Discordant and Concordant Substance Use and Daily Partner Violence in Adolescent and Young Adult Relationships With Baseline Dating Violence.

PURPOSE: Intimate partner violence (IPV) and substance use in adolescents and young adults (AYAs) are significant public health issues in the United States. Together, they can harm emotional regulation and romantic relationship functioning. This study examines the role of concordant and discordant substance use on IPV within AYA relationships. METHODS: A prospective cohort of community-recruited AYA women in a heterosexual dating relationship with past-month IPV completed four months of daily surveys via a cell phone. Each day, participants reported any IPV perpetration and/or victimization, their alcohol and drug use, and observed partner substance use. Concordant substance use was coded when the participant and partner used drugs or alcohol on the same day. Discordant use was coded when only the participant or partner used drugs or alcohol on a given day. Alcohol and drug use were modeled separately. Generalized estimating equations accounted for the correlation of repeated measures. RESULTS: Participants (N = 143) were 18.2 (1.1) years old, 93% African American race. Discordant alcohol and drug use was associated with same-day victimization, perpetration, and co-occurring violence compared to concordant nonuse. Similarly, concordant alcohol use, drug use, and alcohol/drug use were associated with increased odds of victimization, perpetration, and co-occurring violence compared to concordant nonuse. DISCUSSION: Daily data illustrated that dyadic patterns of substance use are associated with IPV. These findings may facilitate the development of effective and developmentally appropriate IPV intervention programs for AYA that also integrate strategies to reduce substance use.

Multi-institutional Analysis of Metastasis-directed Therapy with or Without Androgen Deprivation Therapy in Oligometastatic Castration-sensitive Prostate Cancer.

BACKGROUND: Metastasis-directed therapy (MDT) is increasingly being used in oligometastatic castration-sensitive prostate cancer (omCSPC). However, it is currently unclear how to optimally integrate MDT with the standard of care of systemic hormonal therapy. OBJECTIVE: To report long-term outcomes of MDT alone versus MDT and a defined course of androgen deprivation therapy (ADT) in omCSPC. DESIGN, SETTING, AND PARTICIPANTS: Here, a multicenter, international retrospective cohort of omCSPC as defined by conventional imaging was reported. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Biochemical progression-free survival (bPFS), distant progression-free survival (dPFS), and combined biochemical or distant progression-free survival (cPFS) were evaluated with Kaplan-Meier and multivariable Cox proportional hazard regression models. RESULTS AND LIMITATIONS: A total of 263 patients were included, 105 with MDT + ADT and 158 with MDT alone. The majority of patients had metachronous disease (90.5%). Five-year bPFS, dPFS, and cPFS were, respectively, 24%, 41%, and 19% in patients treated with MDT + ADT and 11% (hazard ratio [HR] 0.48, 95% confidence interval [CI] 0.36-0.64), 29% (HR 0.56, 95% CI 0.40-0.78), and 9% (HR 0.50, 95% CI 0.38-0.67) in patients treated with MDT alone. On a multivariable analysis adjusting for pretreatment variables, the use of ADT was associated with improved bPFS (HR 0.43, p < 0.001), dPFS (HR 0.45, p = 0.002), and cPFS (HR 0.44, p < 0.001). CONCLUSIONS: In this large multi-institutional report, the addition of concurrent ADT to MDT appears to improve time to prostate-specific antigen progression and distant recurrence, noting that about 10% patients had durable control with MDT alone. Ongoing phase 3 studies will help further define treatment options for omCSPC. PATIENT SUMMARY: Here, we report a large retrospective review evaluating the outcomes of metastasis-directed therapy with or without a limited course of androgen deprivation for patients with oligometastatic castration-sensitive prostate cancer. This international multi-institutional review demonstrates that the addition of androgen deprivation therapy to metastasis-directed therapy (MDT) improves progression-free survival. While a proportion of patients appear to have long-term disease control with MDT alone, further work in biomarker discovery is required to better identify which patients would be appropriate for de-escalated therapy.

Perceived Impact of COVID-19 on Cyberabuse, Sexual Aggression, and Intimate Partner Violence Among U.S. Young Adults.

Quarantine guidelines that arose with the COVID-19 pandemic limited opportunities for social interaction, raising concerns about increases in intimate partner violence and cyberabuse while simultaneously restricting access to help. The current study assessed increases in cyberabuse, sexual aggression, and intimate partner violence victimization and perpetration during the first year of the COVID-19 pandemic in a U.S. nationally representative sample of young adults ages 18 to 35, recruited from a probability-based household panel. Data were collected between November 2020 and May 2021. Descriptive analyses were conducted to assess the prevalence of any self-reported increase in cyberabuse, sexual aggression, or intimate partner victimization or perpetration during the COVID-19 pandemic. Logistic regression models were run for each outcome measuring any increase compared to no increase. Approximately one in ten U.S. young adults ages 18 to 35 reported experiencing an increase in cyberabuse victimization (12.6%) and cyberabuse perpetration (8.9%) during the pandemic. Similar proportions were observed for increased sexual aggression victimization (11.8%) and perpetration (9.0%). More than one in five respondents (21.4%) reported that their intimate partner was more physically, sexually, or emotionally aggressive toward them during the pandemic. Conversely, 16.2% of respondents reported that they were more physically, sexually, or emotionally aggressive themselves toward an intimate partner, compared to their behavior before the onset of the pandemic. Having an intimate partner and staying at home more than usual during the pandemic were protective factors for both cyberabuse and sexual aggression victimization. Respondent age, education, and race and ethnicity were not associated with increased victimization or perpetration of cyberabuse or sexual aggression. However, women reported lower odds of increased sexual aggression perpetration than men. These findings improve understanding of changes to interpersonal abuse and associated risk factors during a period of social disruption.

Examining strength at home couples to prevent intimate partner violence on a military installation: A randomized controlled trial.

OBJECTIVES: In this study, the effectiveness of a couples-based group intervention to prevent intimate partner violence (IPV), Strength at Home Couples (SAH-C), was examined on a military installation relative to a comparison intervention, Supportive Prevention (SP). It was expected that greater reductions in use of physical, psychological, and sexual IPV behaviors, as well as reduced suicidality, would be found among service members and their partners in SAH-C relative to SP. METHOD: Participants included 138 couples randomized to SAH-C and SP through a clinical controlled trial embedded in a hybrid effectiveness implementation study which took place on a military installation. The Revised Conflict Tactics Scales and Multidimensional Measure of Emotional Abuse were used to measure IPV, and 13 Military Suicide Research Consortium common data elements were used to assess suicidality. RESULTS: Service members randomized to SAH-C evidenced greater reductions based on effect sizes across the assessment time points for all IPV variables, including use of overall physical IPV, severe physical IPV, sexual IPV, psychological IPV, and coercive control IPV relative to those randomized to SP. Partners of service members demonstrated a similar general pattern for reductions in use of IPV, but findings were not as robust as for service members. Both service members and partners demonstrated greater reductions in suicidality based on effect sizes when randomized to SAH-C relative to SP. CONCLUSIONS: Findings extend prior work demonstrating the promising effects of SAH-C delivered in the military context and highlight the possible benefits of SAH-C in preventing self-harm thoughts and behaviors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Victim-Offender Overlap in Technology-Facilitated Abuse: Nationally Representative Findings Among U.S. Young Adults.

There has been limited examination of the phenomenon of the victim-offender overlap in the field of technology-facilitated abuse (TFA). To design effective strategies to prevent TFA, it is important to understand which individuals are most at risk of victimization, perpetration, and to what extent a subset of people both experience victimization and engage in perpetration. This study drew on Cyber-Abuse Research Initiative (CARI) data, a nationally representative U.S. sample of adults ages 18-35. TFA measurement consisted of parallel scales for victimization and perpetration, each with 27 items assessing forms of technology-facilitated surveillance, monitoring/tracking, interference/communications, reputational harm, controlling/limiting access, and fraud. A bivariate probit of TFA perpetration and TFA victimization, as separate outcomes, was fit to allow for joint estimation of regression coefficients and robust standard errors. Analyses confirmed that TFA, similar to other forms of interpersonal aggression, is characterized by a substantial victim-offender overlap, with 30 percent of the sample reporting involvement both as a victim and as a perpetrator. Internet/social media use and social isolation did not distinguish victimization and perpetration. However, positive and negative affect as well as Lesbian, Gay, Bisexual, Queer, Asexual, or other sexual orientation (LGBQA+) were positively correlated with victimization, whereas female gender and having postsecondary education were positively associated with perpetration. These results may be used to design interventions and anticipate service needs. TFA, as a new topic of research, should capitalize on the theoretical and empirical article related to other forms of the victim-offender overlap.

Mapping the Gap: Understanding the Need for Occupational Therapy Among Older Adults With Visual Impairment.

IMPORTANCE: Visual impairment (VI) affects more than 9 million Americans age 65 yr and older, and it limits meaningful participation in daily living. Occupational therapy can have a considerable impact on the functional performance of those with VI; however, information is limited on the existing occupational therapy services available for older adults with VI across the United States. OBJECTIVE: To calculate the prevalence of VI by U.S. county and quantify and locate the existing occupational therapy practitioners with certification in vision rehabilitation. DESIGN: Synthetic estimation was used to calculate the prevalence of VI among those age 65 yr and older in the United States by county. Geographic Information Systems mapping was used to illustrate the prevalence of VI and availability of occupational therapy practitioners with specialized training in vision rehabilitation by U.S. town. RESULTS: Communities with high concentrations of older adults with VI were more prevalent in the center of the United States, whereas occupational therapy practitioners with specialty training in vision rehabilitation were concentrated primarily on the east coast of the United States, on both Florida coasts, in selected cities in Texas and California, in western Pennsylvania, and in Alabama. CONCLUSIONS AND RELEVANCE: The availability of occupational therapy practitioners with specialty training in vision rehabilitation does not match the visual rehabilitation needs of older adults in the United States. These findings can be used to prioritize efforts for new service provision, provide outreach to underserved populations, and guide occupational therapy education to improve access to vision rehabilitation throughout the United States. What This Article Adds: The data provided in this study can inform resource allocation, workforce development, and entry-level occupational therapy education to address the ongoing needs of older adults with VI.

Alcohol Use Patterns Among Underage Autistic and Non-Autistic Youth.

PURPOSE: We explored factors predicting repeated or hazardous alcohol use among autistic and non-autistic U.S. youth ages 16 to 20 years. METHODS: Autistic (n = 94) and non-autistic (n = 92) youth completed an online survey. By design, half of each group reported past-year alcohol use. We compared drinking patterns for autistic and non-autistic youth, and within each group between abstinent or infrequent drinkers (0-1 drinking episodes in past year) versus those who drank 2 + times in past year. RESULTS: Autistic (vs. non-autistic) youth who drank did so less frequently and consumed fewer drinks per occasion. However, 15% of autistic youth who drank in the past year reported heavy episodic drinking and 9.3% screened positive for AUDIT-C hazardous drinking. For autistic youth only, a diagnosis of depression, bullying or exclusion histories were positively associated with drinking 2 + times in the past year. Autistic youth who put more effort into masking autistic traits were less likely to report drinking 2 + times in the past year. As compared to non-autistic youth, autistic participants were less likely to drink for social reasons, to conform, or to enhance experiences, but drank to cope at similar rates. CONCLUSION: Repeated and hazardous underage alcohol occur among autistic youth. Targeted prevention programs designed to address the specific drinking profiles of autistic youth are needed.

Pathways to Psychopathology Among Autistic Adults.

PURPOSE OF REVIEW: Autistic adults frequently require treatment of mental health problems. Increased rates of suicidality and diminished quality of life among autistic people may be partially attributable to psychiatric symptoms. Some risk factors for mental health problems in autistic people are likely the same as risk factors present in neurotypical individuals, but unique factors that are specific to neurodivergent individuals, and some even more specific to autistic people, may exist. Understanding pathways from autism to mental health problems could inform intervention efforts at the individual and societal levels. RECENT FINDINGS: We review a growing body of research identifying risk processes across the affective, cognitive, and social domains. Consistent with the principle of equifinality, different processes appear to independently and jointly lead to heightened risk for the onset of mental health problems. Autistic adults frequently utilize mental healthcare services, and experience heightened risk for chronic impairment as a result of mental health problems. Understanding causal and developmental risk processes in autism should inform personalized treatment. We synthesize extant research on these processes and offer suggestions for addressing them therapeutically and societally.

Reductions in Depression and Anxiety Among Autistic Adults Participating in an Intervention to Promote Healthy Relationships.

IMPORTANCE: Some autistic adults experience depression and anxiety related to their social relationships. There is a need for evidence-based occupational therapy interventions that decrease depression and anxiety and improve the health of social relationships for autistic adults. OBJECTIVE: To determine the feasibility and preliminary effectiveness of the Healthy Relationships on the Autism Spectrum (HEARTS) intervention, a six-session, group-based psychoeducational intervention for the improvement of relationship health. DESIGN: One-group pretest-posttest design with a 3-mo follow-up after baseline. SETTING: United States; online intervention through community organization. PARTICIPANTS: Fifty-five adults, ages 20 to 43 yr, with a professional or self-diagnosis of autism and the capacity to independently participate in an online, group-based, participatory class. INTERVENTION: Participants received 6 90-min weekly sessions that addressed healthy relationship topics, including recognizing abuse, meeting people, maintaining relationships, setting interpersonal boundaries, neurohealth for relationships, and ending relationships. A psychoeducational approach that provided education and involved guided discovery and strategy acquisition was used. OUTCOMES AND MEASURES: All measures were self-administered through an online survey. Depression and anxiety were assessed using instruments from the Patient-Reported Outcomes Measurement Information System. RESULTS: Fifty-five participants completed the intervention. Postintervention scores revealed statistically significant improvements in depression and anxiety. CONCLUSIONS AND RELEVANCE: HEARTS is a promising intervention for improving depression and anxiety among autistic adults and should be investigated further. What This Article Adds: HEARTS offers a potentially effective, nonpharmacological, psychoeducational group-based intervention option to promote healthy relationships for autistic adults. Positionality Statement: This article uses identity-first language (autistic person) in accordance with the preference of autistic self-advocates (Autistic Self Advocacy Network, 2020; Kenny et al., 2016; Lord et al., 2022).

Introduction to the Special Issue on Substance Use and Occupational Therapy.

Readers of this journal are undoubtedly already aware that substance use disorders (SUDs) are a significant public health problem. More than 2% of the world population is living with a substance abuse disorder, and 1.4% of the global burden of disease is attributable to alcohol and illicit drug use. What readers may have had less opportunity to consider is that occupational therapists are an underutilized resource in our response to the substance use disorder crisis, and that occupational therapy researchers can provide key insights into the nature of substance use in individuals' lives and in our communities. That is the focus of this special issue.

Sexual, physical, and emotional aggression, experienced by autistic vs. non-autistic U.S. college students.

ObjectiveTo compare rates of aggression victimization for autistic vs. non-autistic U.S. college students. Participants: n = 1,411 autistic and n = 218,430 non-autistic students from 78 colleges. Methods: We used a three-way interaction term to examine moderation of the relationship between autism and sexual, physical and emotional aggression victimization by depression and sense of belonging. Results: Autistic students were nearly twice as likely as non-autistic students to report past-year emotional victimization (44% vs. 26%, p < 0.001), and more likely to report physical victimization (8.4% vs. 5.7%, p < 0.001). Autistic students who experienced sexual assault were 2.23 times more likely than non-autistic students to report it affected academic performance (80.4% vs. 36.0%, p < 0.001). At both low and high levels of depression, sense of belonging was protective against physical and sexual victimization for autistic students more than for non-autistic students. Conclusions: Institutions of higher education should prioritize preventing and responding to interpersonal aggression against autistic students.

Reasons for alcohol use and non-use by underage U.S. autistic youth: A qualitative study.

LAY ABSTRACT: What is already known about the topic? Hazardous alcohol use is when a person's drinking puts them at increased risk for negative events (e.g. health problems or car crashes). Some studies show that autistic people may be at greater risk for hazardous alcohol use than non-autistic people, while other studies have found that hazardous alcohol use is less common among autistic people than non-autistic people. We need to learn why autistic underage youth choose to drink alcohol or not. The goal of this study was to learn from US autistic youth about their attitudes and behavior related to alcohol. Forty autistic youth aged 16-20 years old were interviewed.What this article adds? Youth described several reasons why they choose to drink alcohol, including feeling like non-autistic people are more accepting when drinking, that it puts them in a less irritable or bored mood, helps them cope with problems, and helps them fit in. Reasons for not drinking alcohol include worries about becoming addicted, medication interactions, not liking the taste, fear of experiencing hangover and other health problems, and concern about acting foolish when drunk.Implications for practice, research, or policy Results reveal that hazardous alcohol use in autistic adults could have its roots in underage experiences that give autistic youth temporary relief from social anxiety, feeling lonely, and challenges with sensory processing. Right now, there are no evidence-based alcohol prevention programs in the United States for autistic people. One or more such programs may be needed. The results from this study could be used to adapt existing programs for non-autistic youth to the unique needs and risk factors of autistic youth.

U.S. Young Adults' Professional Help-Seeking in Response to Technology-Facilitated Abuse.

Widespread access to an increasing number of technology-enhanced communications channels multiplies the potential for abusive interactions (i.e., technology-facilitated abuse [TFA]). Practitioners will be better prepared to respond to the problem of TFA if more is known about how commonly victims seek help, and from whom. Through a cross-sectional, U.S. nationally representative survey of n = 1,215 young adults aged 18 to 35, respondents completed the TFA scale of the Cyber-Abuse Research Initiative. We calculated the percentage of TFA survivors who sought help for their most damaging experience of TFA, and used logistic regression to model help-seeking for health services, victim services, technological assistance, and/or criminal justice/legal assistance. For each help source, we examined risk markers including sociodemographic characteristics, online activity, the number of different forms of TFA experience, and the perpetrator's relationship to the victim. Use of a broader range of social media sites/platforms, and several indicators of more severe TFA experiences, predicted help-seeking from health services, victim services, and justice/legal assistance. Young adults who identified the TFA perpetrator as a current or ex-intimate partner were less likely than other survivors to seek two forms of help: technological assistance and/or criminal justice/legal assistance. Survivors who self-identified as Black were more likely than White survivors to seek victim services. Professionals who support survivors of interpersonal aggression may use these results to enhance their screening protocols and form cross-disciplinary partnerships to address the harms associated with TFA.

#ChokeMeDaddy: A Content Analysis of Memes Related to Choking/Strangulation During Sex.

Recent research indicates that some young people initially learn about sexual choking through Internet memes. Thus, a qualitative content analysis was performed on 316 visual and textual memes collected from various social media websites and online searches to assess salient categories related to choking during sex. We identified nine main categories: communication, gendered dynamics, choking as dangerous, choking as sexy, sexualization of the nonsexual, shame and worry, romance/rough sex juxtaposition, choking and religious references, instructional/informational. Given that memes, through their humor, can make difficult topics more palatable and minimize potential harm in the phenomenon they depict, more concerted, synergistic effort that integrates media literacy into sexuality education programming on the potential risks that may ensue for those engaging in sexual choking is warranted.

Adolescent Relationship Abuse Prevention in Pediatric Primary Care: Provider, Adolescent, and Parent Perspectives.

OBJECTIVE: Adolescent relationship abuse (ARA) is associated with myriad negative health outcomes. Pediatric primary care presents an opportunity to engage adolescents and parents, who can be protective against ARA, in ARA prevention; however, no family-focused, health care-based ARA interventions exist. The purpose of this study is to explore the perspectives of adolescents, parents, and health care providers (HCPs) on incorporating ARA prevention into primary care, including 1) current discussions around ARA, 2) how to best include ARA prevention education, and 3) how to address implementation barriers. METHODS: We conducted individual, semi-structured interviews with HCPs, adolescents ages 11 to 15, and parents recruited through convenience sampling. Transcripts were individually coded by 4 study team members (with every third transcript co-coded to assess discrepancies) and analyzed via thematic analysis. RESULTS: Participants identified a need for pediatric HCPs to involve younger adolescents and parents in universal, inclusive ARA prevention and noted that HCPs require training, techniques, and resources around ARA. Participants acknowledged multilevel barriers to implementing primary care-based ARA prevention. They suggested that ARA education be intentionally integrated into HCP and clinic workflows and recommended strategies to garner adolescent and parent buy-in to facilitate ARA-focused conversations. CONCLUSIONS: Pediatric primary care is a promising environment to involve parents and adolescents in universal ARA-prevention. Future research should contextualize these results with larger samples across multiple practice settings and integrate relevant partners in the development and evaluation of evidenced-based ARA prevention for pediatric primary care.

The State of the Science on Adverse Childhood Experiences.

The Adverse Childhood Experiences (ACEs) study was conducted to advance understanding of psychological trauma in early life as a possible determinant of adult health. In the past decade, there has been a movement to use the ACEs research questionnaire in a variety of clinical settings to screen individuals and assess their trauma score. But critics argue that the ACEs questionnaire was never intended to be used for individual-level screening, and even that harm can be done by using the questionnaire for this purpose. In the meantime, researchers have developed a protective factor questionnaire that they call the "Positive Childhood Experiences" (PCEs) survey that captures experiences that predict trauma resilience. The objective of this article is to explain the history of the ACEs questionnaire, the current controversy about its use for screening, the emergence of the concept of PCEs, and implications for occupational therapy practitioners and researchers.

Validity of a three-item dating abuse victimization screening tool in a 11-21 year old sample.

BACKGROUND: Dating abuse (DA) is prevalent and consequential, but no brief DA screening tools are available for use in pediatric or other settings. This study was designed to determine the sensitivity, specificity, and predictive values of the MARSHA-C, which is a three-item DA victimization screening tool. METHODS: The participants were 224 U.S. youth ages 11-21 years old (20% male, 77% female, 3% non-binary gender). Youth completed an online questionnaire about adolescent relationship abuse. The survey included the Measure of Adolescent Relationship Harassment and Abuse (MARSHA), which is a comprehensive DA measurement instrument normed on a nationally representative sample. Of 34 DA victimization items from the MARSHA, the three most prevalent items were hypothesized to have good predictive validity of the full scale score as a brief, screening version (MARSHA-C). The sensitivity, specificity, positive predictive value, and negative predictive value of the MARSHA-C to identify victims of DA was calculated. RESULTS: Using the MARSHA as the reference standard, the cutpoint of 1 on the MARSHA-C screening tool was identified as optimal. The MARSHA-C had a sensitivity of 84%, a specificity of 91%, and positive predictive value of 91%. Thus, for youth who endorse ≥ 1 MARSHA-C items, there is a 91% probability that they have experienced DA in the past year. Exploratory analyses by demographic subgroups suggest that the predictive validity of the MARSHA-C is approximately equivalent for females and males, younger and older adolescents, Asian, Black, Latinx, Multiracial and White youth, and heterosexual and lesbian, gay, and bisexual youth. CONCLUSIONS: The MARSHA-C can be used to detect DA among 11-21-year-old youth via online surveys for research purposes, or in clinical care settings to facilitate proactive patient counseling or parent-oriented anticipatory guidance.

Prevalence of Opioid Use and Intimate Partner Violence among Pregnant Women in South-Central Appalachia, USA.

Background: Recent research indicates that pregnant women in rural communities are at increased risk of experiencing IPV and comorbid illicit opioid use compared to urban-residing pregnant women. Few studies of the interactions among rurality, substance use, and victimization in pregnant women exist. The current study sought to examine the relationship between IPV and opioid use and the interaction effects of rurality in Appalachian pregnant women. Methods: A convenience sample of pregnant women who were enrolled in a smoking cessation research study was used for this analysis. Participants included 488 pregnant women from five prenatal clinics in South-Central Appalachia. Data were from self-reported assessments and semi-structured interviews on substance use and IPV conducted from first trimester of pregnancy through eight months postpartum. Results: Four hundred and ten participants reported experiencing any form of IPV in the past year. Logistic regression results indicated that physical IPV was associated with opioid use, but sexual and psychological IPV were not. The moderation model indicated direct effects between IPV and opioid use, but were not moderated by rurality. Conclusion: This study suggests a need to further understand the relationship between substance use, IPV, and rurality in pregnant women. The specific subtopic of opioid use by pregnant women living in rural communities, and its relationship to IPV victimization and adverse fetal and maternal health outcomes, continues to be an understudied, but critically important area. Limitations and future directions pertaining to IPV screenings and interventions for pregnant women are discussed.

Reproductive Health and Substance Use Education for Autistic Youth.

BACKGROUND: We provide an update on reproductive health education (RHE) and substance use prevention education (SUPE) participation for autistic youth compared with other youth with and without individualized education plans (IEPs) and 504 plans. The 800 000 autistic youth served by the US special education system need education to make informed decisions about reproductive health and substance use. METHODS: Data were from the National Longitudinal Transition Study-2012, a survey designed to yield nationally representative estimates of the experiences of US youth. Autistic youth (n = 390) who received RHE and SUPE were compared with youth with all other IEP classifications (n = 4420), with a 504 plan (n = 350), and with no IEP or 504 plan (n = 980). All youth were ≥14 years old and able to self-report on a survey. Bivariate and multivariate regression analyses were performed for each group to identify characteristics associated with RHE and SUPE receipt. RESULTS: Autistic youth reported a significantly lower rate of RHE (47.4%) and SUPE (49.6%) inclusion versus students with no IEP or 504 plan (59.2% and 57.4%, respectively). Autistic girls were more than twice as likely to report RHE receipt than autistic boys (55.1% vs 45.9%). For autistic youth, no markers for receipt of SUPE were identified. CONCLUSIONS: Autistic youth are underserved when it comes to school-based RHE and SUPE, potentially undermining self-determination and leading to poorer lifespan health trajectories. Research and policy advocacy are needed to ensure that these youth have access to RHE and SUPE.