Orphanhood vulnerabilities for violence and HIV by education, sex, and orphan type among 18-24-year-old youth: findings from the 2018 Lesotho violence against children and youth survey.

HIV and violence among orphans are key measures of vulnerability in low-resource settings. Although Lesotho has the second highest HIV adult prevalence rate (21.1%) in the world, and the prevalence of orphanhood (44.2%) and violence exposure (67.0%) is high, little research exist on orphanhood vulnerabilities for violence and HIV in Lesotho. Using data from 4,408 youth (18-24 years old) from Lesotho's 2018 Violence Against Children and Youth survey, a nationally representative cross-sectional household survey, the study examined associations among orphan status, violence, and HIV and assessed how associations differed by education, sex, and orphan type, using logistic regression. Orphans had higher odds of violence (aOR, 1.21; 95% CI, 1.01-1.46) and HIV (aOR, 1.69; 95% CI, 1.24-2.29). Having primary education or less (aOR, 1.43; 95% CI, 1.02-2.02), male sex (aOR, 1.74; 95% CI, 1.27-2.36), and being a paternal orphan (aOR, 1.43; 95% CI, 1.14-1.80) were significant interaction terms for violence. Orphans who completed primary school or less (aOR, 1.61; 95% CI, 1.09-2.39), female (aOR, 3.08; 95% CI, 2.14-4.42) and double orphans (aOR, 2.54; 95% CI, 1.56-4.13) had higher odds of HIV. These relationships highlight the importance of comprehensive strategies to support education and family strengthening for orphans as core violence and HIV prevention efforts.

Cigarette Coupon Receipt and Smoking Relapse by Duration of Smoking Abstinence.

INTRODUCTION: It is unknown whether and to what extent the duration of smoking abstinence may modify the association between receiving cigarette coupons and smoking relapse in the U.S. This study aims to fill this gap. METHODS: Data were from the Population Assessment of Tobacco and Health study Wave 4 (December 2016-January 2018, baseline) and Wave 5 (December 2018-November 2019, follow-up) surveys. Analysis was conducted in May 2022. The study sample was participants who formerly smoked cigarettes at baseline (N=5,186). The exposure was past 12-month receipt of cigarette coupons (yes/no) at baseline, and the outcome was cigarette smoking relapse (yes/no) at follow-up. A potential modifier was the duration of smoking abstinence (within/>1 year) at baseline. Baseline single-wave weights were applied, and a multivariable logistic regression model was used to estimate the adjusted association. Interaction between cigarette coupon receipt and duration of smoking abstinence was examined to explore potential modification effects. RESULTS: Participants who received cigarette coupons at baseline were more likely to relapse at follow-up (AOR=1.63, 95% CI=1.15, 2.32). This association was significantly stronger among participants who quit within 1 year than among participants who quit >1 year at baseline (AOR for the interaction term=2.77, 95% CI=1.22, 6.25). Subgroup analysis shows that receipt of cigarette coupons was significantly associated with smoking relapse among participants who quit within 1 year (AOR=2.10, 95% CI=1.39, 3.17), and this association was not statistically significant among participants who quit >1 year (AOR=0.76, 95% CI=0.36, 1.63). CONCLUSIONS: Policies restricting cigarette coupons may help adults who recently quit sustain abstinence.

The PTSD Symptom Presentation and the Effect of Polytrauma on PTSD Symptom Clusters Among Young People Who Have Experienced Commercial Sexual Exploitation and Trafficking.

Purpose: The purpose of this study was to describe the PTSD symptom presentation (including dissociative symptoms) of PTSD using the Diagnostic and Statistical Manual of Mental Disorders 5 th Edition diagnostic criteria and explore associations between the symptom severity for each of the four PTSD symptom clusters and polytrauma, defined as multiple exposures to different categories of potentially traumatic events. Methods: This is a secondary analysis of cross-sectional program evaluation data among 95 young people (aged 11-19) at therapy initiation in a southeastern state in the U.S. We used descriptive statistics and multivariable linear regression to test study objectives. Results: Eighty-one respondents (90.0%) experienced a potentially traumatic event in ≥ 2 trauma categories, in addition to experiencing CSE/T. Approximately two-thirds of respondents experienced clinically significant PTSD symptoms for each symptom cluster. Of the 31 young people who met full criteria for PTSD, 9 met criteria for the standard PTSD diagnosis, while 22 met criteria for the dissociative subtype of PTSD. On average, experiencing additional trauma categories was associated with substantively higher PTSD symptom cluster scores for each cluster. Conclusions: These findings support the need for a comprehensive assessment of trauma symptoms that includes cluster-specific PTSD symptoms. They also underscore the need to assess the full breadth and chronicity of trauma experiences to guide treatment planning and delivery, targeting specific domains of trauma impact. These findings can also inform the tailoring and adaptation of evidence-based interventions and strategies to better meet the needs of young people who have experienced CSE/T.

The Short-Term and Long-Term Associations Between Receiving Tobacco Discounts or Coupons and Smoking Cessation Among U.S. Adult Cigarette Smokers With Intention to Quit.

INTRODUCTION: To examine the associations between baseline receipt of cigarette and non-cigarette tobacco discounts or coupons and smoking cessation at follow-up among US adult cigarette smokers with the intention to quit at baseline. AIMS AND METHODS: Data were from the Population Assessment of Tobacco and Health (PATH) study wave 3 (October 2015-October 2016), wave 4 (December 2016-January 2018), and wave 5 (December 2018-November 2019) surveys. Two separate sets of analyses were conducted using wave 3-4 data (N = 3707) and wave 4-5 data (N = 6251). Specifically, wave 4 was used as the 1-year follow-up of wave 3 to examine the short-term association, and wave 5 was used as the 2-year follow-up of wave 4 to examine the longer-term association. Study population were current established cigarette smokers with the intention to quit (within 1 year for wave 3-4 data) at baseline. Exposure was self-reported past 12-month receipt of discounts or coupons for cigarettes and non-cigarette tobacco products at baseline, and outcome was self-reported completely quitting cigarette smoking at follow-up. Baseline single-wave weights were applied, and multivariate logistic regressions were used to estimate the adjusted associations. RESULTS: Participants who received cigarette discounts or coupons at baseline were less likely to quit completely for both 1-year follow-up (aOR = 0.66, 95% CI: 0.48 to 0.90) and 2-year follow-up (aOR = 0.74, 95% CI: 0.61 to 0.90). Baseline receipt of discounts or coupons for non-cigarette tobacco products were not consistently associated with cigarette smoking cessation at follow-up. CONCLUSIONS: Receipt of cigarette discounts or coupons was associated with a reduced likelihood of successful quitting among cigarette smokers with intention to quit. Policies restricting cigarette coupons may help them quit completely. IMPLICATIONS: This study found that among baseline current established cigarette smokers with intention to quit in the United States, baseline receipt of cigarette discounts or coupons was negatively associated with cigarette smoking cessation for both 1-year follow-up and 2-year follow-up. Baseline receipt of discounts or coupons for e-cigarettes, cigars, and other tobacco products were not consistently significantly associated with cigarette smoking cessation at follow-up. Our study results indicated that policies restricting cigarette coupons may help increase the likelihood of successful smoking cessation for smokers with intention to quit.

Association of e-Cigarette Advertising, Parental Influence, and Peer Influence With US Adolescent e-Cigarette Use.

Importance: Little is known about the roles of advertising and parental and peer influence in e-cigarette use among US adolescents in recent years, hindering efforts to address the increasing rate of youth vaping. Objective: To examine how e-cigarette advertising exposure and parental and peer e-cigarette use were associated with e-cigarette use among US adolescents. Design, Setting, and Participants: This cohort study used data from waves 4 (December 2016 to January 2018), 4.5 (December 2017 to December 2018), and 5 (December 2018 to November 2019) of the Population Assessment of Tobacco and Health study, an on-going cohort study representative of the noninstitutionalized US population. Sample weights were applied to generate nationally representative estimates. Data were analyzed in January 2022. Exposures: Past 30-day e-cigarette advertising exposure, past 30-day parental e-cigarette use, and the number of best friends using e-cigarettes (none, a few, some, most, and all). Main Outcomes and Measures: Outcomes were contemporary curiosity about using e-cigarettes and e-cigarette initiation at follow-up. Generalized estimating equations were used to estimate the weighted adjusted associations. Results: Wave 4 included 8548 adolescents; wave 4.5, 10 073 adolescents; and wave 5, 11 641 adolescents. Among adolescents in the wave 4 survey, 4425 (51.1%) were boys, 1935 (24.9%) were aged 12 years, 1105 (13.0%) were Black, 2515 (24.4%) were Hispanic, and 3702 (52.3%) were White. More than 60% of adolescents reported past 30-day e-cigarette advertising exposure at each survey. Among adolescents who had never used e-cigarettes, those who reported e-cigarette advertising exposure were more likely to feel curious about using e-cigarettes (adjusted odds ratio [aOR], 1.56 [95% CI, 1.43-1.70]) and were more likely to become ever e-cigarette users (aOR, 1.21 [95% CI, 1.05-1.41]) and current e-cigarette users (aOR, 1.42 [95% CI, 1.16-1.75]) at follow-up. Adolescents who reported having best friends using e-cigarettes were more likely to feel curious about using e-cigarettes (eg, all best friends: aOR, 4.13 [95% CI, 2.35-7.26]) and initiate e-cigarette use at follow-up (eg, among adolescents reporting all best friends use e-cigarettes, risk of ever use: aOR, 4.08 [95% CI, 1.44-11.59]; risk of current use aOR, 5.42 [95% CI, 1.49-19.72]) than adolescents who reported having no best friends using e-cigarettes. Conclusions and Relevance: This cohort study of US adolescents found that e-cigarette advertising and peer influence were significantly associated with e-cigarette initiation. Efforts to address youth vaping need to consider peer influence and incorporate measures reducing e-cigarette advertising exposure.

Posttraumatic Cognitions and Posttraumatic Stress Symptoms Among Young People Who Have Experienced Commercial Sexual Exploitation and Trafficking.

OBJECTIVES: The impact of posttraumatic cognitions on the development and maintenance of posttraumatic stress symptoms (PTSS) is understudied among children and adolescents who have experienced commercial sexual exploitation/trafficking (CSE/T). The objectives of this study were to (1) explore posttraumatic cognitions among help-seeking young people aged 11-19 who have experienced CSE/T; (2) determine whether experiencing direct violence, witnessing violence, polyvictimization (ie, multiple exposures to different categories of potentially traumatic events), or demographic characteristics differentially affect whether these young people meet clinical criteria for posttraumatic cognitions using established cutoffs; and (3) explore associations between posttraumatic cognitions and PTSS among young people who have experienced CSE/T. METHODS: This study is a secondary analysis of a baseline cross-sectional survey of 110 young people with substantiated CSE/T experiences who started trauma-focused cognitive behavioral therapy (mean [SD] age = 15.8 [1.5]) from August 1, 2013, through March 31, 2020, in a southeastern US state. We used descriptive statistics, adjusted modified Poisson regression, and adjusted linear regression to test study objectives. RESULTS: Fifty-seven of 110 (51.8%) young people aged 11-19 met clinical criteria for posttraumatic cognitions. Increased age and a greater number of trauma categories experienced were significantly associated with meeting clinical criteria for posttraumatic cognitions. On average, higher posttraumatic cognition scores were associated with higher PTSS scores, controlling for demographic characteristics (ß = 0.95; 95% CI, 0.64-1.26). CONCLUSIONS: These findings underscore the importance of assessing comprehensive trauma history and PTSS of young people who have experienced CSE/T, with added usefulness of measuring cognitive appraisals to inform a therapeutic treatment plan. Measuring cognitive appraisals that may influence PTSS and therapeutic success can ensure an effective public health response for this population.

Intentions and Attempts to Quit Smoking Among Sexual Minoritized Adult Smokers After Exposure to the Tips From Former Smokers Campaign.

Importance: Significant disparities exist in smoking behaviors by sexual minority status in the US. Objective: To examine potential differences in the associations between exposure to the Tips From Former Smokers (Tips) campaign and intentions and attempts to quit smoking by sexual minority status. Design, Setting, and Participants: This cross-sectional study used data from the wave 5 survey of the Population Assessment of Tobacco and Health study. Data from 8072 adults who were currently established cigarette smokers were collected from December 2018 to November 2019 and analyzed in August 2021. The Population Assessment of Tobacco and Health study is an ongoing cohort study representative of the noninstitutionalized US population. Sample weights were applied to account for the complex sampling strategies. Exposures: Dichotomized self-reported frequent Tips exposure (often and very often) and infrequent exposure (never, rarely, and sometimes). Main Outcomes and Measures: Outcomes were intention to quit within 12 months, any serious quit attempts in the past 12 months, and number of serious quit attempts in the past 12 months. Multivariate logistic and ordinal logistic regressions were used to estimate the weighted associations between exposure and each outcome. Interactions between Tips exposure and sexual minority status were examined to explore potential differences. Results: A total of 8072 participants (mean [SD] age, 44.7 [14.8] years; 3888 [53.2%] male; 4962 [67.4%] non-Hispanic White; and 915 [9.5%] sexual minoritized individuals [ie, those who identified as lesbian, gay, bisexual, or another minoritized sexual identity]) were included. Frequent Tips exposure was associated with higher odds of quit intentions and attempts overall (adjusted odds ratio [aOR], 1.25; 95% CI, 1.07-1.46 for intention to quit within 12 months; aOR, 1.26; 95% CI, 1.08-1.47 for serious quit attempts in the past 12 months; and aOR, 1.24; 95% CI, 1.06-1.44 for number of serious quit attempts in the past 12 months). These associations were significantly stronger for heterosexual smokers than sexual minoritized smokers, as indicated by the significant interaction terms (aOR, 0.58; 95% CI, 0.36-0.96 for intention to quit within 12 months; aOR, 0.41; 95% CI, 0.24-0.70 for serious quit attempts in the past 12 months; and aOR, 0.40; 95% CI, 0.24-0.67 for number of serious quit attempts in the past 12 months). Subgroup analysis showed that heterosexual smokers who reported frequent Tips exposure were more likely to intend to quit within 12 months (aOR, 1.29; 95% CI, 1.10-1.53), have had any serious quit attempts in the past 12 months (aOR, 1.34; 95% CI, 1.13-1.58), and have had more serious quit attempts (aOR, 1.32; 95% CI, 1.12-1.54) than heterosexual smokers who reported infrequent exposure. In contrast, there was no association for sexual minoritized smokers (aOR, 0.82; 95% CI, 0.52-1.30 for intention to quit within 12 months; aOR, 0.65; 95% CI, 0.39-1.07 for serious quit attempts in the past 12 months; and aOR, 0.62; 95% CI, 0.38-1.00 for number of serious quit attempts in the past 12 months). Conclusions and Relevance: These findings suggest that significant differences exist in the associations between Tips exposure and quit intentions or attempts by sexual minority status. More targeted campaign content for sexual minoritized smokers may be needed to increase quit intentions and attempts among this group.

Longitudinal associations between e-cigarette use and onset of multiple modes of cannabis use among US adolescents.

OBJECTIVE: To examine the prospective associations between e-cigarette use and subsequent onset of various modes of cannabis use during a 12-month follow-up period among US adolescents. METHODS: Data were from the Wave 4 (2017, baseline) and Wave 4.5 (12-month follow-up) surveys of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study. Study population was cannabis-naïve US adolescents (12-16 years) at baseline who reported cannabis use status at follow-up (N = 9,692). Outcomes were modality-specific past-12-month cannabis use (vaping, blunting, smoking with hookah) and any cannabis use (past-12-month and past-30-day) at follow-up. Multivariate logistic regressions were used to estimate the weighted association between baseline past-30-day e-cigarette use and each outcome. RESULTS: Baseline e-cigarette use was significantly associated with onset of cannabis vaping (aOR = 4.00, 95% CI = 2.25-7.10), blunting (aOR = 5.30, 95% CI = 2.82-9.94), any cannabis use (aOR = 3.94, 95% CI = 2.35-6.62), and past-30-day cannabis use (aOR = 4.47, 95%CI = 2.64-7.58) at follow-up. Non-Hispanic blacks were more likely to report past-12-month blunting (aOR = 1.55, 95% CI = 1.07-2.24) and smoking cannabis with hookah (aOR = 3.13, 95% CI = 1.14-8.63) compared with non-Hispanic whites. Other tobacco use, alcohol use, perceiving e-cigarette use as having little or some harm, older age, high severity of externalizing mental health problems, and living in states legalized adult recreational cannabis use were significantly associated with future onset of cannabis vaping, blunting, and any cannabis use. CONCLUSIONS: The association of e-cigarette use with cannabis vaping was not stronger than its association with other modes of cannabis use. Future studies are needed to explain the mechanisms linking e-cigarettes and cannabis use.

Effect modification of legalizing recreational cannabis use on the association between e-cigarette use and future cannabis use among US adolescents.

BACKGROUND: Many states have legalized recreational cannabis use for adults. However, no study has examined how this policy may interact with youth vaping to influence cannabis use among US adolescents. This study investigates whether the association between baseline e-cigarette use and subsequent cannabis use differs by state recreational cannabis legalization status. METHODS: This study analyzed data from the first four waves (2013-2018) of the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal survey. The study sample included adolescents (aged 12-17) who reported never used cannabis at baseline. Generalized estimating equations were used to analyze the effect modification of state recreational cannabis law on the association between baseline e-cigarette use and cannabis use at 12-month follow-up, controlling for individual characteristics. RESULTS: Among adolescents who have never used cannabis at baseline, baseline past-30-day e-cigarette use was significantly associated with past-30-day cannabis use at 12-month follow-up (aOR=5.92, 95% CI: 3.52-9.95). This association was different by state recreational cannabis legalization status, as indicated by the significant interaction term. Subgroup analysis showed that the aOR was 18.39 (95% CI: 4.25-79.68) for adolescents living in states that legalized adult recreational cannabis use and 5.09 (95% CI: 2.86-9.07) for adolescents living in states without such laws. CONCLUSIONS: E-cigarette use is associated with cannabis initiation among youth. This association is stronger among those living in states that legalized adult recreational cannabis use. Further examination of the impact of e-cigarette use on cannabis initiation in relation to state cannabis laws is warranted.

Sexual Violence Experience Among Nigerian Girls and Young Women: What Are the Roles of Early Sexual Debut, Multiple Sex Partnerships, and Traditional Gender Role Beliefs?

In Nigeria, one in four females has experienced some form of sexual abuse. Therefore, it is imperative to examine risk factors associated with sexual violence victimization of Nigerian girls and young women to identify targets for prevention and help stakeholders prioritize response efforts. The present article focuses on secondary data analyses of 1,766 females, aged 13 to 24, interviewed in the population-based 2014 Nigeria Violence Against Children Survey. The outcome of interest is lifetime sexual violence (LSV). Several potential predictors were explored: beliefs about gender roles related to sex, early sexual debut (aged <16 years), and multiple sex partners in the past 12 months. Other risk factors assessed were age, ethnicity, religion, education, marital status, and employment. Logistic regression analyses estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results revealed that females who endorsed beliefs about patriarchal sexual decision-making (AOR = 2.1, 95% CI = [1.28, 3.32]) or ever attended school (AOR = 2.4, 95% CI = [1.35, 4.34]) were more likely to report experiencing LSV. Prevention programs that target traditional norm beliefs about gender and sexuality have the potential to influence sexual violence in Nigeria. In addition, school attendance may expose females to potential perpetrators. Thus, to prevent sexual violence of girls who attend school, implementing safety measures may be beneficial for protecting them while in and traveling to/from school.

Exploring the Impact of Trauma History on the Mental Health Presentations of Youth who have Experienced Commercial Sexual Exploitation and Trafficking.

This study explores the types and extent of potentially traumatic events that youth who have experienced commercial sexual exploitation and trafficking (CSE/T) report, and how these experiences influence mental health. CSE/T youth (N = 110, 11-19 years old) referred to Trauma-Focused Cognitive Behavioral therapists affiliated with Project Intersect provided self-report data between August 2013 and March 2020 at the start (baseline), mid-point, and completion of therapeutic services. This study focuses on the baseline data collected. Bivariate relationships were analyzed, and where bivariate associations were statistically significant, associations were assessed in adjusted regression models. Two logistic regressions were performed: one for the adjusted associations between types of potentially traumatic events reported by CSE/T youth and the outcome PTSD, and a second for the outcome emotional distress. Results indicated that polytrauma was significantly associated with PTSD diagnosis among CSE/T youth. Direct violence victimization and polytrauma were significantly associated with CSE/T youth emotional distress. Results inform behavioral medicine practitioner considerations for how to appropriately assess the potentially traumatic experiences of CSE/T youth, and how these experiences may differentially impact the mental health presentations of youth in clinical treatment. Effective treatment may include precision-based customization of evidence-based practices to ensure that the diverse traumatic experiences and related symptomatology of CSE/T youth are effectively addressed.

Role of Mental Health in the Association Between E-Cigarettes and Cannabis Use.

INTRODUCTION: E-cigarette use may be associated prospectively with subsequent cannabis use among U.S. adolescents. However, it remains unclear whether this association differs by individual mental health status. This longitudinal study examines effect modifications by mental health status. METHODS: The first 4 waves (2013-2017) of the Population Assessment of Tobacco and Health study were analyzed in 2020. Adolescents (aged 12-17 years) who reported never using cannabis at baseline waves were included. Waves 1-3 were each considered as baseline for their 12-month follow-up waves. Generalized estimating equations were used to evaluate the effect modification of internalizing mental health and externalizing mental health problems on the associations between baseline past 30-day e-cigarette use and past 30-day cannabis use at follow-up, controlling for individual characteristics and state recreational cannabis laws. RESULTS: Baseline e-cigarette use was significantly associated with cannabis use at follow-up (AOR=4.81, 95% CI=2.93, 7.90). Adolescents with high severity of internalizing mental health/externalizing mental health problems were significantly more likely to initiate cannabis use. However, current e-cigarette users who reported high severity of internalizing mental health symptoms were less likely to initiate cannabis use (AOR=2.51, 95% CI=0.92, 6.83) than those who reported low severity of internalizing mental health problems (AOR=8.84, 95% CI=4.19, 18.65). There were no differences by the severity of externalizing mental health problems. CONCLUSIONS: Baseline e-cigarette use and endorsement of severe internalizing mental health/externalizing mental health problems were significantly associated with subsequent cannabis use among U.S. adolescents. Efforts to reduce youth vaping and improve youth mental health could help curb cannabis initiation. Tailored interventions may be warranted for e-cigarette‒using adolescents with internalizing mental health problems.

Alcohol-Related Physical Abuse of Children in the Slums of Kampala, Uganda.

This study examines the patterns of alcohol-related physical abuse and alcohol use and related behaviors among children living in the slums of Kampala, Uganda. The study is based on a cross-sectional survey, conducted in spring 2014, of service-seeking children ages 12 to 18 years (n = 1134) attending Uganda Youth Development Link drop-in centers for vulnerable children in the slums. Descriptive statistics, chi-squares, and bivariate and multivariable logistic regression analyses were conducted to determine patterns of children's alcohol-related behaviors, based on alcohol-related physical abuse and neglect. Nearly 34% of children (n = 380) reported experiencing physical abuse, and 12.4% (n = 140) reported experiencing alcohol-related physical abuse. Alcohol-related neglect was reported among 19.6% (n = 212) of the children. Past year alcohol use was significantly more prevalent among children who reported experiencing alcohol-related neglect ( χ 2 = 79.18, df = 1, p < 0.0001) and alcohol-related physical abuse ( χ 2 = 62.02, df = 1, p < 0.0001). Reporting physical abuse was also associated with parental alcohol use (OR: 1.85; 95% CI: 1.38, 2.48) and parental partner violence (OR: 5.51; 95% CI: 4.09, 7.43), after adjusting for other variables in the model. Given the high levels of alcohol-related abuse and neglect reported in this population, both primary and secondary prevention initiatives are needed to improve parenting strategies and to reduce alcohol-related harm. Similarly, strategies to reduce and delay alcohol use among these vulnerable children are also needed.

A Technology-Mediated Approach to the Implementation of an Evidence-Based Child Maltreatment Prevention Program.

Implementation of evidence-based parenting programs is critical for parents at-risk for child maltreatment perpetration; however, widespread use of effective programs is limited in both child welfare and prevention settings. This exploratory study sought to examine whether a technology-mediated approach to SafeCare® delivery can feasibly assist newly trained providers in achieving successful implementation outcomes. Thirty-one providers working in child welfare or high-risk prevention settings were randomized to either SafeCare Implementation with Technology-Assistance (SC-TA) or SafeCare Implementation as Usual (SC-IU). SC-TA providers used a web-based program during session that provided video-based psychoeducation and modeling directly to parents and overall session guidance to providers. Implementation outcome data were collected from providers for six months. Data strongly supported the feasibility of SC-TA. Further, data indicated that SC-TA providers spent significantly less time on several activities in preparation, during, and in follow-up to SafeCare sessions compared to SC-IU providers. No differences were found between the groups with regard to SafeCare fidelity and certification status. Findings suggest that technology can augment implementation by reducing the time and training burden associated with implementing new evidence-based practices for at-risk families.

Effects of Exposure to Community Violence and Family Violence on School Functioning Problems among Urban Youth: The Potential Mediating Role of Posttraumatic Stress Symptoms.

Adolescents who are exposed to violence during childhood are at an increased risk for developing posttraumatic stress (PTS) symptoms. The literature suggests that violence exposure might also have negative effects on school functioning, and that PTS might serve as a potential mediator in this association. The purpose of the current study was to replicate and extend prior research by examining PTS symptoms as a mediator of the relationship between two types of violence exposure and school functioning problems among adolescent youth from an urban setting. Participants included a sample of 121 junior high and high school students (M = 15 years; range = 13-16 years; 60 males, 61 females) within high-crime neighborhoods. Consistent with our hypotheses, community violence and family violence were associated with PTS symptoms and school functioning problems. Our data suggest that community and family violence were indirectly related to school functioning problems through PTS symptoms. Findings from this study demonstrate that PTS symptoms potentially mediate the relationship between violence exposure and school functioning problems across two settings (community and home). Future research should further examine protective factors that can prevent youth violence exposure as well as negative outcomes related to violence.

Parents' retrospective reports of youth psychological responses to the sniper attacks in the Washington, DC, area.

A random-digit-dial telephone survey was conducted in May 2003, with 355 parents of children ages 2-17 years old, living in Washington, DC, or in the two surrounding counties during the October 2002 sniper shootings, to examine parent retrospective reports of child event-related psychological distress. An estimated 32% of parents reported that children experienced at least one psychological distress symptom related to sniper shootings. Older children, females, children with a history of trauma exposure prior to sniper attacks, children whose parents reported routine disruption as the result of attacks, children whose parents perceived them as at great risk for harm from sniper attacks, and those children whose parents reported more traumatic stress symptoms in response to attacks were at greatest risk for reported psychological distress.

Effects of community violence exposure and parental mental health on the internalizing problems of urban adolescents.

Previous research has documented an association between adolescent community violence exposure (CVE) and poor psychological functioning. The purpose of this study is to delineate the relations of CVE, parental mental health, and adolescent PTSD and depression. Participants consisted of 121 pairs of junior high and high school students and their parents. Adolescents completed measures to assess their history of violence exposure and current psychological functioning. Parents completed a demographic questionnaire and measures assessing their psychological functioning. Hierarchical regression analyses were conducted, and results indicated that, after controlling for demographic variables and family violence exposure, parental mental health emerged as a moderating variable in the relation between CVE and adolescent-rated PTSD, but not in the association between adolescent CVE and depression. Clinical implications of this study and directions for future research are discussed.