Belt fit for children in vehicle seats with and without belt-positioning boosters.

OBJECTIVE: The purpose of the current study is to use 3D technology to measure in-vehicle belt fit both with and without booster seats across different vehicles among a large, diverse sample of children and to compare belt fit with and without a booster. METHODS: Lap and shoulder belt fit were measured for 108 children ages 6-12 years sitting in the second-row, outboard seats of three vehicles from October 2017 to March 2018. Each child was measured with no booster, a backless booster, and a high-back (HB) booster in three different vehicles. Alternative high-back (HB HW) and backless boosters that could accommodate higher weights were used for children who were too large to fit in the standard boosters. Lap and torso belt scores were computed based on the belt location relative to skeletal landmarks. RESULTS: Both lap and torso belt fit scores were significantly different across vehicles when using the vehicle belt alone (no booster). In all vehicles, lap belt fit improved when using boosters compared with no booster among children ages 6-12 years in rear seats-with one exception of the HB HW booster in the minivan. Torso belt fit improved when using boosters compared with no booster in the sedan, and torso belt fit improved in the minivan and SUV with the use of HB and HB HW boosters when compared with no booster. CONCLUSIONS: Lap and torso belt fit for children ages 6-12 years in rear seats was substantially improved by using boosters. Parents and caregivers should continue to have their children use booster seats until vehicle seat belts fit properly which likely does not occur until children are 9-12 years old. Decision makers can consider strengthening child passenger restraint laws with booster seat provisions that require children who have outgrown car seats to use booster seats until at least age 9 to improve belt fit and reduce crash injuries and deaths.

Examining Patterns of Driving Avoidance Behaviors Among Older People Using Latent Class Analysis.

Objectives: Some older drivers choose to avoid certain situations where they do not feel confident driving. Little is known about the process by which older drivers may use avoidance in transitioning to non-driving. Methods: We analyzed 2015 ConsumerStyles data for 1198 drivers aged 60+. Driving patterns were examined by sociodemographic and driving characteristics. Avoidance classes were characterized by latent class analysis. Results: Among drivers 60+, 79% reported driving 3+ days/week and 84% reported good to excellent health. We identified four driving avoidance classes (low, mild, moderate, and high). High- (versus low-) avoidance drivers were more likely female, 75+, not White/non-Hispanic, and to have income <$25,000/year. Discussion: Avoidance of selected driving behaviors may be one component of a multi-step process supporting the transition to non-driving. Drivers displaying avoidance behaviors may be receptive to resources to prepare for this transition and minimize negative health and quality of life outcomes that accompany driving cessation.

Use of child safety seats and booster seats in the United States: A comparison of parent/caregiver-reported and observed use estimates.

BACKGROUND: Motor-vehicles crashes are a leading cause of death among children. Age- and size-appropriate restraint use can prevent crash injuries and deaths among children. Strategies to increase child restraint use should be informed by reliable estimates of restraint use practices. OBJECTIVE: Compare parent/caregiver-reported and observed child restraint use estimates from the FallStyles and Estilos surveys with the National Survey of the Use of Booster Seats (NSUBS). METHODS: Estimates of child restraint use from two online, cross-sectional surveys-FallStyles, a survey of U.S. adults, and Estilos, a survey of U.S. Hispanic adults-were compared with observed data collected in NSUBS. Parents/caregivers of children aged ≤ 12 years were asked about the child's restraint use behaviors in FallStyles and Estilos, while restraint use was observed in NSUBS. Age-appropriate restraint use was defined as rear-facing child safety seat (CSS) use for children aged 0-4 years, forward-facing CSS use for children aged 2-7 years, booster seat use for children aged 5-12 years, and seat belt use for children aged 9-12 years. Age-appropriate restraint users are described by demographic characteristics and seat row, with weighted prevalence and corresponding 95% confidence intervals (CI) calculated. RESULTS: Overall, child restraint use as reported by parents/caregivers was 90.8% (CI: 87.5-94.1) (FallStyles) and 89.4% (CI: 85.5-93.4) for observed use (NSUBS). Among Hispanic children, reported restraint use was 82.6% (CI: 73.9-91.3) (Estilos) and 84.4% (CI: 79.0-88.6) for observed use (NSUBS, Hispanic children only). For age-appropriate restraint use, estimates ranged from 74.3% (CI: 69.7-79.0) (FallStyles) to 59.7% (CI: 55.0-64.4) (NSUBS), and for Hispanic children, from 71.5% (CI: 62.1-81.0) (Estilos) to 57.2% (CI: 51.2-63.2) (NSUBS, Hispanic children only). Conclusion and Practical Application: Overall estimates of parent/caregiver-reported and observed child restraint use were similar. However, for age-appropriate restraint use, reported use was higher than observed use for most age groups.

Unintentional injury deaths in children and youth, 2010-2019.

BACKGROUND: Unintentional injuries are the leading cause of death for children and youth aged 1-19 in the United States. The purpose of this report is to describe how unintentional injury death rates among children and youth aged 0-19 years have changed during 2010-2019. METHOD: CDC analyzed 2010-2019 data from the National Vital Statistics System (NVSS) to determine two-year average annual number and rate of unintentional injury deaths for children and youth aged 0-19 years by sex, age group, race/ethnicity, mechanism, county urbanization level, and state. RESULTS: From 2010-2011 to 2018-2019, unintentional injury death rates decreased 11% overall-representing over 1,100 fewer annual deaths. However, rates increased among some groups-including an increase in deaths due to suffocation among infants (20%) and increases in motor-vehicle traffic deaths among Black children (9%) and poisoning deaths among Black (37%) and Hispanic (50%) children. In 2018-2019, rates were higher for males than females (11.3 vs. 6.6 per 100,000 population), children aged < 1 and 15-19 years (31.9 and 16.8 per 100,000) than other age groups, among American Indian or Alaska Native (AIAN) and Blacks than Whites (19.4 and 12.4 vs. 9.0 per 100,000), motor-vehicle traffic (MVT) than other causes of injury (4.0 per 100,000), and rates increased as rurality increased (6.8 most urban [large central metro] vs. 17.8 most rural [non-core/non-metro] per 100,000). From 2010-2011 to 2018-2019, 49 states plus DC had stable or decreasing unintentional injury death rates; death rates increased only in California (8%)-driven by poisoning deaths. Conclusion and Practical Application: While the overall injury death rates improved, certain subgroups and their caregivers can benefit from focused prevention strategies, including infants and Black, Hispanic, and AIAN children. Focusing effective strategies to reduce suffocation, MVT, and poisoning deaths among those at disproportionate risk could further reduce unintentional injury deaths among children and youth in the next decade.

Older Adults' Attitudes About Future Mobility Changes and the Usefulness of Mobility Assessment Materials.

OBJECTIVES: To understand older adults' attitudes about future mobility and usefulness of mobility assessment materials. METHODS: Data came from a telephone survey of 1,000 older adults aged 60-74 years. After answering baseline questions, respondents received mobility assessment materials, then completed follow-up interviews. Respondents were asked about future mobility challenges. During baseline and follow-up, subjects were asked four questions about their mobility as they aged which measured thinking about mobility, thinking about protecting mobility, confidence in protecting mobility, and motivation to protect mobility. Differences in percent of respondents' attitudes between baseline and follow-up and 95% confidence intervals were calculated. RESULTS: Driving (42%) was the most commonly reported challenge. Significant increases from baseline to follow-up in thinking about mobility (25%), thinking about protecting mobility (39%), and confidence in protecting mobility (29%) were reported. DISCUSSION: Brief mobility assessment materials can encourage older adults to consider future mobility. Planning for changes can prolong safe mobility.

How do older adult drivers self-regulate? Characteristics of self-regulation classes defined by latent class analysis.

PROBLEM: Motor-vehicle crashes were the second leading cause of injury death for adults aged 65-84years in 2014. Some older drivers choose to self-regulate their driving to maintain mobility while reducing driving risk, yet the process remains poorly understood. METHODS: Data from 729 older adults (aged ≥60years) who joined an older adult ride service program between April 1, 2010 and November 8, 2013 were analyzed to define and describe classes of driving self-regulation. Latent class analysis was employed to characterize older adult driving self-regulation classes using driving frequency and avoidance of seven driving situations. Logistic regression was used to explore associations between characteristics affecting mobility and self-regulation class. RESULTS: Three classes were identified (low, medium, and high self-regulation). High self-regulating participants reported the highest proportion of always avoiding seven risky driving situations and the lowest driving frequency followed by medium and low self-regulators. Those who were female, aged 80years or older, visually impaired, assistive device users, and those with special health needs were more likely to be high self-regulating compared with low self-regulating. CONCLUSIONS AND PRACTICAL APPLICATIONS: Avoidance of certain driving situations and weekly driving frequency are valid indicators for describing driving self-regulation classes in older adults. Understanding the unique characteristics and mobility limitations of each class can guide optimal transportation strategies for older adults.

Driving self-regulation and ride service utilization in a multicommunity, multistate sample of U.S. older adults.

OBJECTIVES: This study examined a multicommunity alternative transportation program available 24 hours a day, 7 days a week, for any purpose, offering door-through-door service in private automobiles to members who either do not drive or are transitioning away from driving. Specific aims were to describe the characteristics of members by driving status and ride service usage of these members. METHODS: Data came from administrative records maintained by a nonprofit ride service program and include 2,661 individuals aged 65+ residing in 14 states who joined the program between April 1, 2010, and November 8, 2013. Latent class analysis was used to group current drivers into 3 classes of driving status of low, medium, and high self-regulation, based on their self-reported avoidance of certain driving situations and weekly driving frequency. Demographics and ride service use rate for rides taken through March 31, 2014, by type of ride (e.g., medical, social, etc.) were calculated for nondrivers and drivers in each driving status class. RESULTS: The majority of ride service users were female (77%) and aged 65-74 years (82%). The primary method of getting around when enrolling for the transportation service was by riding with a friend or family member (60%). Among the 67,883 rides given, nondrivers took the majority (69%) of rides. Medical rides were the most common, accounting for 40% of all rides. CONCLUSIONS: Reported ride usage suggests that older adults are willing to use such ride services for a variety of trips when these services are not limited to specific types (e.g., medical). Further research can help tailor strategies to encourage both nondrivers and drivers to make better use of alternative transportation that meets the special needs of older people.

Child safety and booster seat use in five tribal communities, 2010-2014.

PROBLEM: Motor-vehicle crashes are a leading cause of death for American Indian/Alaska Natives (AI/AN) including AI/AN children. Child safety seats prevent injury and death among children in a motor-vehicle crash, yet use is low among AI/AN children. METHODS: To increase the use of child safety seats (CSS; car seats and booster seats), five tribal communities implemented evidence-based strategies from the Guide to Community Preventive Services during 2010-2014. Increased CSS use was evaluated through direct observational surveys and CSS event data. CSS events are used to check the installation, use, and safety of CSS and new CSS can be provided. RESULTS: CSS use increased in all five programs (ranging from 6% to 40%). Four out of five programs exceeded their goals for increased use. Among the five communities, a total of 91 CSS events occurred resulting in 1417 CSS checked or provided. CONCLUSIONS AND PRACTICAL APPLICATIONS: Evidence-based child passenger safety interventions are both feasible in and transferable to tribal communities.

Assistive device use and mobility-related factors among adults aged≥65years.

INTRODUCTION: Examining how assistive device (cane, walker) use relates to other mobility factors can provide insight into older adults' future mobility needs. METHODS: Data come from the Second Injury Control and Risk Survey, Phase 2 (ICARIS2-P2), conducted from March 2007 to May 2008. Prevalence estimates were calculated for older adults (aged ≥65) and multivariable logistic regression was used to explore associations between assistive device use and mobility-related characteristics. RESULT: Compared with non-users, assistive device users were more likely to report a recent fall (AOR 12.0; 95% CI 4.9-29.3), limit walking outside due to concerns about falling (AOR 7.1; 95% CI 2.6-19.1), be unable to walk outside for 10min without resting (AOR 3.3; 95% CI 1.1-9.3), and be no longer driving (AOR 6.7; 95% CI 2.0-22.3). CONCLUSION: Assistive device users have limited mobility and an increased risk for fall injury compared with non-users. PRACTICAL APPLICATION: Effective fall prevention interventions, and innovative transportation options, are needed to protect the mobility of this high-risk group.

Health Care providers and Teen Driving Safety: Topics Discussed and Educational Resources Used in Practice.

Traffic crashes are the leading cause of death among teens. Health care providers have an opportunity to address what works to keep teens safe on the road during the patient visit. An online survey was conducted of 1088 health care providers who saw patients at or near driving age. The survey assessed which road safety topics were discussed and which types of educational products were used most often. Family and general practice physicians represented 44.3% of the sample, followed by pediatricians (22.5%), nurse practitioners (17.6%), and internists (15.5%). Nearly all respondents (92.9%) reported addressing one or more driving safety factors (seat belt use, nighttime driving, fatigue, teen passengers, alcohol/drug use, speeding/reckless driving, and cell phone use/texting) with adolescent patients and/or their parents. Seat belt use was reported more often (83.7%) than other topics. The use of parent-teen driving agreements, a known effective intervention, was reported by less than 10% of respondents. Since health care providers expressed interest in receiving written resource materials, distribution of parent-teen driving agreements to health care providers might encourage greater uptake and use of this effective intervention.

ATV riding and helmet use among youth aged 12-17†years, USA, 2011: results from the YouthStyles survey.

BACKGROUND: National estimates of all-terrain vehicle (ATV) riding patterns among youth in the USA are lacking. METHODS: We analysed the 2011 YouthStyles survey to estimate the proportion of 12-17 year olds in the USA who had ridden an ATV at least once during the past 12 months and summarise their patterns of helmet use. RESULTS: Of the 831 youth respondents, an estimated 25% reported riding an ATV at least once during the past year. The proportion of youth living outside of a Metropolitan Statistical Area who reported riding an ATV was twice that of those living inside of a Metropolitan Statistical Area. Males and females reported similar proportions of riding at least once during the past year, but among riders, the proportion of males who rode ≥6 times was triple that of females. Only 45% of riders reported always wearing a helmet, and 25% reported never wearing a helmet. The most frequent riders had the lowest consistent helmet use, with 8 of 10 youth who rode ≥6 times during the past year not always wearing a helmet. CONCLUSIONS: ATV riding appears to remain popular among youth in the USA, particularly in rural areas, and consistent helmet use while riding is low. A more thorough understanding of gender differences in ATV riding patterns among youth and perceived risks and benefits of both safe and unsafe riding practices might help inform future ATV injury prevention efforts.

Tribal motor vehicle injury prevention programs for reducing disparities in motor vehicle-related injuries.

A previous analysis of National Vital Statistics System data for 2003-2007 that examined disparities in rates of motor vehicle-related death by race/ethnicity and sex found that death rates for American Indians/Alaska Natives were two to four times the rates of other races/ethnicities. To address the disparity in motor vehicle-related injuries and deaths among American Indians/Alaska Natives, CDC funded four American Indian tribes during 2004-2009 to tailor, implement, and evaluate evidence-based road safety interventions. During the implementation of these four motor vehicle-related injury prevention pilot programs, seat belt and child safety seat use increased and alcohol-impaired driving decreased. Four American Indian/Alaska Native tribal communities-the Tohono O'odham Nation, the Ho-Chunk Nation, the White Mountain Apache Tribe, and the San Carlos Apache Tribe-implemented evidence-based road safety interventions to reduce motor vehicle-related injuries and deaths. Each community selected interventions from the Guide to Community Preventive Services and implemented them during 2004-2009. Furthermore, each community took a multifaceted approach by incorporating several strategies, such as school and community education programs, media campaigns, and collaborations with law enforcement officers into their programs. Police data and direct observational surveys were the main data sources used to assess results of the programs. Results included increased use of seat belts and child safety seats, increased enforcement of alcohol-impaired driving laws, and decreased motor vehicle crashes involving injuries or deaths. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion as an example of a program that might be effective for reducing motor vehicle-related injury disparities in the United States. The Guide to Community Preventive Services recognizes these selected interventions as effective; this report examines the feasibility and transferability for implementing the interventions in American Indian/Alaska Native tribal communities. The findings in this report underscore the effectiveness of community interventions to reduce motor vehicle crashes among selected American Indian/Alaska Native communities.

Vital signs: restraint use and motor vehicle occupant death rates among children aged 0-12 years - United States, 2002-2011.

BACKGROUND: Motor vehicle crashes are a leading cause of death among children in the United States. Age- and size-appropriate child restraint use is the most effective method for reducing these deaths. METHODS: CDC analyzed 2002­2011 data from the Fatality Analysis Reporting System to determine the number and rate of motor-vehicle occupant deaths, and the proportion of unrestrained child deaths among children aged <1 year, 1­3 years , 4­7 years, 8­12 years, and for all children aged 0­12 years. Age group­specific death rates and proportions of unrestrained child motor vehicle deaths for 2009­2010 were further stratified by race/ethnicity. RESULTS: Motor vehicle occupant death rates for children declined significantly from 2002 to 2011. However, one third (33%) of children who died in 2011 were unrestrained. Compared with white children for 2009­2010, black children had significantly higher death rates, and black and Hispanic children both had significantly higher proportions of unrestrained child deaths. CONCLUSIONS: Motor vehicle occupant deaths among children in the United States have declined in the past decade, but more deaths could be prevented if restraints were always used. IMPLICATIONS FOR PUBLIC HEALTH: Effective interventions, including child passenger restraint laws (with child safety seat/ booster seat coverage through at least age 8 years) and child safety seat distribution plus education programs, can increase restraint use and reduce child motor vehicle deaths.

Motor vehicle-related deaths - United States, 2005 and 2009.

Motor vehicle crashes are a leading cause of death for children, teenagers, and young adults in the United States. In 2009, approximately 36,000 persons were killed in motor vehicle crashes, and racial/ethnic minorities were affected disproportionally. Approximately 4.3% of all American Indian/Alaska Native (AI/AN) deaths and 3.3% of all Hispanic deaths were attributed to crashes, whereas crashes were the cause of death for <1.7% of blacks, whites, and Asian/Pacific Islanders (A/PI).

All-terrain vehicle-related nonfatal injuries among young riders in the United States, 2001-2010.

OBJECTIVE: To estimate the numbers and rates of all-terrain vehicle (ATV)-related nonfatal injuries among riders aged ≤ 15 years treated in hospital emergency departments (EDs) in the United States during 2001-2010. METHODS: National Electronic Injury Surveillance System-All Injury Program data for 2001-2010 were analyzed. Numbers and rates of injuries were examined by age group, gender, primary body part injured, diagnosis, and hospital admission status. RESULTS: During 2001-2010, an estimated 361,161 ATV riders aged ≤ 15 years were treated in EDs for ATV-related injuries. The injury rate peaked at 67 per 100,000 children in 2004 and then declined to 42 per 100,000 children by 2010. The annualized injury rate for boys was double that of girls (73 vs 37 per 100,000). Children aged 11 to 15 years accounted for two-thirds of all ED visits and hospitalizations. Fractures accounted for 28% of ED visits and 45% of hospitalizations. CONCLUSIONS: The reasons for the decline in ATV-related injuries among young riders are not well understood but might be related to the economic recession of the mid-2000s and decreased sales of new ATVs. Although many states have regulations governing children's use of ATVs, their effectiveness in reducing injuries is unclear. Broader use of known effective safety measures, including prohibiting children aged ≤ 15 years from riding adult-sized ATVs, always wearing a helmet while riding, not riding on paved roads, and not riding as or carrying a passenger could additionally reduce ATV-related injuries among children. Last, more research to better understand ATV crash dynamics might lead to safer designs for ATVs.

Disparities in motor vehicle-related deaths among females-United States, 2005-2009.

BACKGROUND: In 2010, almost 11,000 females were killed in motor vehicle crashes, and racial/ethnic minorities were affected disproportionally. METHODS: To assess disparities in motor vehicle-related death rates by race/ethnicity among females in the United States, the Centers for Disease Control and Prevention analyzed 2005-2009 data from the National Vital Statistics System. Death rates and corresponding 95% confidence intervals were calculated, and differences between 2005 and 2009 death rates were examined. RESULTS: The motor vehicle-related death rate for females was 6.8 deaths per 100,000 population in 2009. American Indian/Alaska Native females had the highest motor vehicle-related death rates, followed by whites, blacks, Hispanics, and Asian/Pacific Islanders. The greatest decrease in death rates between 2005 and 2009 occurred among whites from a rate of 9.4 per 100,000 population (95% CI: 9.2-9.6) to 7.1 per 100,000 population (95% CI: 6.9-7.2; absolute rate change: -2.3; p<0.001). CONCLUSION: Despite the recent declines in motor vehicle-related death rates noted in this article, the need remains for increased use of evidence-based strategies to reduce the burden of motor vehicle-related deaths among females overall and especially among American Indian/Alaska Natives.

Adult opinions about the age at which children can be left home alone, bathe alone, or bike alone: Second Injury Control and Risk Survey (ICARIS-2).

PROBLEM: This study describes adult opinions about child supervision during various activities. METHODS: Data come from a survey of U.S. adults. Respondents were asked the minimum age a child could safely: stay home alone; bathe alone; or ride a bike alone. Respondents with children were asked if their child had ever been allowed to: play outside alone; play in a room at home for more than 10 minutes alone; bathe with another child; or bathe alone. RESULTS: The mean age that adults believed a child could be home alone was 13.0 years (95% CI=12.9-13.1), bathe alone was 7.5 years (95% CI=7.4-7.6), or bike alone was 10.1 years (95% CI=10.0-10.3). There were significant differences by income, education, and race. DISCUSSION: Assessing adult's understanding of the appropriate age for independent action helps set a context for providing guidance on parental supervision. Guidelines for parents should acknowledge social norms and child development stages. IMPACT ON INDUSTRY: Knowledge of social norms can help guide injury prevention messages for parents.

Fatal crashes of 16- to 17-year-old drivers involving alcohol, nighttime driving, and passengers.

OBJECTIVE: The objective of this study was to provide a contemporary analysis of the alcohol-impaired driving problem among 16- to 17-year-olds and to consider the potential role of night and passenger restrictions in dealing with the alcohol problem by determining how many of the alcohol-related crashes take place at night or with passengers. METHODS: The data were derived from the Fatality Analysis Reporting System for 16- to 17-year-old passenger vehicle drivers in fatal crashes during 2005-2009. RESULTS: During the 5-year period, 15 percent of the 8664 16- to 17-year-old drivers in fatal crashes had positive blood alcohol concentrations, most of which were 0.08 percent or greater. Drivers in alcohol-related crashes were more likely than those in non-alcohol-related crashes to be male, unbelted, in single vehicles, and speeding, and their crashes were more likely to occur on Saturday or Sunday, at night, and when passengers were present. Of the alcohol-related crashes, 88 percent took place at night or with passengers present or both, as did 67 percent of the non-alcohol-related crashes. CONCLUSIONS: Stronger night and passenger restrictions with increased compliance and greater application of alcohol-specific policies would likely be effective in reducing the alcohol-related and non-alcohol-related crashes of 16- to 17-year-olds. Increasing the licensing age beyond age 16 would supplement the effectiveness of these actions.

Children at Risk for Suicide Attempt and Attempt-related Injuries: Findings from the 2007 Youth Risk Behavior Survey.

PURPOSE: The current study examines the associations between a range of risk factors and reports of suicide attempts and attempts requiring medical care in a nationally representative study of high school students. The goal is to examine sex differences in the risk factors associated with suicide attempts and attempt-related injuries requiring treatment by a health-care provider. METHODS: We used data from the 2007 Youth Risk Behavior Survey for students in grades 9-12 to assess the prevalence and risk factors for suicidal behavior, as well as differences in these for boys and girls. Cross-sectional multivariate logistic regression analyses were computed to determine the most important risk factors for suicide attempts and for suicide attempts requiring medical care for the sample overall and also stratified for boys and for girls. RESULTS: Overall, 6.9% of adolescents attempted suicide (9.3% of girls versus 4.6% of boys). Girls were more likely than boys to report a suicide attempt in the past year (Adj.OR=2.89). Among girls, sadness (Adj.OR=5.74), weapon carrying (Adj.OR=1.48), dating violence (Adj.OR=1.60), forced sex (Adj.OR=1.72), and huffing glue (Adj.OR=2.04) were significantly associated with suicide attempts. Among boys, sadness (Adj.OR=10.96), weapon carrying (Adj.OR=1.66), forced sex (Adj.OR=2.60), huffing glue (OR=1.63), hard drug use (Adj.OR=2.18), and sports involvement (Adj.OR=1.52) were significantly associated with suicide attempts. CONCLUSION: These findings demonstrate similarities and differences in the modifiable risk factors that increase risk for suicide attempts among boys and girls. In terms of the differences between boys and girls, hard drug use and sports involvement may be important factors for suicide-prevention strategies directed specifically towards boys, while dating violence victimization may be an important risk factor to address for girls. Overall, these findings can help guide prevention, clinical practice, and intervention strategies to prevent suicidal behaviors among adolescents.