Latent Class Models of Early-life Trauma and Incident Breast Cancer.

BACKGROUND: Psychosocial trauma has been hypothesized to influence breast cancer risk, but little is known about how co-occurring traumas-particularly during early life-may impact incidence. We examine the relationship between multiple measures of early-life trauma and incident breast cancer. METHODS: The Sister Study is a prospective cohort study of US women (n = 50,884; enrollment 2003-2009; ages 35-74). Of 45,961 eligible participants, 3,070 developed invasive breast cancer or ductal carcinoma in situ through 2017. We assessed trauma before age 18 using previously studied measures (cumulative score, individual trauma type, and substantive domain) and a six-class latent variable to evaluate co-occurring traumas. We accounted for missing data using multiple imputation and estimated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional-hazards models. RESULTS: Approximately 49% of participants reported early-life trauma. Using the latent class variable approach, breast cancer hazard was higher among participants who had sexual trauma or household dysfunction (HR = 1.1; CI = 0.93, 1.3) or moderate (HR = 1.2; CI = 0.99, 1.4) but not high trauma (HR = 0.66; CI = 0.44, 0.99) compared to low trauma. Breast cancer HRs associated with sexual early-life trauma or household dysfunction were elevated for pre- and postmenopausal breast cancer and by estrogen receptor status. We found no effect modification by race-ethnicity. Estimated effects were attenuated with report of constant childhood social support. CONCLUSIONS: Breast cancer incidence varied by latent patterns of co-occurring early-life trauma. Models capturing childhood social support and trauma patterning, rather than cumulative or discrete indicators, may be more meaningful in breast cancer risk assessment.

Are we Truly "Safer-At-Home"? A Test of Contextual Effects on Mental Health and Drug Overdose Incidents During the COVID-19 Pandemic.

This study examined whether the social restrictions stemming from COVID-19 impacted the locations of mental health and drug overdose incidents, while controlling for immediate and community contextual indices. Addresses for mental health/overdose calls to law enforcement or emergency medical services between January 1, 2018 and August 13, 2020 were collected from one police department in the Midwestern United States. Businesses and previous victimization/offending were joined with parcels (level-1; N = 20,019), whereas local services and socioeconomic indicators were joined with block groups (level-2; N = 32), to allow for a multi-level (HLM7) examination of context on mental health/overdose incidents. Event Rate Ratios (ERR) revealed the greatest contextual effects took place following social distancing mandates. Findings highlight the importance of allocating to areas with the highest likelihood of reporting incidents and suggest that parcels with a history of sex offenses, drug offenses, and prior mental health calls may benefit the greatest from preventative resources.

The Effects of Risky Places, Motivated Offenders, and Social Disorganization on Sexual Victimization: A Microgeographic- and Neighborhood-Level Examination.

We test microgeographic (i.e., street segment) effects reflective of routine activities/lifestyle theories (e.g., the locations of sex offenders, gang members, drug houses, bars) and neighborhood-level (i.e., block group) effects consistent with social disorganization theory (e.g., socioeconomic disadvantage, residential mobility, racial heterogeneity) on the locations of sexual offenses within one rural and one suburban city. We employ multilevel modeling to examine neighborhood (N = 41) and microgeographic (N = 1,382) effects on sex offenses. Neighborhood context was associated with the locations of sex offenses in which disadvantage, concentrated poverty, racial heterogeneity, violent crime rates, and suburban (vs. rural) areas were positively associated with sex offense rates, whereas residential mobility had a negative effect on sex offense rates. Microgeographic context also explained variation in sex offense rates in which gang members, sex offenders, drug houses, and high population housing communities had positive effects on sexual assault rates, while controlling for spatially lagged effects. Finally, the effect of high-density housing communities was moderated by the level of disadvantage and racial heterogeneity. Neighborhood context and variables linked to exposure to crime operate differently in nonurban areas. Beyond considering community-based characteristics, contextual characteristics related to potential victims' exposure to motivated offenders should focus on small spatial places.