Exposure to personal and community violence and associated drug use outcomes in African American young adults.

BACKGROUND: Exposure to violence (ETV) during one's life has been associated with increased risk for substance abuse. Adolescent ETV is also related to substance abuse into adulthood, and has been shown to have a cumulative effect. This study adds to the understanding of how ETV relates to a range of substance use outcomes by specifying how different types of violence affects substance use behaviors in African American young adults, and examines how this exposure is moderated by other life stressors, and health and social experiences. METHOD: Factor analysis was conducted to identify unique types of ETV in 638 African American men and women ages 18-25. The resulting factors represent 1) childhood ETV and 2) community ETV as adults. These were regressed upon substance abuse outcomes. RESULTS: 78% of the respondents were exposed to some form of violence during their childhood. Lower childhood ETV were significantly associated with a lower risk of engaging in dangerous substance use behaviors. Adult experiences of community violence had more significant predictors of drug use than childhood ETV. Witnessing gunfire or an assault, witnessing or being a victim of sexual assault, and carrying a weapon were consistent risk factors for dangerous drug behaviors, although specific drug use behaviors differed across genders. CONCLUSIONS: ETV served as an independent explanatory factor for specific drug use behaviors at different stages of life. Future research is needed to understand how these factors put respondents at risk for drug use behaviors or make them less likely to engage in dangerous use patterns.

Effects of Different Types of Childhood Victimization on Health Outcomes: A Study of African American Young Adults in Washington, D.C.

OBJECTIVE: Some children experience violence and trauma with effects lasting into adulthood. We examine how five types of childhood exposure to violence (ETV) affect the current depression, sleep habits, and drug use of 638 African American youth ages 18 to 25, in Washington, D.C. METHODS: We correlated childhood exposure to conventional crime, child maltreatment, peer/sibling victimization, sexual victimization, and witnessing crime/indirect (WC/I) victimization with depressive symptoms, depressive moods, trouble sleeping, current drug use, lifetime alcohol, tobacco, and other drug (ATOD) use, and current ATOD use problems. RESULTS: Depressive symptoms and lifetime ATOD use were significantly correlated with each childhood ETV measure; depressive moods with WC/I and peer/sibling victimization, trouble sleeping with childhood maltreatment and current drug use, and problems with ATOD with childhood sexual victimization. CONCLUSIONS: Specific types of ETV are correlated with different behavioral and health outcomes in young adulthood and these differences are important to study further.

Violence Exposure, Drug Use and HIV/AIDS Risk Taking Behaviors: The Role of Gender.

OBJECTIVE: To examine gender differences among African American young adults in their exposure to violence (ETV) before age 18 and community violence as an adult, and the relationship of these exposures to drug use and HIV risk taking behaviors (HIVRTB). METHOD: We detail these experiences in 440 self-identified African Americans, ages 18 to 25, from socio-economically disadvantaged wards in Washington, DC. Factor analysis was used to identify the types of violence experienced before age 18 and as adults. Regression was used to identify which types of violence had the greatest impact on subsequent drug use and HIVRTB. RESULTS: We found gender differences in the types of violence experienced and their effects on drug use and HIVRTB. For women, the strongest ETV factors were direct personal violence, and exposure to drug sales or physical violence as adults. For men, the strongest factors were feeling unsafe in different situations as adults and exposure to violence among adults before age 18. CONCLUSIONS: We identified the specific kinds of violence that are most likely to impact drug use and risky sexual behaviors that can leave one vulnerable to HIV and how these differ between women and men exposed to both childhood violence and community violence as an adult. Our findings point toward the need for trauma-informed programs that are tailored to gender.

Racial and Ethnic Disparities in Health and Health Care: an Assessment and Analysis of the Awareness and Perceptions of Public Health Workers Implementing a Statewide Community Transformation Grant in Texas.

INTRODUCTION: Little is known about the awareness of public health professionals regarding racial and ethnic disparities in health in the United States of America (USA). Our study objective was to assess the awareness and perceptions of a group of public health workers in Texas regarding racial health disparities and their chief contributing causes. METHODS: We surveyed public health professionals working on a statewide grant in Texas, who were participants at health disparities' training workshops. Multivariable logistic regression was employed in examining the association between the participants' characteristics and their perceptions of the social determinants of health as principal causes of health disparities. RESULTS: There were 106 respondents, of whom 38 and 35 % worked in health departments and non-profit organizations, respectively. The racial/ethnic groups with the highest incidence of HIV/AIDS and hypertension were correctly identified by 63 and 50 % of respondents, respectively, but only 17, and 32 % were knowledgeable regarding diabetes and cancer, respectively. Seventy-one percent of respondents perceived that health disparities are driven by the major axes of the social determinants of health. Exposure to information about racial/ethnic health disparities within the prior year was associated with a higher odds of perceiving that social determinants of health were causes of health disparities (OR 9.62; 95 % CI 2.77, 33.41). CONCLUSION: Among public health workers, recent exposure to information regarding health disparities may be associated with their perceptions of health disparities. Further research is needed to investigate the impact of such exposure on their long-term perception of disparities, as well as the equity of services and programs they administer.