Sexual Violence Victimization and Associations with Health in a Community Sample of African American Women.

Limited information exists on the relationship between sexual violence victimization and health among African American women. Using data from a community sample of African American women, we examine the association between current health and lifetime experiences of sexual violence. Inperson interviews were completed in 2010. Among interviewees, 53.7% of women reported rape victimization and 44.8% reported sexual coercion in their lifetime. Victims of rape or sexual coercion were significantly more likely to report depression and posttraumatic stress disorder during their lifetime. Among victims whose first unwanted sexual experience was rape or sexual coercion, perpetrators were mostly acquaintances and intimate partners, and over one third were injured and needed services. More attention is needed on the health needs of African American women and their association to victimization status.

Longitudinal Associations Among Bullying, Homophobic Teasing, and Sexual Violence Perpetration Among Middle School Students.

Bullying perpetration and sexual harassment perpetration among adolescents are major public health issues. However, few studies have addressed the empirical link between being a perpetrator of bullying and subsequent sexual harassment perpetration among early adolescents in the literature. Homophobic teasing has been shown to be common among middle school youth and was tested as a moderator of the link between bullying and sexual harassment perpetration in this 2-year longitudinal study. More specifically, the present study tests the Bully-Sexual Violence Pathway theory, which posits that adolescent bullies who also participate in homophobic name-calling toward peers are more likely to perpetrate sexual harassment over time. Findings from logistical regression analyses (n = 979, 5th-7th graders) reveal an association between bullying in early middle school and sexual harassment in later middle school, and results support the Bully-Sexual Violence Pathway model, with homophobic teasing as a moderator, for boys only. Results suggest that to prevent bully perpetration and its later association with sexual harassment perpetration, prevention programs should address the use of homophobic epithets.

Sexual Violence Victimization and Associations with Health in a Community Sample of Hispanic Women.

This study sought to add to the limited information currently available on circumstances of sexual violence victimization and associated negative health experiences among Hispanic women. Data come from a community sample of mostly Mexican women in an urban southwestern city. Household interviews were completed with a sample of 142 women during 3 months in 2010. Findings indicate that 31.2% of women reported rape victimization and 22.7% reported being sexually coerced in their lifetime. Victims of rape and/or sexual coercion were significantly more likely to report symptoms of depression and post-traumatic stress disorder (PTSD) during their lifetime. Among victims whose first unwanted sexual experience resulted in rape and/or sexual coercion, perpetrators were almost always someone known to the victims, and were mostly family members or intimate partners, depending on the victim's age. About one-fifth of victims were injured and 17.1% needed medical services. These findings suggest the need for more attention to the physical and mental health needs of sexually victimized Hispanic women.

Sexual Violence Perpetration by Adolescents in Dating versus Same-Sex Peer Relationships: Differences in Associated Risk and Protective Factors.

INTRODUCTION: Little is known about the risk and protective factors for youth sexual violence (SV) perpetration across different types of relationships. This study examined factors associated with perpetrating SV against a dating partner and a same-sex peer. METHODS: Analyses were based on data from a survey conducted in 2004 with public school boys and girls in grades 7, 9, 11, and 12 (N = 4,131) in a high-risk, urban school district in the United States. SV perpetration was defined broadly to include forcing someone, about the same age and of the same or opposite sex as the respondent, to have sex or to do something sexual that they did not want to do. Analyses examined the associations between risk and protective factors and SV perpetration, adjusting for SV victimization and demographic characteristics. RESULTS: Findings revealed that 2.1% of respondents reported perpetration against a same-sex peer and 3.2% reported perpetration against a date during the past 12 months. Victims of SV for each relationship type were more likely than non-victims to perpetrate SV. A combination of factors across the individual, relationship, and community level were significantly associated with SV perpetration and there were both shared and unique factors across the relationship types. CONCLUSION: Data suggest that programs to prevent SV perpetration for both relationship types should start when students are young, with particular focus on middle school boys. Prevention efforts should have slightly different foci to address these 2 types of SV perpetration.

Expect respect support groups: preliminary evaluation of a dating violence prevention program for at-risk youth.

Expect Respect support groups, a selective prevention strategy, are designed to prevent and reduce dating violence among at-risk middle and high school students. This preliminary, uncontrolled evaluation examined changes in healthy relationship skills and emotionally and physically abusive behaviors in participants' peer and dating relationships. Self-reports (N = 144) showed significant increases in healthy relationship skills from baseline to program completion, whereas levels of victimization and perpetration remained unchanged. A subgroup of students who reported baseline levels of victimization and perpetration with means at least one standard deviation above the group mean reported significantly less victimization and perpetration at program completion.

Bullying perpetration and subsequent sexual violence perpetration among middle school students.

PURPOSE: This study examines the association between bullying experiences and sexual violence (SV) perpetration among a sample of middle school students (n = 1391; males and females in grades 5-8) across five middle schools in a Midwestern state. METHODS: We include waves 1 and 2 of a larger longitudinal study that aimed to track the overlap between bullying and SV victimization and/or perpetration across a 3-year period. Wave 1 data were collected in the spring of 2008, and wave 2 data were collected in the fall of 2008. Student participants completed a series of scales in a paper and pencil survey. After missing data imputation, a total sample of 1391 students was analyzed. RESULTS: Using cutoff scores, 12% of males and 12% of females could be considered bully perpetrators. Thirty-two percent of the boys (22% of girls) reported making sexual comments to other students, 5% of boys (7% of girls) spread a sexual rumor, and 4% of boys (2% of girls) pulled at someone's clothing. Bullying perpetration and homophobic teasing were significant predictors of sexual harassment perpetration over time. CONCLUSIONS: Given the overlap among bullying, homophobic teasing perpetration, and SV perpetration, future studies should address the link among these forms of aggression so that prevention programs can be enhanced to address gender-based bullying and sexual harassment.

Attitudes affecting physical dating violence perpetration and victimization: findings from adolescents in a high-risk urban community.

This study examines the associations between attitudes supporting physical dating violence against boys hitting girls and girls hitting boys and experiences with physical dating violence perpetration and victimization among youth in a high-risk community. Cross-sectional logistic regression analyses are based on data from the Youth Violence Survey, conducted in 2004, and administered to more than 80% of public school students in grades 7, 9, 11, and 12 (N = 4,131) in an urban school district. Findings show that attitudes supporting physical dating violence against boys and girls are significantly associated with physical dating violence perpetration and victimization. Prevention programs that seek to reduce physical dating violence among adolescents may benefit from including sex-specific attitude modification as part of a comprehensive violence prevention approach.

Healthy People 2010 objectives for unintentional injury and violence among adolescents. Trends from the National Youth Risk Behavior Survey, 1999-2009.

BACKGROUND: In 2000, the USDHHS released Healthy People 2010 (HP2010), a series of disease prevention and health promotion objectives for the nation. Thirty-nine of these objectives were dedicated to injury prevention and six of these objectives related to adolescents, who were tracked through CDC's National Youth Risk Behavior Survey (YRBS). PURPOSE: This paper uses national YRBS data from 1999 to 2009 to analyze overall and subgroup trends and determine progress toward targets for the following HP2010 objectives: seatbelt use (HP2010 objective 15-19); motorcycle helmet use (15-21); riding with a driver who had been drinking alcohol (26-6); physical fighting (15-38); weapon carrying on school property (15-39); and suicide attempts requiring medical attention (18-2). METHODS: The CDC conducted the national YRBS biennially from 1999 to 2009 and used similar three-stage cluster-sample designs to obtain representative samples of high school students in the U.S. This study was conducted in 2010 and used linear and quadratic time variables simultaneously in logistic regression models while controlling for gender, race/ethnicity, and grade to test for secular trends over time. RESULTS: Only two objectives met their HP2010 targets: riding with a driver who had been drinking alcohol (26-6) and physical fighting (15-38). Progress was seen for four additional objectives and within some subgroups. CONCLUSIONS: Substantial policy and practice changes must occur if the recently released Healthy People 2020 targets are to be met. School-, community-, and state-level policies and programs may be effective tools to prevent injuries and victimizations.

X-rated material and perpetration of sexually aggressive behavior among children and adolescents: is there a link?

Longitudinal linkages between intentional exposure to x-rated material and sexually aggressive behavior were examined among youth 10-15 year olds surveyed nationally in the United States. At Wave 1 in 2006, participants (n = 1,588) were queried about these exposures and outcomes in the preceding 12 months. Wave 2 data (n = 1,206) were collected approximately 12 months after Wave 1 and Wave 3 data (n = 1,159) were collected approximately 24 months after Wave 1. Thus, data for this project represent a 36-month time frame. A marginal model with generalized estimating equations was used to represent the population-average odds of sexually aggressive behavior over the 36 months as a function of exposure to x-rated material over the same time and to account for clustering in the data within person over time. An average of 5% of youth reported perpetrating sexually aggressive behavior and 23% of youth reported intentional exposure to x-rated material. After adjusting for other potentially influential proximal (i.e., sexual aggression victimization) and distal characteristics (e.g., substance use), we found that intentional exposure to violent x-rated material over time predicted an almost 6-fold increase in the odds of self-reported sexually aggressive behavior (aOR: 5.8, 95% CI: 3.2, 10.5), whereas exposure to nonviolent x-rated material was not statistically significantly related (aOR: 1.7, 95% CI: 0.94, 2.9). Associations were similar for boys and girls (boys nonviolent x-rated material aOR = 2.0, 95% CI: 0.8, 4.7; violent x-rated material aOR = 6.5, 95% CI: 2.7, 15.3; girls nonviolent x-rated material aOR = 1.2, 95% CI: 0.5, 3.2; violet x-rated material aOR = 6.1, 95% CI: 2.5, 14.8).

Linkages between internet and other media violence with seriously violent behavior by youth.

OBJECTIVE: The goal was to examine the association between violence in the media and the expression of seriously violent behavior among older children and teenagers in a national sample. METHODS: The Growing up with Media survey was a national, online survey of 1588 youths that was conducted in August and September 2006. Participants were 10- to 15-year-old youths who had used the Internet at least once in the past 6 months. The main outcome measure was self-reported seriously violent behavior, including (1) shooting or stabbing someone, (2) aggravated assault, (3) robbery, and (4) sexual assault. RESULTS: Five percent of youths reported engaging in seriously violent behavior in the past 12 months. Thirty-eight percent reported exposure to violence online. Exposures to violence in the media, both online and off-line, were associated with significantly elevated odds for concurrently reporting seriously violent behavior. Compared with otherwise similar youths, those who indicated that many, most, or all of the Web sites they visited depicted real people engaged in violent behavior were significantly more likely to report seriously violent behavior. After adjustment for underlying differences in youth characteristics, respondents' alcohol use, propensity to respond to stimuli with anger, delinquent peers, parental monitoring, and exposures to violence in the community also were associated with significantly increased odds of concurrently reporting seriously violent behavior. CONCLUSIONS: Exposure to violence in the media is associated with concurrent reports of seriously violent behavior across media (eg, games and music). Newer forms of violent media seem to be especially concerning.

Childhood maltreatment and early alcohol use among high-risk adolescents.

OBJECTIVE: Child maltreatment (CM) is prevalent among U.S. youth and has been associated with subsequent maladaptive behaviors, including substance use. The current study examines the associations between early child maltreatment and (1) preteen alcohol-use initiation and (2) heavy episodic drinking among students in a large study of adolescents. METHOD: The Youth Violence Survey is a cross-sectional survey of public school students enrolled in Grades 7,9, 11, and 12 in a school district in a high-risk community. The analysis sample was limited to students who provided complete data on all relevant variables (N= 3,559). Fifty-two percent of the analysis sample was female. Early child maltreatment was defined as witnessing domestic violence and experiencing physical and/or sexual abuse before the age of 10 years. Outcome variables include ever drinking alcohol, preteen alcohol-use initiation, and heavy episodic drinking. RESULTS: Witnessing domestic violence, experiencing physical abuse, and experiencing sexual abuse were significantly associated with preteen alcohol-use initiation (adjusted odds ratio [AOR] = 1.55, 95% confidence interval [CI]: 1.26-1.91; AOR = 2.10, 95% CI: 1.69-2.63; AOR = 1.57, 95% CI: 1.16-2.14, respectively). Students who experienced one or more types of maltreatment were 1.5-3 times more likely to report preteen alcohol-use initiation. Heavy episodic drinking was associated only with childhood sexual abuse in boys (AOR = 2.62, 95% CI: 1.52-4.50). CONCLUSIONS: Prevention and treatment of the negative impact of early child maltreatment may delay and reduce alcohol use.

Linking dating violence, peer violence, and suicidal behaviors among high-risk youth.

BACKGROUND: Gaps in the understanding of how different types of violent behavior are linked have limited the ability to design violence prevention efforts that can address multiple types of violence. The objective of this study was to quantify the associations among suicide attempts, and date and peer violence victimization and perpetration and to determine any differences in these associations by gender. METHODS: Analyses, computed in 2006 and 2007, used data from the Youth Violence Survey conducted in 2004. This survey was administered to over 80% of public school students in grades 7, 9, 11, and 12 (N=4131) in a high-risk, urban school district. Analyses were restricted to adolescents who dated in the past year (n=2888). Five forms of violent behaviors (i.e., dating violence perpetration, dating violence victimization, peer violence perpetration, peer violence victimization, and suicide attempts) were examined. RESULTS: Peer violence victimization was the most common type of violence reported (33.0%), followed by date violence victimization (30.7%), peer violence perpetration (29.9%), date violence perpetration (24.8%), and suicide attempts (11.2%). Among all students, 9.8% reported involvement in at least four of the five violent behaviors examined. All five forms of violent behaviors were associated. The highest ORs were observed for victimization and perpetration within either the dating or peer context. However, associations across contexts were also observed. CONCLUSIONS: There is a substantial overlap among different forms of violent behavior, suggesting that additional research is needed to better understand the factors that contribute to involvement in multiple forms of violence.

Hierarchical messages for introducing multiple HIV prevention options: promise and pitfalls.

In battling HIV, many interventionists advocate the use of hierarchical messages that present multiple prevention options in order of decreasing effectiveness. The purpose of the present study was to determine if hierarchical messages provide women with additional prevention options without reducing the perceived efficacy of and willingness to use the primary method mentioned (in this case, male condoms). African American and Mexican American women between 18 and 32 years of age (n=112) at risk for HIV were randomly assigned to receive either a male-condom-only message (use male condoms) or a hierarchical message (use male condoms; if not, use female condoms; if not, use spermicide). Compared with women in the male-condom-only condition, a significantly smaller percentage of women who received the hierarchical message perceived male condoms as highly effective against HIV. Women currently not using male condoms who received the hierarchical, rather than the male-condom-only, message were less likely to consider using male condoms in the future. Among current male condom users, however, the hierarchical message did not influence intent to use male condoms. These data point to the need for examining both the intended and unintended effects of hierarchical health care messages.

Persistence of inconsistent condom use: relation to abuse history and HIV serostatus.

This study longitudinally examines the relation between a history of experiencing childhood and adult physical or sexual abuse, and male condom use by women with or at risk for HIV. Abuse history and prospective condom use data were collected from 214 HIV infected and 189 uninfected women participating in the HIV Epidemiology Research Study (HERS) who were inconsistent condom users at baseline and received two safer sex counseling sessions. Analyses were conducted to assess the association between abuse history and condom use while controlling for sociodemographic variables and other risk factors. HIV-uninfected women with a history of adult physical abuse were five times less likely to report consistent condom use at 1-year follow-up than uninfected women without a history of abuse while holding control variables constant. Expectations of a negative reaction by the partner to suggested condom use did not explain this association. Though in the same direction as in uninfected women, abuse history was not significantly related to consistent condom use among HIV-infected women. These data indicate the need to develop risk prevention strategies tailored to uninfected women with a history of adult abuse. In lieu of specialized interventions, health care providers should assess women's abuse history and supplement HIV prevention counseling with mental health counseling when indicated.

Factors associated with maintenance of long-term plasma human immunodeficiency virus RNA suppression.

To analyze factors associated with long-term (>or=2 years) suppression of virus load (VL), we performed a nested case-control analysis of 1235 Human Immunodeficiency Virus Outpatient Study cohort participants who were well characterized by multiple VL and CD4(+) cell count determinations. Of these patients, 286 (23.1%) had maintained undetectable VLs (i.e., <400 copies/mm(3) or <50 copies/mm(3)) for >or=2 years. Being treatment naive at the start of antiretroviral therapy was associated with a greater likelihood of achieving long-term suppression of VL (odds ratio [OR], 1.5; 95% confidence interval, 1.0-2.0; P=.028). In multivariate models, abacavir, indinavir, efavirenz, and drug combinations that included both lamivudine and indinavir were the most effective treatments for achieving long-term suppression of VL (adjusted OR for each, >3.6; P value for each, <.01). Long-term suppression of VL is more likely in treatment-naive than in treatment-experienced patients, but there were several drugs--abacavir, efavirenz, indinavir, and drug combinations including lamivudine and indinavir--that appeared to be effective, whether they were part of a first or subsequent drug regimen.

Mortality rates and causes of death in a cohort of HIV-infected and uninfected women, 1993-1999.

HIV/AIDS-associated and non-HIV/AIDS-associated death rates and causes of death between 1993 and 1999 were examined in 885 HIV-infected women and 425 uninfected women of the HIV Epidemiology Research Study cohort. Causes of death were determined by review of death certificates and the National Death Index. Adjusted hazard ratios were calculated for mortality risk factors. In the 885 HIV-infected women and 425 uninfected women, 234 deaths and 8 deaths, respectively, occurred by December 31, 1999. All-cause death rates in the HIV-infected women were unchanged between the pre-HAART (1993-1996) and HAART eras (1997-1999)-5.1 versus 5.4 deaths per 100 person-years (py). AIDS as a cause of death decreased from 58% of all deaths in 1996 to 19% in 1999, while HAART use increased to 42% by the end of 1999. In spite of the modest proportion ever using HAART, HIV-related mortality rates did decline, particularly in women with CD4+ cell counts less than 200/mm(3). Drug-related factors were prominent: for the 129 non-AIDS-defining deaths, hepatitis C positivity (relative hazard [RH] 2.6, P <.001) and injection drug use (RH 1.7, P = 0.02) were strong predictors of mortality, but were not significant in the Cox model for 105 AIDS-defining deaths (RH 0.9, P >.30 and RH 0.7, P >.30, respectively. The regression analysis findings, along with the high percentage of non-AIDS deaths attributable to illicit drug use, suggest that high levels of drug use in this population offset improvements in mortality from declining numbers of deaths due to AIDS.