Explaining the Relationship Between Intimate Partner Violence Victimization and Human Immunodeficiency Virus Status in Transgender and Nonbinary Individuals.

STUDY QUESTIONS: Previous research has shown that human immunodeficiency virus (HIV) status and intimate partner violence (IPV) victimization are correlated. Furthermore, it has been consistently reported that transgender individuals are at an increased risk of experiencing IPV victimization and testing positive for HIV compared to cisgender individuals. However, past research examining the potential explanations for the correlation between HIV status and IPV victimization in transgender individuals using a large and inclusive sample is nonexistent. SUBJECTS: A total of 12,592 transgender and nonbinary individuals from across the United States were included in the analyses. METHODS: Through a bivariate probit analysis of data from the 2015 U.S. Transgender Survey, this study examines potential explanations for the association between HIV and IPV victimization in a sample of transgender individuals. FINDINGS: The results support previous research, which indicates that a transgender individual's HIV status is significantly correlated with their likelihood to experience IPV victimization. Additionally, a participant's involvement in sex work and other risk-taking behaviors, such as binge drinking, was found to, in part, explain this co-occurring relationship. Other variables, such as coercive control and prescription drug misuse, were found to correlate significantly with IPV victimization but not HIV status. The relationships between participants' demographic variables, such as their race, sexuality, sex assigned at birth, IPV victimization, and HIV status, were examined and discussed as well. IMPLICATIONS: We conclude that it is imperative for LGBTQ + organizations to provide services aimed at protecting transgender individuals suffering from IPV victimization who have also tested positive for HIV through increased accessibility of care and a deeper understanding of the potential relationships in which a person may be involved. This type of outreach would likely be an important first step in allowing transgender individuals to feel safer in their romantic relationships while simultaneously encouraging safe sex practices and a healthy lifestyle, which would increase overall quality of life.

Recurring Victimization and Same-Sex Attraction.

STUDY QUESTIONS: People who identify as same-sex attracted (SSA) face significantly greater risk for victimization than their non-SSA counterparts. However, little distinction is made between single versus recurring victimization among the SSA population. There are no national prevalence estimates, and we do not know the extent to which disproportionate risk of victimization among SSA populations applies to recurring victimization versus single occurrences. SUBJECTS: We analyze data from 483 survey respondents who reported same-sex attraction and 8544 respondents who do not report SSA. METHODS: The current study utilizes a nationally representative sample to estimate the prevalence of single and recurring victimization among SSA populations, and compare these estimates with those found in the non-SSA population. We further investigate some possible mediating processes that may explain differences between these groups in risk for recurring victimization, drawing upon lifestyles, self-control, and minority stress frameworks. Findings indicate that SSA groups have significantly greater risk for both single and recurring physical assault victimization. Much of the disproportionate recurring victimization risk can be explained by differences in both risky lifestyles and low self-control, as well as minority stress. IMPLICATIONS: Recurring victimization is an important problem for SSA individuals. Prevention efforts may focus on school contexts, including the addition of Gay-Straight alliances, creating supporting peer groups, and providing supportive adult role models.

Risk Factors for Experiencing Gender Based Violence Across Racial Groups.

BACKGROUND: College student interpersonal violence victimization is a major public health issue. Sexual assault and intimate partner violence have negative effects on mental and physical health, as well as an individual's ability to perform well academically and fully participate in the college experience. Because an individual's race impacts how they experience the world, it is important to consider racial differences in experiences of interpersonal violence. STUDY QUESTION: This study sought to understand the particular characteristics of Black, White, and Hispanic students that increase their risk of experiencing interpersonal violence victimization. METHOD AND SUBJECTS: Researchers performed a latent class analysis using the Spring 2013 data from the American College Health Association's National College Health Assessment II to determine whether the risk factors for victimization of college students vary based on race. Data was collected from 123,078 college students attending 153 institutions of higher learning. FINDINGS: Results of this latent class analysis showed a 5 class solution where each class had unique risks that increased the potential for interpersonal violence victimization based on the race of the respondent. IMPLICATIONS: Group based differences need to be considered when developing prevention strategies to reduce the risk of victimization on college campuses. Because different risks increase victimization for White, Black, and Hispanic students, it is important to consider how risk reduction strategies may differ for these groups; and ensure that all prevention strategies are culturally informed.

Opioid Agonist Treatment Recipients within Criminal Justice-Involved Populations.

Background: In 2014, nearly 2.5 million Americans had a substance use disorder for opioids (e.g., prescription pain medication or heroin) with over half estimated to have had prior contact with the criminal justice system. Despite strong evidence that opioid agonist treatment (OAT) is effective in reducing overdose, increasing treatment retention, and improving physical health and well-being outcomes, the use of OAT among justice-involved individuals is relatively rare. Methods: The current study uses national data of publicly funded admissions to substance abuse treatment to assess the extent to which OAT is used for cases referred to treatment by the criminal justice system. We explore the relationship between demographics, substance use severity, and access to treatment and OAT receipt. Results: Findings indicate that fewer than 6% of criminal justice cases received OAT as part of the treatment plan. Those with daily substance use, comorbid psychiatric problems, prior treatment, females, Latinos, and those who were older and those who were living independently were more likely to receive OAT, as were those living in the Northeast and with government health insurance. Conclusions: Improving the integration of the criminal justice system with substance use treatment programs would improve access to care and potentially reduce multiple health disparities faced by those in the justice system. As criminal justice responses to substance use disorder move toward a public health approach, it is imperative that the criminal justice system consider mechanisms for improving access and referrals to OAT.

Estimating the Relationship Between Perceived Stigma and Victimization of People With Mental Illness.

Over the past two decades, we have substantially increased our understanding of violence committed by individuals with mental illness, while comparatively less is known about the victimization experiences of this population. What has been established in the literature is that individuals with mental illness are more likely to experience victimization than the general public, and certain risk factors influence the likelihood of victimization. What remains unexplored is the possibility that a person with mental illness' perception that mental illness is stigmatized may be significantly associated with victimization experiences. Thus, the purpose of the current study is to examine whether stigma and victimization are associated, and in what direction. In other words, does perceived stigma lead to victimization? Or does victimization lead to perceived stigma? To assess these research questions, data from the Community Outcomes of Assisted Outpatient Treatment study are used, which is a longitudinal study of individuals with serious mental illness (n = 184). A variety of methods are employed to assess the association between victimization and perceived stigma including logistic and ordinary least squares regression models. Results from the logistic regression model indicate that perceived stigma is associated with an increase in the odds that a person with mental illness will experience victimization at later follow-ups. Results from the ordinary least squares regression analysis, however, show that victimization at baseline does not predict perceived stigma at later times. Implications regarding future research and clinical practice are discussed.

Weapon Carrying and Weapon Brandishing at School: Responses to Strain Among Same-Sex Attracted Youth.

Studies consistently find lesbian, gay, bisexual, and questioning youth are more likely than other youth to experience discrimination, fear for their safety, and be victimized at school. We argue that same-sex attracted youth may be more likely to both carry weapons and to brandish those weapons as coping mechanisms in response to the strain of real or perceived mistreatment school. Using data from the National Longitudinal Study of Adolescent to Adult Health (Wave 1, 1994-1995), we examine the relationships between same-sex attraction, fear, victimization, weapon carrying, and weapon brandishing at school. We find that same-sex attracted youth are significantly more likely than other youth to carry a weapon to school, and to brandish the weapon in front of peers. Consistent with general strain explanations, victimization, discrimination, and fear mediate the association between sexual minority status and both outcomes. We discuss the implications of these patterns for primary prevention interventions.

The Contingent Effect of Guardianship on Victimization: An Examination of People With and Without Mental Health Problems.

Mixed effects of guardianship on victimization have been found in the literature. It is possible that these divergent findings have emerged because research has not recognized how the need for guardianship may shape the results. That is, individuals who are not suitable targets (i.e., individuals without mental health problems-those who are not perceived as vulnerable or incapable of defending themselves) do not need guardianship, resulting in null findings for the protective effects of guardianship on victimization. We examine the possibility that mental health problems and guardianship interact to produce victimization in the Life Opportunities Survey, a nationally representative survey of individuals in the United Kingdom (N = 27,516). Logistic regression analyses support our hypothesis that the effects of guardianship on victimization, which is measured as violence or the threat of violence against an individual, are contingent on the presence of mental health problems (i.e., any emotional or psychological health condition). The risk of victimization for those with mental health problems who had guardianship was substantially lower than for those with mental health problems who lacked guardianship (11.5% vs. 17%, respectively). We discuss this finding in light of routine activities theory and crime prevention for people with mental health problems.

The Prediction of Repeated Violence Among Individuals With Serious Mental Disorders: Situational Versus Dispositional Factors.

The question we attempt to answer in this study is why some individuals with serious mental illness engage in repeated violence, while others do not. There appear to be two perspectives that may explain repeated violence: one that emphasizes situational factors and one that emphasizes dispositional factors. Situational factors are those that are constantly changing within one's life, whereas dispositional factors are those that remain relatively stable over time. Therefore, dispositional factors would theoretically put individuals with serious mental illness at stable risk for repeated violence because these factors remain relatively stable over time. In fact, perhaps individuals with mental illness repeatedly engage in violence because they have a dispositional trait (like impulsivity, for example) that puts them at stable risk for repeated violence. Conversely, situational factors would theoretically explain why individuals do not engage in repeated violence because they are transient and constantly changing. Therefore, perhaps one desists from violence because some situational factors changed in that individual's life. Using data from the MacArthur Violence Risk Assessment Study (i.e., MacRisk), a longitudinal study of people with serious mental illness, repeated violence was evaluated across waves. A multilevel logistic regression model was employed. Results indicate that both situational and dispositional factors are significantly associated with repeated violence. Specifically, situational factors such as marital status, drug use, perceived stress, and time away from the psychiatric hospital and dispositional factors such as personality traits including agreeableness, conscientiousness, openness, and extraversion are all significantly associated with repeated violence. These findings have important policy implications regarding criminal justice intervention and clinical practice.

Severe mental illness and firearm access: Is violence really the danger?

In response to a spate of mass shootings, national debate over the root of America's gun violence epidemic has centered on mental illness. Consequently, calls have been made to legislatively restrict firearm access among individuals with mental illness to reduce gun violence. While there is a link between mental illness and suicide, a dearth of empirical evidence exists to inform public policy on the link between firearm access and mental illness. The current study addresses this gap by exploring the nature of firearm-related risk among disordered individuals as compared to others from the same communities. We examined a subsample of the MacArthur Violence Risk Assessment Study, including 255 recently discharged psychiatric patients and 490 census-matched community residents. We conducted binomial logistic regressions to explore the impact of firearm access and patient status on violence and suicidality. In total, 15.3% reported firearm access, 23.5% violence, and 21.5% suicidality. Multivariate analyses revealed that, in the context of firearm access, patients were no more likely to perpetrate violence (OR=0.588; 95% CI=0.196-1.764) but were significantly more likely to report suicidality (OR=4.690; 95% CI=1.147-19.172). These results indicate that firearms constitute a serious risk factor for suicide, not violence, for disordered individuals. Thus, legislative efforts to reduce firearm-related risk among disordered individuals should focus on self-harm, not violence. Moreover, claims that mental illness is a principal cause of gun violence may reduce help-seeking among individuals at high risk for suicide. Researchers should devote further attention to addressing these claims empirically.

Violent Victimization in the Prison Context: An Examination of the Gendered Contexts of Prison.

Currently there are few published, multilevel studies of physical assault victimization of prisoners. This study builds on the extant research by utilizing a nationally representative sample of correctional facilities (n = 326) and inmates (n = 17,640) to examine the impacts of a large set of theoretically and empirically derived individual- and contextual-level variables on prison victimization, including how the gendered context of prison impacts victimization. Results support the lifestyles/routine activities approach. Inmates who were charged with a violent offense, were previously victimized, were smaller in size, were not married, were without a work assignment, misbehaved, did not participate in programs, used alcohol or drugs, and those who had a depression or personality disorder were more likely to be victimized. In addition, the data suggest that 8% of the variance in victimization is due to the prison context. Prisons with high proportions of violent offenders, males, inmates from multiracial backgrounds, and inmates with major infractions had increased odds of victimization. Moreover, the sex-composition of the prison has significant main and interactive effects predicting victimization. Specifically, we find that the effects of being convicted of a drug crime, drug use, military service, major infractions, and diagnosed personality disorders are all gendered in their impacts on victimization.

Trajectories of recurring victimization among people with major mental disorders.

Relatively little is known about the violent victimization experiences of people with major mental disorders. Moreover, to date, no studies have examined recurring violent victimization experiences of people with major mental disorders. Using a risk heterogeneity framework commonly used in the study of recurring victimization, the current study examines the extent of recurring victimization among people with Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I mental disorders and trajectories of recurring violent victimization (n = 262), across four waves of data collected during a 1-year longitudinal study. Multilevel logistic regression analyses tested disorder, time, and time by disorder cross-level interactions predicting recurring victimization. Results suggest that recurring violent victimization is not uncommon among mentally disordered victims of violence, with 64% of victims experiencing a recurring victimization at a later point in time. However, trajectories of recurring violent victimization are not uniform across types of mental illness. Indeed, individuals diagnosed with a substance abuse disorder or major depression show significantly declining trajectories across the follow-up period whereas individuals diagnosed with a manic disorder or a schizophrenia spectrum disorder have flat trajectories of recurring violent victimization across the study period. Results of tests for cross-level interactions between disorder type and time demonstrate that individuals with a major depression or substance abuse/dependence diagnosis are significantly different from those with a schizophrenia spectrum diagnosis in their trajectories of recurring victimization.

Methods for synthesizing findings on moderation effects across multiple randomized trials.

This paper presents new methods for synthesizing results from subgroup and moderation analyses across different randomized trials. We demonstrate that such a synthesis generally results in additional power to detect significant moderation findings above what one would find in a single trial. Three general methods for conducting synthesis analyses are discussed, with two methods, integrative data analysis and parallel analyses, sharing a large advantage over traditional methods available in meta-analysis. We present a broad class of analytic models to examine moderation effects across trials that can be used to assess their overall effect and explain sources of heterogeneity, and present ways to disentangle differences across trials due to individual differences, contextual level differences, intervention, and trial design.

Crisis intervention team officer dispatch, assessment, and disposition: Interactions with individuals with severe mental illness.

The Crisis Intervention Team (CIT) model is a specialized police response program for people in a mental illness crisis. We analyzed 2174 CIT officers' reports from one community, which were completed during a five year period. These officers' reports described interactions with people presumed to be in a mental illness crisis. We used hierarchical logistic and multinomial regression analyses to compare transport to treatment to either transport to jail or no transport by how the calls were dispatched. The results revealed that both dispatch codes and officers' on-scene assessments influenced transport decisions. Specifically, calls dispatched as suspected suicide were more likely to be transported to treatment than calls dispatched as mental disturbance. Furthermore, calls dispatched as calls for assistance, disturbance, suspicious person, assault, suspicion of a crime, and to meet a citizen were all less likely than mental disturbance calls to result in transportation to treatment. Officer assessments of the use of substances, being off medications, signs and symptoms of mental or physical illness, and violence to self or others were associated with the likelihood of being transported to treatment. These results build on previous work that demonstrated differences in transport decisions between CIT trained and non-CIT trained officers.

Adolescent same-sex attraction and mental health: the role of stress and support.

This study draws on the social stress model from the sociology of mental health to examine the impact of same-sex attraction on depressed mood and suicidal tendencies. Specifically, we hypothesize that across multiple contexts, adolescents with same-sex attractions are likely to experience more social stress and less social support than heterosexual adolescents. In turn, these experiences increase the likelihood of negative mental health outcomes. Using data from the National Longitudinal Study of Adolescent Health (n = 11,911), we find that adolescents with same-sex attraction are more likely than their heterosexual counterparts to report depressed mood and suicidal tendencies. Moreover, stress and social support were found to mediate a substantial part of the relationship between same-sex attraction and depressed mood. In addition, stress and social support mediated about one third of the relationship between same-sex attraction and suicidal tendencies. These findings give strong support for the social stress model. We conclude with a discussion of the role that alienation plays in same-sex-attracted adolescent mental health.

Prescription drug abuse among adolescent arrestees: correlates and implications.

This preliminary study examines the correlates of prescription drug abuse in a sample of adolescents in an urban juvenile detention center in Ohio. The study measures risk in 359 incarcerated females (20.1%) and 1,425 males (79.9%) by asking questions related to problems with alcohol, drug use, treatment history, mental and physical health problems, sexual behavior, anger management, physical violence, and family support. The results of the study suggest that incarcerated adolescents may benefit from interventions targeting prescription drug misuse. Female adolescent detainees abuse prescription drugs at a higher level than male adolescent detainees (17% vs. 10%). The correlates of prescription drug abuse are complex and multidimensional and offer opportunities for further study.

The influence of program mediators on eleventh grade outcomes for seventh grade substance users and nonusers.

OBJECTIVES: In their work examining the effects of the Take Charge of Your Life (TCYL) program, Sloboda and colleagues (This Issue) found that the TCYL program had significant positive effects on baseline marijuana users and significant negative effects on baseline nonusers of cigarettes and alcohol. METHODS: Mediational analyses were used to understand why the program had these differential impacts on baseline users and nonusers. RESULTS: Path models for binary outcomes revealed significant program impacts on marijuana normative beliefs and refusal skills. The treatment impacts were between 1.5 and 3 times larger for the baseline users than for nonusers. These direct effects of the program on normative beliefs and refusal skills mediated the treatment impact on use for baseline marijuana users. In contrast, the negative treatment effects on alcohol and cigarette use could not be explained by the program's targeted mediators (normative beliefs, refusal skills, consequences, attitudes and intentions). The direct effects of treatment on use for the baseline nonusers of cigarettes and alcohol remain unexplained. CONCLUSIONS: Possible explanations for this pattern and implications for strengthening universal prevention programs that are delivered to both users and nonusers are discussed. The importance of mediational analyses for programs that show negative impacts, as well as for those that show positive impacts is stressed.

The Adolescent Substance Abuse Prevention Study: A randomized field trial of a universal substance abuse prevention program.

OBJECTIVES: The purpose of the study was to determine whether a universal school-based substance abuse prevention program, Take Charge of Your Life (TCYL), prevents or reduces the use of tobacco, alcohol, or marijuana. METHODS: Eighty-three school clusters (representing school districts) from six metropolitan areas were randomized to treatment (41) or control (42) conditions. Using active consenting procedures, 19,529 seventh graders were enrolled in the 5-year study. Self-administered surveys were completed by the students annually. Trained Drug Abuse Resistance Education (D.A.R.E.) police officers presented TCYL in seventh and ninth grades in treatment schools. Analyses were conducted with data from 17,320 students who completed a baseline survey. Intervention outcomes were measured using self-reported past-month and past-year use of tobacco, alcohol, and marijuana when students were in the 11th grade. RESULTS: Main effect analyses show a negative program effect for use of alcohol and cigarettes and no effect for marijuana use. Subgroup analyses indicated that the negative effect occurred among nonusers at baseline, and mostly among white students of both genders. A positive program effect was found for students who used marijuana at baseline. Two complementary papers explore the relationship of the targeted program mediators to the use of alcohol, tobacco, and marijuana and specifically for students who were substance-free or who used substances at baseline. CONCLUSIONS: The negative impact of the program on baseline nonusers of alcohol and tobacco indicate that TCYL should not be delivered as a universal prevention intervention. The finding of a beneficial effect for baseline marijuana users further supports this conclusion. The programmatic and methodological challenges faced by the Adolescent Substance Abuse Prevention Study (ASAPS) and lessons learned offer insights for prevention researchers who will be designing similar randomized field trials in the future.

Universal school-based substance abuse prevention programs: Modeling targeted mediators and outcomes for adolescent cigarette, alcohol and marijuana use.

OBJECTIVE: We examined the relationships among targeted constructs of social influences and competence enhancement prevention curricula and cigarette, alcohol and marijuana use outcomes in a diverse sample of high school students. We tested the causal relationships of normative beliefs, perceptions of harm, attitudes toward use of these substances and refusal, communication, and decision-making skills predicting the self-reported use of each substance. In addition, we modeled the meditation of these constructs through the intentions to use each substance and tested the moderating effects of the skills variables on the relationships between intentions to use and self-reported use of each of these substances. METHODS: Logistic regression path models were constructed for each of the drug use outcomes. Models were run using the Mplus 5.0 statistical application using the complex sample function to control for the sampling design of students nested within schools; full information maximum likelihood estimates (FIML) were utilized to address missing data. RESULTS: Relationships among targeted constructs and outcomes differed for each of the drugs with communication skills having a potentially iatrogenic effect on alcohol use. Program targets were mediated through the intentions to use these substances. Finally, we found evidence of a moderating effect of decision-making skills on perceptions of harm and attitudes toward use, depending upon the outcome. CONCLUSIONS: Prevention curricula may need to target specific drugs. In addition to normative beliefs, perceptions of harm, and refusal and decision-making skills, programs should directly target constructs proximal to behavioral outcomes such as attitudes and intentions. Finally, more research on the effects of communication skills on adolescent substance use should be examined.

Is the receptivity of substance abuse prevention programming affected by students' perceptions of the instructor?

Drawing on the elaboration likelihood model of persuasive communication, the authors examine the impact of the perceptions of the instructor or source on students' receptivity to a new substance abuse prevention curriculum. Using survey data from a cohort of students participating in the Adolescent Substance Abuse Prevention Study, the authors use structural equation modeling to determine the effects of the perceptions students have of their program instructor on measures of the targeted program mediators and the use of cigarettes, alcohol, and marijuana. They test these instructor effects after each component of a two-part curriculum is administered (during the seventh and ninth grades). They find that the perceptions of the instructor significantly affect refusal, communication and decision-making skills, normative beliefs, perceived consequences of use, and substance use. The authors discuss the implications of these findings for school-based prevention programming and indications for further research.

Implementation fidelity: the experience of the Adolescent Substance Abuse Prevention Study.

While researchers have developed more effective programs and strategies to prevent the initiation of substance use and increasingly communities are delivering these interventions, determining the degree to which they are delivered as they were designed remains a significant research challenge. In the past several years, more attention has been given to implementation issues during the various stages of program development and diffusion. This paper presents the findings from a substudy of an evaluation of a newly designed middle and high school substance abuse prevention program, Take Charge of Your Life delivered by local Drug Abuse Resistance Education officer instructors. A key aspect of the study was to determine the extent to which implementation fidelity, using the measures of content coverage and appropriate instructional strategy, was associated with improvement in the program mediators of realistic normative beliefs, understanding the harmful effects of substance use and the acquisition of decision-making and resistance skills. Although it was found that higher fidelity was associated with better scores on some of the mediators, this was not a consistent finding. The mixed results are discussed within the context of the lesson activities themselves.