen school districts selected schools to implement a sexual health program (exposed) or usual programming (unexposed). We analyzed LGB student health outcomes using 2015 and 2017 Youth Risk Behavior Surveys. Analyses compared LGB student health outcomes by exposure status across time points using a multilevel approach. Program exposure was associated with decreased odds of ever having sex, ever testing for HIV, and using effective hormonal birth control, and an increased odds of condom use. There were no significant findings among secondary violence, mental health, and substance use outcomes. This evaluation highlights the potential for schools to reduce sexual risk behaviors among LGB youth, and opportunities to improve access to health services.

The Association of LGBTQ-Supportive School Health Policies and Practices with Sexual Health Outcomes.

Purpose: We examined the association of lesbian, gay, bisexual, transgender, and questioning (LGBTQ)-supportive school policies and practices with sexual health outcomes among LGB and heterosexual students. Methods: The 2014 and 2016 School Health Profiles data from principals and lead health educators from 117 high schools in 16 local education agencies across the United States assessed LGBTQ-supportive school policies and practices (e.g., having a gay/straight alliance or similar club). The 2015 and 2017 Youth Risk Behavior Survey data from 75,638 students from the same schools assessed sexual health outcomes (e.g., being currently sexually active). We conducted multilevel cross-sectional logistic regression analyses to examine the associations between school-level LGBTQ-supportive policies and practices with student-level sexual health outcomes, while controlling for sex, grade, race/ethnicity, and school priority status. Results: Several LGBTQ-supportive school policies and practices were significantly associated with lower odds of sexual risk behaviors (e.g., having four or more lifetime sexual partners) and ever being tested for human immunodeficiency virus (HIV) among both LGB and heterosexual students but not with using a condom during last sexual intercourse among sexually active gay, bisexual, or heterosexual male students. Having a greater number of LGBTQ-supportive school policies and practices was significantly associated with lower odds of ever having sex for LGB students and with sexual risk behaviors and ever being tested for HIV for heterosexual students. Conclusion: The study highlights the relationship between multifaceted LGBTQ-supportive school policies and practices and improving sexual health outcomes among both LGB and heterosexual students.

Dosage in Implementation of an Effective School-Based Health Program Impacts Youth Health Risk Behaviors and Experiences.

PURPOSE: This study is part of a larger evaluation of a multilevel, multistrategy federal program to reduce high school students' risk for HIV/sexually transmitted infection and unintended pregnancy. Local education agencies supported schools in implementing three strategies: delivering exemplary sexual health education, increasing student access to quality sexual health services, and enhancing safe and supportive school environments (SSE). We examined how levels of school implementation of these strategies moderated program effects on targeted student outcomes. METHODS: The Youth Risk Behavior Survey was implemented in participating local education agencies in 2015 and 2017 to assess student behaviors and experiences, whereas the School Health Profiles surveys assessed school policies and practices in 2014 and 2016. We used these surveys to measure student-level outcomes and school-level program delivery, respectively, which were analyzed using multilevel modeling in a difference-in-differences framework. RESULTS: Levels of SSE implementation significantly moderated program effects on multiple student outcomes, including ever having sex, having four or more lifetime sexual partners, being sexually active, using hormonal birth control, dual use of a condom and hormonal birth control, ever being forced to have sex, missing school because of safety concerns, and lifetime and current marijuana use. However, we found few moderating effects of exemplary sexual health education and sexual health services dosage. DISCUSSION: We found a significant relationship between incremental increases in implementation of activities to increase the safety and supportiveness of school environments and enhanced program effects in improving multiple student health outcomes. These findings suggest that school implementation of SSE activities contributed to intended program effects.

Examining the Relationship Between LGBTQ-Supportive School Health Policies and Practices and Psychosocial Health Outcomes of Lesbian, Gay, Bisexual, and Heterosexual Students.

Purpose: We examined the association of lesbian, gay, bisexual, transgender, and questioning (LGBTQ)-supportive school policies and practices with psychosocial health outcomes among lesbian, gay, bisexual (LGB), and heterosexual students. Methods: The 2014 and 2016 School Health Profiles data from principals and health educators from 117 schools assessed LGBTQ-supportive school policies and practices. We computed the sum of school policies and practices, indicating the number available for each student. The 2015 and 2017 Youth Risk Behavior Survey data from 75,638 students from the same schools measured psychosocial health outcomes. We conducted multilevel cross-sectional logistic regressions of the associations of school-level policies and practices with student-level health outcomes by sexual identity while controlling for sex, grade, race/ethnicity, and school priority. Results: Several LGBTQ-supportive school policies and practices were significantly associated with lower odds of feeling threatened at school, suicide-related behaviors, and illicit drug use among LGB students. For heterosexual students, having a gay-straight alliance or similar club was linked to multiple health outcomes, whereas other policies and practices were significantly associated with lower odds of safety concerns at school, forced sexual intercourse, feeling sad or hopeless, and illicit drug use. Increasing the sum of policies and practices was linked to lower odds of suicide-related behaviors among LGB students and safety concerns and illicit drug use among heterosexual students. Conclusion: These findings suggest that LGBTQ-supportive school policies and practices are significantly associated with improved psychosocial health outcomes among both LGB and heterosexual students, although more research is needed to better understand these relationships.

Exploring gender differences in sexual and reproductive health literacy among young people from refugee backgrounds.

Young refugees often have limited access to sexual health information and resources in their places of resettlement. However, there is currently little research examining differences in sexual health literacy between young refugee men and women. Consequently, this study employed qualitative research methods to better understand sexual health literacy, sources of information and perceived barriers to access across groups of refugee men and women between the ages of 18 and 24 years old. Three focus groups and 12 interviews were conducted with 25 refugee men and women living in the metropolitan Atlanta area. Both men and women appeared to have limited knowledge about sexual health. School was their primary source of information; women also talked with their parents, whereas men preferred to reach out to teachers, peers and online sources. For both groups, barriers to access included language difficulties and lack of money, insurance and transport. Men also stressed concerns about confidentiality, whereas women focused on shame and embarrassment when discussing sexual health. Overall, study findings emphasise the need for sexual health education as part of resettlement services. Moreover, programmes need to be independently designed for men and women to address gender differences in sexual health literacy and concerns.