Lifetime use of multiple substances and youth suicide risk: assessing the role of depressive symptoms using structural equation modeling.

OBJECTIVES: This study assessed the direct and indirect effects (via depressive symptoms) of lifetime use of a broad range of substances on suicide risk among US adolescents. STUDY DESIGN: This was a cross-sectional study. METHODS: Data from the 2021 Youth Risk Behavior Survey were used (N = 12,303, 48.7% female). Associations between five types of substance use (cigarette, e-cigarette, alcohol, marijuana, and prescription pain medicine) and three dimensions of suicide risk (suicidal ideation, suicide plan, and suicide attempt) were measured by multivariate logistic regression models. The role of depressive symptoms was further examined by structural equation modeling. RESULTS: Almost three in five (57.5%) adolescents had used one or more substances in their lifetime (18.1% one type, 12.2% two types, 13.1% three types, 10.2% four types, and 3.8% five types). Adolescents using five substances were up to 16 times more likely to experience suicidal ideation and behaviors. Depressive symptoms significantly linked the pathway from substance use to suicide risk, resulting in much stronger indirect effects than the direct effects. Collectively, the five substance use behaviors and depressive symptoms explained about 60.4% of variance in suicidal ideation, 53.6% of variance in suicide plan, and 55.0% of variance in suicide attempt. CONCLUSIONS: Lifetime use of multiple substances is significantly correlated with suicidal ideation and behaviors among adolescents via the pathway of depressive symptoms. Routine screening for a broad range of substance use behaviors is needed to identify adolescents at risk for suicide and accessible mental health services could potentially attenuate the linkage between substance use and suicide risk.

Enhancing contrast distribution with the far lateral approach in lumbar transforaminal epidural steroid injections: A retrospective analysis.

BACKGROUND: Herniated intervertebral disc (HIVD) with radiculopathy is a common degenerative spine disorder. Transforaminal epidural steroid injection (TFESI) is one of the pain relief treatments for lumbar radiculopathy recommended by evidence-based guidelines. Adequate contrast distribution is correlated with better pain control, but the best approach has not been confirmed yet. AIM: To confirm the distribution of contrast medium injected with a new approach of TFESI, that is, far lateral lateral recess approach (FLLR-TFESI). METHODS: Patients receiving TFESI due to HIVD with radiculopathy between 2010 January and 2020 August were retrospectively enrolled. While the FLLR-TFESI was taken as the experimental group, the conventional approach was viewed as the control group. The baseline characteristics, the pattern of contrast enhancement under fluoroscopic guidance, and the complications of these patients were collected and analyzed. RESULTS: A total of 380 patients were analyzed (143 in control group and 237 in experimental group). The two groups were balanced in most baseline characteristics, except disc extrusion (p = 0.01) and scoliosis (p = 0.04). The FLLR-TFESI have a better contrast distribution (p < 0.01), even after adjustment (p < 0.001). No intrathecal injection was noted, but higher rate of intra-disc injection was noted in FLLR-TFESI group (10% vs. 3%, p = 0.008). CONCLUSION: The FLLR-TFESI has a superior contrast enhancement and distribution in comparison to conventional approach. Prospective study to confirm the study result as well as the clinical benefits is suggested in the future.

Emerging strategies for combating Fusobacterium nucleatum in colorectal cancer treatment: Systematic review, improvements and future challenges.

Colorectal cancer (CRC) is generally characterized by a high prevalence of Fusobacterium nucleatum (F. nucleatum), a spindle-shaped, Gram-negative anaerobe pathogen derived from the oral cavity. This tumor-resident microorganism has been closely correlated with the occurrence, progression, chemoresistance and immunosuppressive microenvironment of CRC. Furthermore, F. nucleatum can specifically colonize CRC tissues through adhesion on its surface, forming biofilms that are highly resistant to commonly used antibiotics. Accordingly, it is crucial to develop efficacious non-antibiotic approaches to eradicate F. nucleatum and its biofilms for CRC treatment. In recent years, various antimicrobial strategies, such as natural extracts, inorganic chemicals, organic chemicals, polymers, inorganic-organic hybrid materials, bacteriophages, probiotics, and vaccines, have been proposed to combat F. nucleatum and F. nucleatum biofilms. This review summarizes the latest advancements in anti-F. nucleatum research, elucidates the antimicrobial mechanisms employed by these systems, and discusses the benefits and drawbacks of each antimicrobial technology. Additionally, this review also provides an outlook on the antimicrobial specificity, potential clinical implications, challenges, and future improvements of these antimicrobial strategies in the treatment of CRC.

Phenyl-Extended Resorcin[4]arenes: Synthesis and Highly Efficient Iodine Adsorption.

The continuous exploration of new analogs of calixarenes and pillararenes unlocks infinite opportunities in supramolecular chemistry and materials. In this work, we introduce a new class of macrocycle, phenyl-extended resorcin[4]arenes (ExR4), a unique and innovative design that incorporates unsubstituted phenylene moieties into the resorcin[4]arene scaffold. Single-crystal analysis reveals a chair-like conformation for per-methylated ExR4 (Me-ExR4) and a twisted "figure-of-eight" shaped conformation for per-hydroxylated ExR4 (OH-ExR4). Notably, OH-ExR4 demonstrates exceptional adsorption capability toward I3- ions in an aqueous solution, with a rapid kinetic rate of 1.18×10-2 g·mg-1·min-1. Furthermore, OH-ExR4 shows excellent recyclability and potential as a stationary phase in column setups. The discovery of ExR4 opens up new avenues for constructing new macrocycles and inspires further research in functional adsorption materials for water pollutant removal.

An Antibiotic Nanobomb Constructed from pH-Responsive Chemical Bonds in Metal-Phenolic Network Nanoparticles for Biofilm Eradication and Corneal Ulcer Healing.

In the treatment of refractory corneal ulcers caused by Pseudomonas aeruginosa, antibacterial drugs delivery faces the drawbacks of low permeability and short ocular surface retention time. Hence, novel positively-charged modular nanoparticles (NPs) are developed to load tobramycin (TOB) through a one-step self-assembly method based on metal-phenolic network and Schiff base reaction using 3,4,5-trihydroxybenzaldehyde (THBA), ε-poly-ʟ-lysine (EPL), and Cu2+ as matrix components. In vitro antibacterial test demonstrates that THBA-Cu-TOB NPs exhibit efficient instantaneous sterilization owing to the rapid pH responsiveness to bacterial infections. Notably, only 2.6 µg mL-1 TOP is needed to eradicate P. aeruginosa biofilm in the nano-formed THBA-Cu-TOB owing to the greatly enhanced penetration, which is only 1.6% the concentration of free TOB (160 µg mL-1). In animal experiments, THBA-Cu-TOB NPs show significant advantages in ocular surface retention, corneal permeability, rapid sterilization, and inflammation elimination. Based on molecular biology analysis, the toll-like receptor 4 and nuclear factor kappa B signaling pathways are greatly downregulated as well as the reduction of inflammatory cytokines secretions. Such a simple and modular strategy in constructing nano-drug delivery platform offers a new idea for toxicity reduction, physiological barrier penetration, and intelligent drug delivery.

Supramolecular Modular Assembly of Imaging-Trackable Enzymatic Nanomotors.

Self-propelled micro/nanomotors (MNMs) have shown great application potential in biomedicine, sensing, environmental remediation, etc. In the past decade, various strategies or technologies have been used to prepare and functionalize MNMs. However, the current preparation strategies of the MNMs were mainly following the pre-designed methods based on specific tasks to introduce expected functional parts on the various micro/nanocarriers, which lacks a universal platform and common features, making it difficult to apply to different application scenarios. Here, we have developed a modular assembly strategy based on host-guest chemistry, which enables the on-demand construction of imaging-trackable nanomotors mounted with suitable driving and imaging modules using a universal assembly platform, according to different application scenarios. These assembled nanomotors exhibited enhanced diffusion behavior driven by enzymatic reactions. The loaded imaging functions were used to dynamically trace the swarm motion behavior of assembled nanomotors with corresponding fuel conditions both in vitro and in vivo. The modular assembly strategy endowed with host-guest interaction provides a universal approach to producing multifunctional MNMs in a facile and controllable manner, which paves the way for the future development of MNMs systems with programmable functions.

Metal-Phenolic Nanocapsules with Photothermal Antibacterial and Ros Scavenging Ability for Diabetic Wound Healing.

The presence of bacteria in diabetic wounds not only leads to the formation of biofilms but also triggers oxidative stress and inflammatory responses, which hinder the wound-healing process. Therefore, it is imperative to formulate a comprehensive strategy that can proficiently eliminate bacteria and enhance the wound microenvironment. Herein, this work develops multifunctional metal-phenolic nanozymes (TA-Fe/Cu nanocapsules), wherein the one-pot coordination of tannic acid (TA)and Fe3+/Cu2+ using a self-sacrificial template afforded hollow nanoparticles (NPs) with exceptional photothermal and reactive oxygen species scavenging capabilities. After photothermal disruption of the biofilms, TA-Fe/Cu NPs autonomously capture bacteria through hydrogen bonding interactions with peptidoglycans (the bacterial cell wall component), ultimately bolstering the bactericidal efficacy. Furthermore, these NPs exhibit peroxidase-like enzymatic activity, efficiently eliminating surplus hydrogen peroxide in the vicinity of the wound and mitigating inflammatory responses. As the wound transitions into the remodeling phase, the presence of Cu2+ stimulates vascular migration and regeneration, expediting the wound-healing process. This study innovatively devises a minimalist approach to synthesize multifunctional metal-phenolic nanozymes integrating potent photothermal antibacterial activity, bacterial capture, anti-inflammatory, and angiogenesis properties, showcasing their great potential for diabetic wound treatment.

Pillararene-Based Stimuli-Responsive Supramolecular Delivery Systems for Cancer Therapy.

Cancer poses a significant challenge to global public health, seriously threatening human health and life. Although various therapeutic strategies, such as chemotherapy (CT), radiotherapy, phototherapy, and starvation therapy, are applied to cancer treatment, their limited therapeutic effect, severe side effects, and unsatisfactory drug release behavior need to be carefully considered. Thus, there is an urgent need to develop efficient drug delivery strategies for improving cancer treatment efficacy and realizing on-demand drug delivery. Notably, pillararenes, as an emerging class of supramolecular macrocycles, possess unique properties of highly tunable structures, superior host-guest chemistry, facile modification, and good biocompatibility, which are widely used in cancer therapy to achieve controllable drug release and reduce the toxic side effects on normal tissues under various internal/external stimuli conditions. This review summarizes the recent advance of stimuli-responsive supramolecular delivery systems (SDSs) based on pillararenes for tumor therapy from the perspectives of different assembly methods and hybrid materials, including molecular-scale SDSs, supramolecular nano self-assembly delivery systems, and nanohybrid SDSs. Moreover, the prospects and critical challenges of stimuli-responsive SDSs based on pillararenes for cancer therapy are also discussed.

Multimodal Therapeutic Platforms Based on Self-Assembled Metallacycles/Metallacages for Cancer Radiochemotherapy.

Discrete organometallic complexes with defined structures are proceeding rapidly in combating malignant tumors due to their multipronged treatment modalities. Many innovative superiorities, such as high antitumor activity, extremely low systemic toxicity, active targeting ability, and enhanced cellular uptake, make them more competent for clinical applications than individual precursors. In particular, coordination-induced regulation of luminescence and photophysical properties of organic light-emitting ligands has demonstrated significant potential in the timely evaluation of therapeutic efficacy by bioimaging and enabled synergistic photodynamic therapy (PDT) or photothermal therapy (PTT). This review highlights instructive examples of multimodal radiochemotherapy platforms for cancer ablation based on self-assembled metallacycles/metallacages, which would be classified by functions in a progressive manner. Finally, the essential demands and some plausible prospects in this field for cancer therapy are also presented.

Pillararene-Based Supramolecular Polymers for Adsorption and Separation.

Supramolecular polymers have attracted increasing attention in recent years due to their perfect combination of supramolecular chemistry and traditional polymer chemistry. The design and synthesis of macrocycles have driven the rapid development of supramolecular chemistry and polymer science. Pillar[n]arenes, a new generation of macrocyclic compounds possessing unique pillar-shaped structures, nano-sized cavities, multi-functionalized groups, and excellent host-guest complexation abilities, are promising candidates to construct supramolecular polymer materials with enhanced properties and functionalities. This review summarizes recent progress in the design and synthesis of pillararene-based supramolecular polymers (PSPs) and illustrates their diverse applications as adsorption and separation materials. All performances are evaluated and analyzed in terms of efficiency, selectivity, and recyclability. Typically, PSPs can be categorized into three typical types according to their topologies, including linear, cross-linked, and hybrid structures. The advances made in the area of functional supramolecular polymeric adsorbents formed by new pillararene derivatives are also described in detail. Finally, the remaining challenges and future perspectives of PSPs for separation-based materials science are discussed. This review will inspire researchers in different fields and stimulate creative designs of supramolecular polymeric materials based on pillararenes and other macrocycles for effective adsorption and separation of a variety of targets.

Superstructure-Induced Hierarchical Assemblies for Nanoconfined Photocatalysis.

Most attempts to synthesize supramolecular nanosystems are limited to a single mechanism, often resulting in the formation of nanomaterials that lack diversity in properties. Herein, hierarchical assemblies with appropriate variety are fabricated in bulk via a superstructure-induced organic-inorganic hybrid strategy. The dynamic balance between substructures and superstructures is managed using covalent organic frameworks (COFs) and metal-organic frameworks (MOFs) as dual building blocks to regulate the performances of hierarchical assemblies. Significantly, the superstructures resulting from the controlled cascade between COFs and MOFs create highly active photocatalytic systems through multiple topologies. Our designed tandem photocatalysis can precisely and efficiently regulate the conversion rates of bioactive molecules (benzo[d]imidazoles) through competing redox pathways. Furthermore, benzo[d]imidazoles catalyzed by such supramolecular nanosystems can be isolated in yields ranging from 70 % to 93 % within tens of minutes. The multilayered structural states within the supramolecular systems demonstrate the importance of hierarchical assemblies in facilitating photocatalytic propagation and expanding the structural repertoire of supramolecular hybrids.

Grinding-induced supramolecular charge-transfer assemblies with switchable vapochromism toward haloalkane isomers.

Synthetic macrocycles have proved to be of great application value in functional charge-transfer systems in the solid state in recent years. Here we show a switchable on-off type vapochromic system toward 1-/2-bromoalkane isomers by constructing solid-state charge-transfer complexes between electron-rich perethylated pillar[5]arene and electron-deficient aromatic acceptors including 4-nitrobenzonitrile and 1,4-dinitrobenzene. These charge-transfer complexes with different colors show opposite color changes upon exposure to the vapors of 1-bromoalkanes (fading) and 2-bromoalkanes (deepening). Single-crystal structures incorporating X-ray powder diffraction and spectral analyses demonstrate that this on-off type vapochromic behavior is mainly attributed to the destruction (off) and reconstruction (on) of the charge-transfer interactions between perethylated pillar[5]arene and the acceptors, for which the competitive host-guest binding of 1-bromoalkanes and the solid-state structural transformation triggered by 2-bromoalkanes are respectively responsible. This work provides a simple colorimetric method for distinguishing positional isomers with similar physical and chemical properties.

Smart organic materials based on macrocycle hosts.

Innovative design of smart organic materials is of great importance for the advancement of modern technology. Macrocycle hosts, possessing cyclic skeletons, intrinsic cavities, and specific guest binding properties, have demonstrated pronounced potential for the elaborate fabrication of a variety of functional organic materials with smart stimuli-responsive characteristics. In this tutorial review, we outline the current development of smart organic materials based on macrocycle hosts as key building blocks, focusing on the design principles and functional mechanisms of the tailored systems. Three main types of macrocycle-based smart organic materials are exemplified as follows according to the distinct forms of construction patterns: (1) supramolecular polymeric materials and nanoassemblies; (2) adaptive molecular crystals; (3) smart porous organic materials. The responsive performances of macrocycle-containing smart materials in versatile aspects, including mechanically adaptive polymers, soft optoelectronic devices, data encryption, drug delivery systems, artificial transmembrane channels, crystalline-state gas adsorption/separation, and fluorescence sensing, are illustrated by discussing the representative studies as paradigms, where the roles of macrocycles in these systems are highlighted. We also provide in the conclusion part the perspectives and remaining challenges in this burgeoning field.

Gun carrying among US adolescents: the mutual impact of violence experiences, safety concerns, and substance use behaviors.

OBJECTIVES: Youth firearm carriage significantly contributes to firearm-related injuries and deaths in the United States (US). This study examined the sex-specific patterns and cumulative effects of violence experiences, safety concerns, and substance use behaviors on youth firearm carriage. STUDY DESIGN: Cross-sectional study. METHODS: Based on a nationally representative sample (N = 13,526), the multigroup structural equation modeling (SEM) was used to examine the interplay of violence experiences (weapon threats, physical fights, and sexual violence), safety concerns, and substance use behaviors (cigarette, electronic vapor, alcohol, marijuana, and prescription opioid), and their direct, indirect, and total effects on youth gun carrying behavior. RESULTS: About one in 50 females and one in 15 males reported firearm carriage in the past year. Sex-specific patterns existed. Among female adolescents, gun carrying was strongly correlated with violence experiences (standardized coefficient (ß) = 0.77, P < 0.001), but no direct connection was observed with substance use behaviors. Among males, both violence experiences (ß = 0.56, P < 0.001) and substance use behaviors (ß = 0.26, P < 0.001) were significantly correlated with gun carrying. Although safety concerns did not show a direct effect on gun carrying, a significant indirect effect was observed via the pathway of violence experiences. Collectively, the three clusters of predictors explained about 59.9% of variance in gun carrying among females and 54.6% of variance among males. CONCLUSIONS: Violence experiences have a robust impact on gun carrying behavior in both female and male adolescents. Effective violence prevention programs and sex-specific strategies (e.g., substance use intervention for males) are needed to reduce youth firearm carriage.

IrMo Nanocluster-Doped Porous Carbon Electrocatalysts Derived from Cucurbit[6]uril Boost Efficient Alkaline Hydrogen Evolution.

Electrocatalysts based on noble metals have been proven efficient for high-purity hydrogen production. However, the sluggish kinetics of the hydrogen evolution reaction (HER) in alkaline media caused by high water dissociation energy largely hampers this electrochemical process. To improve the electrocatalytic activity, we fabricate an effective porous carbon matrix derived from cucurbit[6]uril using a template-free method to support iridium-molybdenum (IrMo) nanoclusters. As proof of concept, the resulting IrMo-doped carbon electrocatalyst (IrMo-CBC) was found to boost the alkaline HER significantly. Owing to the unique in-plane hole structure and the nitrogen-rich backbone of cucurbit[6]uril as well as the ultrafine IrMo nanoclusters, IrMo-CBC exhibits pronounced alkaline HER activity with an extremely low overpotential of 12 mV at 10 mA cm-2, an ultrasmall Tafel slope (28.06 mV dec-1), a superior faradic efficiency (98%), and a TOF of 11.6 H2 s-1 at an overpotential of 50 mV, outperforming most iridium-based electrocatalysts and commercial Pt/C.

Using a Syndemic Framework and Structural Equation Modeling to Assess the Co-occurrence and Mutual Impact of Violence Experiences and Substance Use Behaviors Among Adolescents.

Adolescents are at particular risk for multiple violence experiences and substance use behaviors. The extent to which the two clusters of experiences correlate with each other remains unclear. The purpose of this study is to assess the co-occurrence and mutual impact of violence experiences and substance use behaviors in adolescents using structural equation modeling (SEM) based on syndemic theory. This study utilized data collected by 2019 Youth Risk Behavior Survey from a nationally representative sample (N = 13,677). Bivariate associations and correlations between four forms of violence experiences (weapon threats, sexual violence, dating violence, and bullying) and three types of substance use behaviors (e-cigarette smoking, alcohol drinking, and marijuana use) were examined. Two SEM models were built to measure the correlation between the two clusters of variables. The results showed that 36.8% of adolescents experienced at least one form of violence in the past year (22.0% one form, 8.9% two forms, and 5.9% three or more forms) and 42.4% reported one or more types of substance use in the past month (16.3% one type, 14.0% two types, and 12.1% three types). Youths with multiple violence experiences were three to four times more likely to report substance use, and those using three types of substances were two to six times more likely to report violence victimization. All examined associations and correlations between violence experiences and substance use behaviors were statistically significant. In the final SEM model, the four violence variables indicated a syndemic factor and the three substance use variables indicated another syndemic factor. The two syndemic factors were positively correlated (ß = .43, p < .05), with 19% of variance being explained by each other. Findings in this study highlight the needs for comprehensive prevention efforts to address the co-occurring and mutually reinforced situation between violence experiences and substance use behaviors in the youth population. Targeted intervention programs and mental health services are needed for adolescents with multiple violence experiences and concurrent substance use behaviors.

The Creation of DNA Origami-Based Supramolecular Nanostructures for Cancer Therapy.

DNA origami technology, a unique type of DNA nanotechnology, has attracted much attention from researchers and is applied in various fields. Through exquisite design and precise self-assembly of four kinds of deoxyribonucleotides, DNA origami nanostructures are endowed with excellent programmability and addressability and show outstanding biocompatibility in bio-related applications, especially in cancer treatment. In this review, nanomaterials based on DNA origami for cancer therapy are concluded, whereby chemotherapy and photo-assisted therapy are the main focus. Furthermore, the working mechanisms of the functional materials attached to the rigid DNA structures to enable targeted delivery and circumvent drug resistance are also discussed. DNA origami nanostructures are valuable carriers for delivering multifunctional therapeutic agents and demonstrate great potential in cancer treatment both in vitro and in vivo. It is undoubted that DNA origami technology is a promising strategy for constructing versatile nanodevices in biological fields and will excel in human healthcare.

Multifunctional Metal-Organic Framework (MOF)-Based Nanoplatforms for Crop Protection and Growth Promotion.

Phytopathogen, pest, weed, and nutrient deficiency cause severe losses to global crop yields every year. As the core engine, agrochemicals drive the continuous development of modern agriculture to meet the demand for agricultural productivity and increase the environmental burden due to inefficient use. With new advances in nanotechnology, introducing nanomaterials into agriculture to realize agrochemical accurate and targeted delivery has brought new opportunities to support the sustainable development of green agriculture. Metal-Organic frameworks (MOFs), which weave metal ions/clusters and organic ligands into porous frameworks, have exhibited significant advantages in constructing biotic/abiotic stimuli-responsive nanoplatforms for controlled agrochemical delivery. This review emphasizes the recent developments of MOF-based nanoplatforms for crop protection, including phytopathogen, pest, and weed control, and crop growth promotion, including fertilizer/plant hormone delivery. Finally, forward-looking perspectives and challenges on MOF-based nanoplatforms for future applications in crop protection and growth promotion are also discussed.

Macrocycle-Strutted Coordination Microparticles for Fluorescence-Monitored Photosensitization and Substrate-Selective Photocatalytic Degradation.

The prosperous advancement of supramolecular chemistry has motivated us to construct supramolecular hybrid materials with integrated functionalities. Herein, we report an innovative type of macrocycle-strutted coordination microparticle (MSCM) using pillararenes as the struts and "pockets", which performs unique activities of fluorescence-monitored photosensitization and substrate-selective photocatalytic degradation. Prepared via a convenient one-step solvothermal method, MSCM showcases the incorporation of supramolecular hybridization and macrocycles, endowed with well-ordered spherical architectures, superior photophysical properties, and photosensitizing capacity, where a self-reporting fluorescence response is exhibited upon photoinduced generation of multiple reactive oxygen species. Importantly, photocatalytic behaviors of MSCM show marked divergence toward three different substrates and reveal pronounced substrate-selective catalytic mechanisms, attributing to the variety in the affinity of substrates toward MSCM surfaces and pillararene cavities. This study brings new insight into the design of supramolecular hybrid systems with integrated properties and further exploration of functional macrocycle-based materials.

Suicide attempt and suicide plan among U.S. adolescents: The role of repeated and co-occurring violence experiences.

PURPOSE: This study is to measure the impact of repeated and co-occurring violence experiences on suicidal behaviors among U.S. adolescents. METHODS: Data from a nationally representative sample (N = 13, 677) were utilized, collected by 2019 Youth Risk Behavior Survey. Association and correlation between suicidal behaviors (suicide attempt and suicide plan) and multiple violence experiences (weapon-involved violence, physical violence, and sexual violence) were examined using a series of logistic regression models and structural equation modeling (SEM). RESULTS: In the past year, nearly one in eleven adolescents had attempted suicide, one in six planned for suicide, and one in five suffered from at least one form of violence. Adolescents experiencing high frequency of victimization were up to 12 times greater odds of attempting suicide and up to 6 times more likely to plan for suicide. Those with multiple forms of violence experiences had much greater likelihood of attempting suicide and planning for suicide. The three violence experiences were highly correlated with each other and collectively explained about 40% of variance in suicide attempt and 24% of variance in suicide plan. CONCLUSION: Comprehensive intervention programs and mental health services are needed for adolescents with repeated and concurrent violence experiences to prevent their suicidal behaviors.