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BACKGROUND: Despite evidence that childhood adversities (CAs) are associated with increased risk of mental disorders, little is known about their associations with disorder-related impairment. We report the associations between CAs and functional impairment associated with 12-month DSM-IV disorders in a national sample. METHOD: We used data from the US National Comorbidity Survey Replication (NCS-R). Respondents completed diagnostic interviews that assessed 12-month DSM-IV disorder prevalence and impairment. Associations of 12 retrospectively reported CAs with impairment among cases (n=2242) were assessed using multiple regression analysis. Impairment measures included a dichotomous measure of classification in the severe range of impairment on the Sheehan Disability Scale (SDS) and a measure of self-reported number of days out of role due to emotional problems in the past 12 months. RESULTS: CAs were positively and significantly associated with impairment. Predictive effects of CAs on the SDS were particularly pronounced for anxiety disorders and were significant in predicting increased days out of role associated with mood, anxiety and disruptive behavior disorders. Predictive effects persisted throughout the life course and were not accounted for by disorder co-morbidity. CAs associated with maladaptive family functioning (MFF; parental mental illness, substance disorder, criminality, family violence, abuse, neglect) were more consistently associated with impairment than other CAs. The joint effects of co-morbid MFF CAs were significantly subadditive. Simulations suggest that CAs account for 19.6% of severely impairing disorders and 17.4% of days out of role. CONCLUSIONS: CAs predict greater disorder-related impairment, highlighting the ongoing clinical significance of CAs at every stage of the life course. [ABSTRACT FROM AUTHOR]

Returning results to participants of environmental exposure studies has become more common in recent years. Despite evidence of benefits for study participants, there are challenges in communicating results to people with limited resources or capacity to mitigate chemical exposures. We interviewed N = 54 participants and compared exposure report-back conducted in 2010-2013 across three susceptible study populations: 1) low-income pregnant individuals in the Chemicals in Our Bodies (CIOB) study; 2) the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) cohort; and 3) early childhood educators (ECE). Report-back differed between the cross-sectional studies (CIOB and ECE), which offered an opportunity to consult with research staff by phone or email, and the prospective cohort study (CHAMACOS), which allowed for participants to discuss individual and group-level results directly with researchers at a community meeting. Participants in all three studies were motivated to participate by children's health and wanted more information about health implications and exposure reduction strategies, with cost and limited resources cited as common barriers to change. We observed overall positive experiences with report-back across studies, with improved environmental health literacy and constructive learning experiences that were most evident in CHAMACOS. While many noted individual actions they had made or intended to make to reduce exposures, CHAMACOS participants were more likely to mention systems-level changes achieved through actions such as contacting decision-makers and raising community awareness. Our findings suggest that researchers may have a unique opportunity to support environmental health literacy and informed action at both the individual and community or policy levels through long-term study engagement, various forms of direct consultation with study participants, and thoughtful report-back methods that leverage existing tools and are sensitive to barriers faced by specific study populations. This work informs best practices for communicating chemical exposure results among sensitive or highly exposed communities., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Inc. All rights reserved.)

Bias-based bullying (i.e., bullying targeting actual or perceived aspects of one's identity) is a form of interpersonal victimization that has adverse consequences for youth functioning. While research has documented foundational knowledge on bias-based bullying, few studies have incorporated a multilevel longitudinal approach to examining theorized risk and protective factors of this complex phenomenon. The current study addresses this gap by investigating predictors (e.g., school climate and state laws) at multiple social-ecological levels and comparing the magnitude of coefficients. Three data sources were used: (a) data from a sample of adolescents ( N  = 639) participating in a four-wave longitudinal study regarding their experiences with bias-based bullying, (b) external data on enumerated anti-bullying laws, and (c) external data on protected categories in state hate crime statutes. We estimated a series of latent growth curve models to examine trajectories of bias-based bullying victimization over the 18-month study period and added social-ecological predictors (sociodemographic characteristics, peer support, family support, school climate, enumerated anti-bullying laws, and an index of protected categories in state hate crime laws) of bias-based bullying victimization. Key findings documented that sexual minority youth and youth identifying as another racial identity, non-Hispanic had higher initial bias-based bullying victimization scores, with sexual minority youth decreasing at a significantly more rapid rate than heterosexual youth. Peer support, family support, school climate, and enumerated anti-bullying laws were significantly associated with the intercept factor (i.e., initial status) of bias-based bullying victimization. Notably, school climate emerged as an important protective factor in the fully adjusted model, predicting initial bias-based bullying victimization scores. This study provides new information on risk and protective factors and is critical for tailoring prevention and intervention efforts to mitigate this form of victimization. Bolstering support for vulnerable youth and promoting a positive school climate are recommended., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Youth who experience bias-based harassment report more adverse functioning than those who report peer victimization not targeted at identity. Yet, there has been little research aimed at understanding how different forms of bias-based harassment influence well-being. The current study adds to the existing research through its comprehensive assessment of adolescents' direct and witnessed bias-based harassment exposures and examination of how exposures are associated with mental health and grades. We also evaluated three protective factors (adult support at school, peer support, and school belonging) for their associations with functioning after taking into account bias-based harassment exposures. Participants were 7,402 high school adolescents in the Northeast ( M age = 15.41 years, SD = 1.08). Results revealed differential associations with mental health and grades based on bias-based harassment types and highlighted the importance of support and belonging., (© 2025 Springer Publishing Company.)

Abstract: Objective: This abbreviated version of the American College of Occupational and Environmental Medicine's (ACOEM) Work Disability Prevention and Management Guideline reviews the available evidence and provides recommendations to clinicians regarding interventions to help patients remain at or return to work.Methods: Systematic literature reviews were conducted. Studies were graded and evidence tables were created, with involvement of a multidisciplinary expert panel that evaluated the evidence and finalized recommendations for all clinical questions. Extensive peer review was performed. Consensus recommendations were formulated when evidence was lacking.Results: Evidence-based recommendations have been developed to guide work disability prevention and management.Conclusion: Clinicians should utilize quality evidence in determining treatment methods to prevent and alleviate work disability for workers., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 American College of Occupational and Environmental Medicine.)

We characterized experiences and strategies used by frontline healthcare workers to prevent severe-acute-respiratory-syndrome-related coronavirus transmission at work and to household members during the coronavirus disease pandemic. Alongside an online questionnaire (n = 234), remote semi-structured interviews (n = 23: 15 clinicians, 8 non-clinicians) were conducted in 2021. Mitigation challenges and facilitators were identified from data to represent experiences as a process considering the before, during, and after work shifts. Journey mapping was utilized to visually describe how healthcare workers experienced the stages of the work environment, leaving work, commuting home, and the home environment, and strategies implemented to stay safe. Major facilitators included the uptake of coronavirus disease vaccines and testing, information regarding virus transmission, and adequate personal protective equipment. The most critical challenges identified included a lack of designated areas for end-of-day disinfection, changing rooms, showers, and lockers in the leaving work stage. Psychosocial and environmental factors must be considered in future hospital pandemic preparations., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Occupational Hygiene Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Changes in sexual orientation identity (SOI) and gender identity (GI) have rarely been studied in transgender and/or nonbinary youth (TNBY), but documenting such changes is important for understanding identity development and gender transition and supporting the needs of TNBY. This study examined the frequency and patterning of changes in GI and SOI across 3 months (T1-T2) and 1.5 years (T1-T4) among 183 TNBY (baseline age 14-17 years; 83.6% White, 16.9% Hispanic/Latinx) who participated in a longitudinal US study. Participants completed online surveys including measures of GI and SOI. The most common gender identity selected at T1 (with or without another gender identity) was nonbinary (56.3%), and more than half (57.4%) of youth identified with a plurisexual identity (e.g., bisexual, pansexual). GI fluidity from T1-T2 was 13.2% and from T1-T4 was 28.9%. It was equally common to move toward a nonbinary gender identity as toward a binary gender identity. SOI fluidity was more common (30.6% from T1-T2; 55.8% from T1-T4) than GI fluidity. Shifts toward plurisexual identities were more common than shifts toward monosexual identities (e.g., straight, gay). Findings highlight the need to assess changes in GI and SOI in research and clinical practice to address the unique needs of TNBY accurately and effectively.

Take-home exposures occur when workers accidentally bring workplace contaminants home. Regular job responsibilities may expose construction workers to lead, which extends to their households via the take-home pathway. The present study aimed to develop and evaluate 2 educational sessions addressing take-home lead exposure tailored to construction workers and their families. Educational materials on take-home lead exposure and prevention strategies were designed following guidance from US government institutions and experts on construction work, lead exposure, and educational interventions. The educational materials were pilot-tested with construction workers and their family members during in-person or online sessions in English or Spanish. Changes in knowledge of take-home lead exposure were assessed through pre- and post-testing and open-ended feedback was collected from both participants and session facilitators. The study sample comprised 44 participants, including 33 workers and 11 family members. Among all participants, 81% were male, 46% were Hispanic or Latino, and the average age was 29 years. Post-test scores (µ = 93%, SD = 10%) were higher than pre-test scores (µ = 82%, SD = 19%), and younger participants (<30 years) were more likely to have a lower pre-test score compared to older participants (≥30 years). Overall, feedback from participants and facilitators was positive, indicating appropriate duration, appealing visuals, and ease of engagement through the training activities. Effective public health education for lead-exposed construction workers and their families is needed to reduce lead exposure disparities, especially among children of workers. Interventions must recognize that take-home exposures are not isolated to occupational or home environments., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Occupational Hygiene Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Bias-based harassment in U.S. schools is an increasingly significant concern for students' well-being. Although research on bullying broadly defined has indicated that the ways in which youth are involved in bullying (i.e., as bullies, victims, and bully-victims) are differentially associated with functioning, this study adds to extant research by exploring whether similar patterns emerge for bias-based harassment. A nationally representative sample of 639 adolescents, ages 13-17, completed online surveys in 2021 that included measures of bias-based harassment, anxiety, depression, substance use, and school social support. Findings from a multivariate latent variable model indicated that after controlling for demographic variables, compared to individuals not involved in bias-based harassment, students involved as victims, perpetrators, or both victims and perpetrators of bias-based harassment (i.e., bias-based bully-victims) reported more mental health symptoms. Substance use was elevated for bias-based perpetrators and bully-victims, whereas school social support was diminished for bias-based victims and bully-victims. Notably, bias-based bully-victims had the highest levels of anxiety symptoms and substance use, and lowest levels of school social support, among all adolescents. Findings highlight that involvement in bias-based harassment in any capacity is associated with deleterious functioning, with bias-based bully-victims reporting particularly adverse functioning across domains. Bolstering protective factors such as school social support would be a useful component of school practices and prevention programs related to bias-based harassment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Chemicals that induce mammary tumors in rodents or activate estrogen or progesterone signaling are likely to increase breast cancer (BC) risk. Identifying chemicals with these activities can prompt steps to protect human health., Objectives: We compiled data on rodent tumors, endocrine activity, and genotoxicity to assess the key characteristics (KCs) of rodent mammary carcinogens (MCs), and to identify other chemicals that exhibit these effects and may therefore increase BC risk., Methods: Using authoritative databases, including International Agency for Research on Cancer (IARC) Monographs and the US Environmental Protection's (EPA) ToxCast, we selected chemicals that induce mammary tumors in rodents, stimulate estradiol or progesterone synthesis, or activate the estrogen receptor (ER) in vitro . We classified these chemicals by their genotoxicity and strength of endocrine activity and calculated the overrepresentation (enrichment) of these KCs among MCs. Finally, we evaluated whether these KCs predict whether a chemical is likely to induce mammary tumors., Results: We identified 279 MCs and an additional 642 chemicals that stimulate estrogen or progesterone signaling. MCs were significantly enriched for steroidogenicity, ER agonism, and genotoxicity, supporting the use of these KCs to predict whether a chemical is likely to induce rodent mammary tumors and, by inference, increase BC risk. More MCs were steroidogens than ER agonists, and many increased both estradiol and progesterone. Enrichment among MCs was greater for strong endocrine activity vs. weak or inactive, with a significant trend., Discussion: We identified hundreds of compounds that have biological activities that could increase BC risk and demonstrated that these activities are enriched among MCs. We argue that many of these should not be considered low hazard without investigating their ability to affect the breast, and chemicals with the strongest evidence can be targeted for exposure reduction. We describe ways to strengthen hazard identification, including improved assessments for mammary effects, developing assays for more KCs, and more comprehensive chemical testing. https://doi.org/10.1289/EHP13233.

Background: The practice of reporting back individual results to participants in environmental health research has evolved significantly over the past 20 years. Research findings support the potential of report-back to enhance the ethics, quality, and impact of environmental health research. Nonetheless, implementation of environmental health report-back practices is not yet routine., Objectives: We propose a framework for institutionalizing appropriate report-back to participants of their individual results across the environmental health research enterprise. We provide a brief overview of the rationales for report-back, social science research on report-back experiences over the past two decades, and recent efforts to synthesize guidance in this field. We also describe barriers to be addressed in moving toward widespread implementation of report-back., Discussion: Report-back of individual results is increasingly recognized as an ethical responsibility and essential component of impactful environmental health research. Experience shows that when personal results are returned with appropriate contextual information, report-back can increase environmental health literacy, promote individual actions, and enhance engagement in policy change. Therefore, report-back can promote environmental justice and reduce disparities in access to science. Despite this evidence base, report-back is not widely implemented. We recommend the collaborative development of guidelines, training, and resources to build capacity for appropriate report-back to study participants across the environmental health research enterprise, and we identify research priorities to advance the field. Development of tools and shared infrastructure for report-back holds promise for reducing barriers while ensuring high-quality personalized reports. Disseminating successful case studies could also advance excellence. We recommend including diverse scientific disciplines, community partners, representatives of study populations, clinicians, institutional review boards (IRBs), legal experts, public health professionals, and government officials in further developing this critical aspect of environmental health research. https://doi.org/10.1289/EHP12463.

Background: Communities across the U.S. have acted to eliminate or curb police presence in schools. These efforts have primarily focused on School Resource Officers. However, school staff also call upon local police to respond in their buildings, for example by calling 911. The reasons that police are called upon to respond in schools has rarely been studied., Objective: The current study aimed to identify the primary reasons that local police were asked to respond to incidents in one urban school district, and the outcomes of those responses., Participants and Setting: We analyzed 882 police incident report narratives, selected from a stratified sample of 57 schools in one urban school district during the 2017-18 school year. Incident reports, which were written by officers responding in schools, included narrative descriptions of officer intervention, the events precipitating police involvement, and outcomes of incidents., Methods: By coding incident report narratives, we identified categories describing the reasons for police response to events in schools and the outcomes of those events., Results: Most incident reports originating from school addresses (n = 730; 82.8 %) involved students. Among those reports, police most frequently responded to instances of sexual physical violence (17.5 %), physical assault (15.8 %), dysregulated behavior (11.2 %), threatening language (10.8 %), and threat of or actual school violence (4.4 %). Incidents involving students most often resulted in: (1) parents/guardians being contacted (57.3 %), (2) schools engaging in disciplinary actions (39.7 %) or school safety actions (27.0 %), and (3) child maltreatment reports being made to Crimes Against Children (a subdivision of the police department focused on child maltreatment; 26.0 %) or to the Department of Children and Families (26.2 %)., Conclusions: Findings indicate that many events leading to police responses in schools are related to maltreatment and behavioral health. These events rarely result in a criminal justice response, and most often result in action by families and schools (e.g., contacting parents/guardians, school disciplinary/safety actions), and filed reports of maltreatment. Additional supports in these areas may have the potential to reduce the perceived need to call upon police and to provide more direct access to services for students., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: To make informed decisions about endocrine-disrupting chemicals (EDCs), people need functional understanding of exposures and health and an ability to act on their knowledge. The return of biomonitoring results is an opportunity to educate people about EDCs and motivate exposure reduction., Objectives: This study investigates environmental health knowledge about EDCs, concerns about health effects, and exposure-reducing behaviors before and after the return of individual-level exposure results or only study-wide results., Methods: Women in the Child Health and Development Studies who were biomonitored for 42 EDCs were randomly assigned to receive a report with personal chemical results or only study-wide findings. We interviewed participants before and after report-back about their knowledge and concerns about EDCs and how frequently they performed exposure-related behaviors. We investigated baseline differences by education and race and examined changes after report-back by race and report type., Results: Participants ( n = 135 ) demonstrated general understanding of exposure pathways and health impacts of EDCs. For 9 out of 20 knowledge questions, more than 90% of participants ( n ≥ 124 ) gave correct responses at baseline, including for questions about chemicals' persistence in the body and effects of early-life exposure. Most participants held two misconceptions-about chemical safety testing in the United States and what doctors can infer from EDC results-although errors decreased after report-back. Initially, concern was higher for legacy pollutants, but report-back increased concern for consumer product chemicals. After report-back, participants took some actions to reduce exposures, particularly to per- and polyfluoroalkyl substances, and total behavior was associated with knowledge and concern but not race, education, or report type., Discussion: This study demonstrated that participants had foundational knowledge about EDCs and that report-back further built their environmental health literacy. We conclude that future communications should target misconceptions about chemicals regulation in the United States, because information about regulations is crucial for people to evaluate risks posed by consumer product chemicals and decide whether to engage with public policy. https://doi.org/10.1289/EHP12565.

Background: We report on community-based participatory research (CBPR) initiated by women firefighters in order to share successful elements that can be instructive for other community-engaged research. This CBPR initiative, known as the Women Worker Biomonitoring Collaborative (WWBC) is the first we are aware of to investigate links between occupational exposures and health outcomes, including breast cancer, for a cohort of exclusively women firefighters., Methods: In order to be reflective of the experiences and knowledge of those most intimately involved, this article is co-authored by leaders of the research initiative. We collected leaders' input via recorded meeting sessions, emails, and a shared online document. We also conducted interviews (N = 10) with key research participants and community leaders to include additional perspectives., Results: Factors contributing to the initiative's success in enacting broadscale social change and advancing scientific knowledge include (1) forming a diverse coalition of impacted community leaders, labor unions, scientists, and advocacy organizations, (2) focusing on impacts at multiple scales of action and nurturing different, yet mutually supportive, goals among partners, (3) adopting innovative communication strategies for study participants, research partners, and the broader community, (4) cultivating a prevention-based ethos in the scientific research, including taking early action to reduce community exposures based on existing evidence of harm, and (5) emphasizing co-learning through all the study stages. Furthermore, we discuss external factors that contribute to success, including funding programs that elevate scientist-community-advocacy partnerships and allow flexibility to respond to emerging science-policy opportunities, as well as institutional structures responsive to worker concerns., Conclusions: While WWBC shares characteristics with other successful CBPR partnerships, it also advances approaches that increase the ability for CBPR to translate into change at multiple levels. This includes incorporating partners with particular skills and resources beyond the traditional researcher-community partnerships that are the focus of much CBPR practice and scholarly attention, and designing studies so they support community action in the initial stages of research. Moreover, we emphasize external structural factors that can be critical for CBPR success. This demonstrates the importance of critically examining and advocating for institutional factors that better support this research., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: The association between early childhood psychosocial problems and poorer educational outcomes is well-documented, but the extent to which this association persists is less understood. The current study assessed the correlations between first-grade psychosocial functioning and educational outcomes through eighth grade in a large longitudinal sample of Chilean students., Methods: The Pediatric Symptom Checklist-Chilean (PSC-CL) and Teacher Observation of Classroom Adaptation Re-Revised (TOCA-RR) assessed psychosocial functioning for 9736 students who were screened four times from first through eighth grade through the Skills for Life program. Adjusted linear mixed effects models assessed the association between first grade PSC-CL and TOCA-RR risk and third, sixth, and eighth grade GPA and school attendance., Results: First-grade PSC-CL and TOCA-RR risk both significantly predicted lower third, sixth, and eighth grade GPAs; all p < .001. The relationships between first-grade psychosocial functioning and later school attendance rates were less consistent but still significant at certain time points., Conclusions: First-grade psychosocial risk was persistently associated with lower academic performance in a longitudinal sample of Chilean students followed through elementary and middle school., Implications for School Health Policy, Practice, and Equity: Early school-based psychosocial screening and follow-up interventions have the potential to improve students' long-term educational outcomes., (© 2023 American School Health Association.)

Linelike features in TeV γ rays constitute a "smoking gun" for TeV-scale particle dark matter and new physics. Probing the Galactic Center region with ground-based Cherenkov telescopes enables the search for TeV spectral features in immediate association with a dense dark matter reservoir at a sensitivity out of reach for satellite γ-ray detectors, and direct detection and collider experiments. We report on 223 hours of observations of the Galactic Center region with the MAGIC stereoscopic telescope system reaching γ-ray energies up to 100 TeV. We improved the sensitivity to spectral lines at high energies using large-zenith-angle observations and a novel background modeling method within a maximum-likelihood analysis in the energy domain. No linelike spectral feature is found in our analysis. Therefore, we constrain the cross section for dark matter annihilation into two photons to ⟨σv⟩≲5×10^{-28}  cm^{3} s^{-1} at 1 TeV and ⟨σv⟩≲1×10^{-25}  cm^{3} s^{-1} at 100 TeV, achieving the best limits to date for a dark matter mass above 20 TeV and a cuspy dark matter profile at the Galactic Center. Finally, we use the derived limits for both cuspy and cored dark matter profiles to constrain supersymmetric wino models.

Background: The PROTECT Center is a multi-project initiative that studies the relationship between exposure to environmental contaminants and preterm births during the prenatal and postnatal period among women living in Puerto Rico. PROTECT's Community Engagement Core and Research Translation Coordinator (CEC/RTC) play a key role in building trust and capacity by approaching the cohort as an engaged community that provides feedback about processes, including how personalized results of their exposure to chemicals should be reported back. The goal of the Mi PROTECT platform was to create a mobile-based application of DERBI (Digital Exposure Report-Back Interface) for our cohort that provides tailored, culturally appropriate information about individual contaminant exposures as well as education on chemical substances and approaches to exposure reduction., Methods: Participants (N = 61) were presented with commonly used terms in environmental health research related to collected samples and biomarkers, followed by a guided training on accessing and exploring the Mi PROTECT platform. Participants evaluated the guided training and Mi PROTECT platform answering a Likert scale in separated surveys that included 13 and 8 questions, respectively., Results: Participants provided overwhelmingly positive feedback on the clarity and fluency of presenters in the report-back training. Most participants reported that the mobile phone platform was both accessible and easy to navigate (83% and 80%, respectively) and that images included in the platform facilitated comprehension of the information. Overall, most participants (83%) reported that language, images, and examples in Mi PROTECT strongly represented them as Puerto Ricans., Conclusions: Findings from the Mi PROTECT pilot test informed investigators, community partners and stakeholders by demonstrating a new way to promote stakeholder participation and foster the "research right-to-know.", Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Cardona Cordero et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study examines patterns and trends in 911 calls from Boston public school addresses related to mental health and physical assaults/fights generated from 2014 to 2018. We analyzed 12,113 Boston Police Department (BPD) 911 call records from 102 Boston Public School addresses during the 2014-2018 school years. In addition, we separately analyzed calls coded by BPD as Emotionally Disturbed Person ("EDP"), indicating a psychiatric crisis was the primary reason for the call, as well as calls coded as "Fight," "Assault," or "Assault and battery." Call frequency ranged from 0 to 277 per school each year. Although the annual average number of calls increased each school year over the 4-year period, this was primarily due to an increase in hang-ups and abandoned calls. Overall, 7.4% calls were coded as EDP and 6.5% were coded as assault/fight. Call volume was highest in the middle of the school day, with a median time of 12 pm. EDP calls were significantly earlier in the day than non-EDP calls, and the percentage of calls labeled as EDP decreased in frequency each day over the course of the week. There were more overall 911 calls, on average, per day in late spring than in other seasons. The frequency with which schools call upon police as emergency service providers for psychiatric crises indicates a need for additional school-based resources. Such resources may be most effective if they are allocated mid-day, responsive to changing student needs over the course of the week, and increased in spring., Competing Interests: Conflict of interestThe authors have no potential conflicts of interest to disclose. Analyses used de-identified administrative records; researchers did not have access to any identifiable information about individuals., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Participants in biomonitoring studies who receive personal exposure reports seek information to reduce exposures. Many chemical exposures are driven by systems-level policies rather than individual actions; therefore, change requires engagement in collective action. Participants' perceptions of collective action and use of report-back to support engagement remain unclear. We conducted virtual focus groups during summer 2020 in a diverse group of peripartum people from cohorts in the Environmental influences on Child Health Outcomes (ECHO) Program (N = 18). We assessed baseline exposure and collective action experience, and report-back preferences. Participants were motivated to protect the health of their families and communities despite significant time and cognitive burdens. They requested time-conscious tactics and accessible information to enable action to reduce individual and collective exposures. Participant input informed the design of digital report-back in the cohorts. This study highlights opportunities to shift responsibility from individuals to policymakers to reduce chemical exposures at the systems level., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate the associations of childhood adversities (CAs) with lifetime onset and transitions across suicidal thoughts and behaviors (STB) among incoming college students., Methods: Web-based self-report surveys administered to 20,842 incoming college students from nine countries (response rate 45.6%) assessed lifetime suicidal ideation, plans and attempts along with seven CAs: parental psychopathology, three types of abuse (emotional, physical, sexual), neglect, bully victimization, and dating violence. Logistic regression estimated individual- and population-level associations using CA operationalizations for type, number, severity, and frequency., Results: Associations of CAs with lifetime ideation and the transition from ideation to plan were best explained by the exact number of CA types (OR range 1.32-52.30 for exactly two to seven CAs). Associations of CAs with a transition to attempts were best explained by the frequency of specific CA types (scaled 0-4). Attempts among ideators with a plan were significantly associated with all seven CAs (OR range 1.16-1.59) and associations remained significant in adjusted analyses with the frequency of sexual abuse (OR = 1.42), dating violence (OR = 1.29), physical abuse (OR = 1.17) and bully victimization (OR = 1.17). Attempts among ideators without plan were significantly associated with frequency of emotional abuse (OR = 1.29) and bully victimization (OR = 1.36), in both unadjusted and adjusted analyses. Population attributable risk simulations found 63% of ideation and 30-47% of STB transitions associated with CAs., Conclusion: Early-life adversities represent a potentially important driver in explaining lifetime STB among incoming college students. Comprehensive intervention strategies that prevent or reduce the negative effects of CAs may reduce subsequent onset of STB., (© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.)

The first year of college may carry especially high risk for onset of alcohol use disorders. We assessed the one-year incidence of alcohol use disorders (AUD) among incoming first-year students, predictors of AUD-incidence, prediction accuracy and population impact. A prospective cohort study of first-year college students (baseline: N = 5843; response rate = 51.8%; 1-year follow-up: n = 1959; conditional response rate = 41.6%) at a large university in Belgium was conducted. AUD were evaluated with the AUDIT and baseline predictors with the Composite International Diagnostic Interview Screening Scales (CIDI-SC). The one-year incidence of AUD was 3.9% (SE = 0.4). The most important individual-level baseline predictors of AUD incidence were being male (OR = 1.53; 95% CI = 1.12-2.10), a break-up with a romantic partner (OR = 1.67; 95% CI = 1.08-2.59), hazardous drinking (OR = 3.36; 95% CI = 1.31-8.63), and alcohol use characteristics at baseline (ORs between 1.29 and 1.38). Multivariate cross-validated prediction (cross-validated AUC = 0.887) shows that 55.5% of incident AUD cases occurred among the 10% of students at highest predicted risk (20.1% predicted incidence in this highest-risk subgroup). Four out of five students with incident AUD would hypothetically be preventable if baseline hazardous drinking was to be eliminated along with a reduction of one standard deviation in alcohol use characteristics scores, and another 15.0% would potentially be preventable if all 12-month stressful events were eliminated. Screening at college entrance is a promising strategy to identify students at risk of transitioning to more problematic drinking and AUD, thus improving the development and deployment of targeted preventive interventions., (© 2021. Springer-Verlag GmbH, DE part of Springer Nature.)

Objectives: Emerging adulthood-spanning 18-29 years of age-is associated with the highest risk for onset of certain behavioral health disorders (e.g. major depression, bipolar disorder, psychosis, substance use disorders) and high prevalence of many behavioral health disorders. Yet, rates of mental health service use remain low in this age range. Racial/ethnic minorities are particularly impacted by individual, cultural/linguistic, and community-level barriers to mental health care. This study examined community-level factors associated with mental health service use and investigated whether these associations varied by race/ethnicity. Design: This study analyzed individual- and county-level data for emerging adults in the United States (N=3,294) from the nationally representative Collaborative Psychiatric Epidemiological Surveys (CPES). Using the Andersen Model of Health Care Utilization, analyses examined predisposing, enabling, and need factors utilized in prior studies with adult samples as well as novel community characteristics hypothesized to impact service use among emerging adults of diverse racial/ethnic backgrounds. Past-year use of both specialty and any mental health services were assessed, controlling for individual- and community-level variables, and adjusting for presence of past-year mental health disorder, overall health status, and functional impairment. Differences between racial/ethnic minority groups and Non-Latino Whites were tested through a multilevel model incorporating random intercepts logistic regression, with analysis focusing on the interaction between race/ethnicity and community-level supply variables. Results: For past-year use of specialty mental health services, density of hospitals with child wellness programs was linked to service use among Black emerging adults, whereas density of hospitals with linguistic/translation services was linked to service use among Latino emerging adults. Conclusions: This study expands on previous research in behavioral health disparities to examine ways to improve behavioral health services for an emerging adult population with unmet service needs and identifies specific community-level factors that can improve mental health for racial/ethnic minority emerging adults.

Objective: To determine whether red cell distribution width (RDW) can predict illness severity and mortality risk in a heterogenous population of dogs admitted to the ICU., Design: Prospective observational study., Setting: Large, urban, private teaching hospital., Animals: One hundred eleven dogs consecutively admitted to the ICU between September 2017 and December 2018., Interventions: None., Measurements and Main Results: Abbreviated Acute Patient Physiologic and Laboratory Evaluation (APPLE fast ) score and RDW were measured within 6 h of ICU admission. This study did not demonstrate a significant difference in illness severity across patients stratified by RDW. There was no difference in RDW between survivors and nonsurvivors at hospital discharge or at 30 days., Conclusions: In this study population, RDW did not correspond with illness severity as measured by APPLE fast . Moreover, RDW did not predict in-hospital or 30-day mortality., (© Veterinary Emergency and Critical Care Society 2021.)

Transgender and gender diverse youth (TGD) report high rates of mental health concerns. However, there is reason to expect that among TGD youth there is variation in mental health experiences related to specific aspects of gender identity. Furthermore, although certain school characteristics are related to improved mental health for sexual minority youth, it is unclear whether the same school characteristics are associated with improved mental health for TGD youth and whether gender identity moderates the associations between school characteristics and mental health. Using baseline data from Project AVANT, a longitudinal study of TGD youth ages 14-18 years in the United States (N = 252), we report on several mental health outcomes (i.e., depression, anxiety, nonsuicidal self-injury, and PTSD), with attention to differences by gender identity. Secondly, we examined associations of three protective school-related factors (i.e., school-connectedness, presence of a Gay-Straight or Gender-Sexuality Alliance [GSA], and state mandated protections for sexual and gender minority students) with TGD youth mental health. TGD youth reported elevated levels of anxious and depressive symptoms, with nonbinary youth assigned female at birth reporting higher mean depressive symptoms relative to transgender females. Among the aggregate sample of TGD youth, 69.9% reported clinically significant anxiety, 57.9% reported clinically significant depression, 56.7% reported nonsuicidal self-injury, and 46.4% met screening criteria for posttraumatic stress disorder. Despite a small effect size, greater school-connectedness was significantly associated with fewer mental health concerns and gender identity moderated the association between school-connectedness and number of anxiety symptoms. Gender identity also moderated the association between presence of a GSA and number of anxious symptoms, depressive symptoms, and clinically significant depression, respectively. No significant associations of state-level protections and mental health outcomes were detected. Findings highlight the importance of improving mental health and fostering GSA-engagement and school-connectedness among TGD youth. Implications for school psychologists are discussed., (Copyright © 2021 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.)

Purpose: Prior studies have been inconclusive in documenting whether the prevalence of adolescent anxiety is increasing, given sampling and measurement limitations. This study adds new information on recent time trends in anxiety prevalence, specifically investigating trends among previously unexamined sociodemographic subgroups., Methods: Weighted data of 37,360 youth respondents (51.1% female, 71.8% White, 91.3% heterosexual, 99.2% cisgender) from the 2012-2018 Dane County Youth Assessment, a county-wide survey administered to youth in participating school districts, were analyzed to estimate time trends in anxiety prevalence among the whole sample and by sociodemographic subgroups., Results: The prevalence of youth meeting anxiety-screening criteria increased from 34.1% (95% CI 33.4-34.9) in 2012 to 44% (95% CI 43.2-44.7) in 2018 (OR for trend = 1.07, P for trend < 0.001). The trend remained significant after adjusting for known confounds (AOR for trend = 1.07, P for trend < 0.001). Anxiety increased significantly for several subgroups and widening disparities were documented among females relative to males (P < 0.001), and sexual minority youth relative to heterosexual youth (P = 0.003). In addition, Black youth did not increase at the same swift rate as White youth over the study period (P < 0.001)., Conclusion: This study reports recent data on anxiety time trends and finds that among a geographically representative sample of adolescents, anxiety prevalence is rising. Findings provide new evidence documenting increased anxiety prevalence among sexual minority youth relative to their peers. Results highlight the need to bolster public health interventions focused on adolescent mental health, with tailored interventions for vulnerable groups., (© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.)

Teachers contribute to the process of identifying and referring students for mental health services, however, relatively little is known about how they make those decisions and how decision-making differs across school contexts. This study used a vignette-based method to investigate individual and school contextual factors associated with the likelihood that teachers identify and refer students for mental health services. Teachers were recruited from public middle and high schools across the U.S. using a stratified random sampling strategy. Teachers ( N  = 462) responded to vignettes by indicating their concern for students, as well as their likelihood of providing mental health referrals. Vignettes varied by problem type (depression, oppositional defiant disorder), problem severity (moderate, severe), and student gender (male, female). Data on school characteristics were extracted from the U.S. Department of Education database. Regression models indicated several significant associations of teacher demographic characteristics and school characteristics with vignette ratings. For example, female teachers were more likely than males to rate vignettes as concerning, and middle school teachers were more likely than high school teachers to indicate they would refer students for mental health services. Teachers in schools with a higher proportion of Black students rated depression vignettes as less serious and indicated they were less likely to refer students for mental health services than teachers in majority white schools. Results suggest school characteristics may contribute to established disparities in mental health service access. Findings have implications for targeting mental health supports in schools., Supplementary Information: The online version contains supplementary material available at 10.1007/s12310-021-09491-1., Competing Interests: Conflict of interestThe authors have no conflict of interest to disclose., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.)

School connectedness is consistently associated with adolescent mental health and well-being. We investigated whether student perceptions of school connectedness were associated with anxiety and depressive symptoms, even during remote learning due to COVID-19. In June of 2020, after 13 weeks of remote learning, 320 middle and high school students in one Massachusetts school district completed an online survey that included questions about their perceptions of school connectedness, social connectedness, and symptoms of anxiety and depression. Students were approximately evenly distributed across grades, with 37% in middle school (grades 6-8) and 63% in high school (grades 9-12). School connectedness had a significant negative association with symptoms of anxiety and depression. This association persisted in models controlling for demographic factors and social connectedness. Findings indicate that school connectedness is associated with student mental health, even in the context of remote learning due to COVID-19. Schools engaged in remote learning should consider how to foster school connectedness as a means of supporting youth mental health, particularly given expected increases in the mental health needs of adolescents., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Study participants want to receive their biomonitoring results for environmental chemicals, and ethics guidelines encourage reporting back. However, few studies have quantitively assessed participants' responses to individual exposure reports, and digital methods have not been evaluated., Objectives: We isolated effects of receiving personal results vs. only study-wide findings and investigated whether effects differed for Black participants., Methods: We randomly assigned a subset of 295 women from the Child Health and Development Studies, half of whom were Black, to receive a report with personal environmental chemical results or only study-wide (aggregate) findings. Reports included results for 42 chemicals and lipids and were prepared using the Digital Exposure Report-Back Interface (DERBI). Women were interviewed before and after viewing their report. We analyzed differences in website activity, emotional responses, and intentions to participate in future research by report type and race using Wilcoxon rank sum tests, Wilcoxon-Pratt signed ranks tests, and multiple regression., Results: The personal report group spent approximately twice as much time on their reports as the aggregate group before the post-report-back interview. Among personal-report participants ( n = 93 ), 84% (78) viewed chemical group information for at least one personal result highlighted on their home page; among aggregate-report participants ( n = 94 ), 66% (62) viewed any chemical group page. Both groups reported strong positive feelings (curious, informed, interested, respected) about receiving results before and after report-back and mild negative feelings (helpless, scared, worried). Although most participants remained unworried after report-back, worry increased by a small amount in both groups. Among Black participants, higher post report-back worry was associated with having high levels of chemicals., Conclusions: Participants were motivated by their personal results to access online information about chemical sources and potential health effects. Report-back was associated with a small increase in worry, which could motivate appropriate action. Personal report-back increased engagement with exposure reports among Black participants. https://doi.org/10.1289/EHP9072.

Background and Objectives: New diagnostic criteria for posttraumatic stress disorder (PTSD) were introduced by DSM-5 and ICD-11. It remains unclear how well these new definitions of PTSD capture the posttrauma responses of children, particularly when using parent report. This study compared different conceptual models of PTSD in children following the Boston Marathon bombing and manhunt., Design and Methods: Parents/caretakers ( N  = 254) reported on PTSD symptoms of their children (ages 4-11) following the Boston Marathon bombing and manhunt. Algorithms compared criteria from ICD-11, DSM-IV, and DSM-5 (specifically the "Preschool" criteria)., Results: DSM-5 Preschool criteria identified twice as many children as ICD-11, and over four times as many as DSM-IV. DSM-5 Preschool criteria identified all cases detected by ICD-11 and DSM-IV. Across models, all identified cases had greater trauma exposure than non-identified children. DSM-5 Preschool and ICD-11 (but not DSM-IV) cases had greater clinical decline than non-identified children. The Avoidance cluster showed the most variability in identifying cases., Conclusions: Newer models of PTSD are likely to identify more children than DSM-IV, mostly related to changes in the Avoidance criteria. The DSM-5 Preschool definition is the most inclusive model. ICD-11 may provide a balance between inclusivity and stringency in detecting childhood PTSD.

WHAT IS KNOWN ON THIS SUBJECT?: Police are often called on to respond to student mental health needs in schools. School nurses, who are part of interdisciplinary mental health teams, may collaborate with responding police officers. Currently, there are no reviews of the literature describing the use of police to respond to mental health crises in schools. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This systematic review found six articles addressing police response to student mental health needs in elementary and secondary schools. Articles primarily focused on the School Resource Officer programme; however, there was a lack of research on the effectiveness of this and other programmes in addressing the mental health needs of students. This paper highlights a significant gap in knowledge about how police are involved in responding to student mental health crises within schools. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Understanding how police respond to mental health crises on school campuses will help nurses serve in collaborative roles with responding officers. This study highlights gaps in research that need to be addressed for researchers and policymakers to best support students in crisis., Abstract: INTRODUCTION: Response to student mental health crises involves interdisciplinary school-community teams, which can include police officers. This paper presents the first systematic review of literature on how police address mental health in school settings. Results have implications for school nurses interacting with responding police., Question/aim: How are police involved in responding to student mental health needs in elementary and secondary schools?, Method: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, six articles met criteria for inclusion in this review., Results: Two themes were identified: (1) descriptions of roles of police in schools and (2) studies presenting programmes or models of police engagement. The most common use of police in schools is through the School Resource Officer model., Discussion: There are very few studies examining police involvement in mental health response in schools and little data available on whether prevailing models are effective. We are therefore unable to ascertain what impact school police have in responding to mental health crises or the extent to which they interact with school nurses., Implications for Practice: Understanding mental health crisis responses in schools can inform policy, practice, research and education for police and school providers, including nurses., (© 2020 John Wiley & Sons Ltd.)

Background Little is known about the epidemiology of Major Depressive Episode (mde) in university students. Aim To investigate the prevalence of mde, psychiatric comorbidity, and the association with academic performance among first-year university students, and to investigate to what extent these students use professional mental health services. Method All first-year students at the ku Leuven (Leuven, Belgium) were invited to complete a computer-assisted survey with a weighted cross-sectional design (N=5,460; response rate corrected for drop-out=51.8%). mde was assessed using the Composite International Diagnostic Interview - Screening Scales (cidi-sc) with dsm-iv criteria. Results We found that 13.6% of first-year students met criteria for a cidi-sc mde in the past year. mde was associated with a wide range of other comorbid disorders (such as generalized anxiety disorder or hypo[mania]) and suicidal thoughts and behaviors. mde was associated with significantly lower academic year percentage (-3.6 to -6.4%) and elevated odds of academic year failure (ors=1.5-2.0). Professional service use was estimated at 21.5%. Conclusion mde is common among first-year university students and is associated with a high degree of psychiatric comorbidity and poor academic performance. It is therefore surprising that so few students actually receive treatment for their psychiatric and emotional problems. Tijdschrift voor Psychiatrie 63(2021)1, 24-31.

Little is known about the willingness of prospective study participants to share environmental health data. To fill this gap, we conducted a hypothetical vignette survey among 1,575 women who have volunteered to be contacted about breast cancer studies. Eighty-three percent were interested in participating in the environmental studies, with little difference whether data were restricted to the research team, shared with approved researchers, or publicly accessible. However, participants somewhat preferred controlled access for children's data. Respondents were more interested in studies with environmental rather than biological samples and more interested when researchers would return personal results, a practice of increasing importance. They were more reluctant to share location or to participate if studies involved electronic medical records. Many expressed concerns about privacy, particularly security breaches, but reidentification risks were mentioned infrequently, indicating that this topic should be discussed during informed consent.

Purpose: Studies document the substantial underutilization of mental health services by US Latinos in young adulthood. Rates of service use are higher in childhood, raising questions about whether mental health service use during childhood may facilitate access to services later in life. This article examines the extent to which utilization of mental health services in childhood is predictive of utilization in young adulthood among US Latinos., Methods: Data come from the Boricua Youth Study, a longitudinal study of Puerto Rican youth at two sites (South Bronx, New York, and the standard metropolitan area of San Juan, Puerto Rico). Data were collected in three waves during childhood (ages 5-13; surveyed 1 year apart), with an approximately 11-year follow-up in young adulthood (ages 16-29). In childhood, parents reported on youth mental health service use (Waves 1-3). In Wave 4, as youth transitioned to young adults (N = 2004), they reported on their past year mental health service use., Results: Whereas 30.2% of parents reported their child received mental health services, only 3.5% of young adults reported mental health service use in the past year. After controlling for young adult disorders and their severity, childhood disorders were associated with increased likelihood of mental health service use in young adulthood. Childhood mental health service use was also associated with young adult service use; however, this association attenuated when controlling for childhood disorders., Conclusion: Findings suggest the importance of specifically considering childhood disorders in understanding mechanisms for improving access to mental health services among Latino young adults.

Purpose: Schools provide access to mental health services for traditionally underserved youth. However, there is variability in the types of school-based services students receive (e.g., school counseling, services in separate classrooms, or schools serving students with psychiatric disorders). Prior research has typically not distinguished among these different types of school-based services. The present study examines sociodemographic characteristics and disorders associated with the types of services received in schools., Methods: Data were analyzed from a sample of adolescent-parent pairs in the U.S. National Comorbidity Survey Adolescent Supplement who received school mental health services (N = 1,204). DSM-IV diagnoses were based on the Composite International Diagnostic Interview administered to adolescents and questionnaires self-administered to parents. Adolescents (aged 13-18 years) and parents also responded to questions about lifetime school-based mental health service receipt., Results: Among those receiving school-based mental health services, almost one-third (29.7%) received services in a separate classroom and almost one-fourth (22.3%) in a separate school. Increased likelihood of lifetime placement in a separate classroom or school was detected among older youth, males, blacks, Latinos, youth with learning disabilities, those whose parents had fewer years of education, and those who received community-based mental health services. Oppositional defiant disorder was associated with increased lifetime placement in a separate school., Conclusions: The results advance the evidence base by indicating that racial/ethnic minority youth and those whose parents have fewer years of education were more likely to receive school-based mental health services in separate settings. These results provide more context to studies of school-based mental health service receipt., (Copyright © 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Nearly all Americans have detectable concentrations of endocrine disrupting chemicals from consumer products in their bodies, and expert panels recommend reducing exposures. To inform exposure reduction, we investigated whether consumers who are trying to avoid certain chemicals in consumer products have lower exposures than those who are not. We also aimed to make exposure biomonitoring more widely available. We enrolled 726 participants in a crowdsourced biomonitoring study. We targeted phenolic compounds-specifically parabens, bisphenol A (BPA) and analogs bisphenol F (BPF) and bisphenol S (BPS), the UV filter benzophenone-3, the anti-microbial triclosan, 2,4-dichlorophenol, and 2,5-dichlorophenol-and collected survey data on consumer products, cleaning habits, and efforts to avoid related chemicals. We investigated associations between 68 self-reported exposure behaviors and urine concentrations of ten chemicals, and evaluated whether associations were modified by intention to avoid exposures. A large majority (87%) of participants reported taking steps to limit exposure to specific chemicals, and, overall, participants achieved lower concentrations than the general U.S. population for parabens, BPA, triclosan, and benzophenone-3 but not BPF and BPS. Participants who reported avoiding all four ingredient groups-parabens, triclosan, bisphenols, and fragrances-were twice as likely as others to be in the lowest quartile of cumulative exposure. Avoiding certain products and reading ingredient labels to avoid chemicals was most effective for parabens, triclosan, and benzophenone-3. Avoiding BPA was not effective for reducing bisphenol exposures. Avoiding certain chemicals in products was generally associated with reduced exposure for chemicals listed on labels. Greater ingredient transparency will help consumers who read labels to reduce their exposure to a wider range of potentially harmful chemicals. In order to more equitably address public health, labeling policies should be complemented by regulations that exclude harmful chemicals from consumer products., (Copyright © 2020 The Author(s). Published by Elsevier GmbH.. All rights reserved.)

This study examines racial/ethnic differences in perceived need for mental health treatment, barriers to treatment receipt, and reasons for dropout. Data are from the Collaborative Psychiatric Epidemiology Studies, a pooled dataset from three U.S. nationally-representative adult samples. Among respondents with a 12-month psychiatric disorder who received no treatment (N = 1417), Asians and Latinos reported lower perceived need than Blacks and Whites, and Latinos reported the fewest attitudinal barriers. Among those with a 12-month disorder who dropped out of treatment, Asians and Latinos gave more reasons for dropping out. Significant interactions of race/ethnicity with other characteristics identified subpopulations with high unmet need.

Research consistently documents high rates of mental health problems among college students and strong associations of these problems with academic role impairment. Less is known, though, about prevalence and effects of physical health problems in relation to mental health problems. The current report investigates this by examining associations of summary physical and mental health scores from the widely-used Short-Form 12 (SF-12) Health Survey with self-reported academic role functioning in a self-report survey of 3,855 first-year students from five universities in the northeastern United States (US; mean age 18.5; 53.0% female). The mean SF-12 physical component summary (PCS) score (55.1) was half a standard deviation above the benchmark US adult population mean. The mean SF-12 mental component summary (MCS) score (38.2) was more than a full standard deviation below the US adult population mean. Two-thirds of students (67.1%) reported at least mild and 10.5% severe health-related academic role impairment on a modified version of the Sheehan Disability Scale. Both PCS and MCS scores were significantly and inversely related to these impairment scores, but with nonlinearities and interactions and much stronger associations involving MCS than PCS. Simulation suggests that an intervention that improved the mental health of all students with scores below the MCS median to be at the median would result in a 61.3% reduction in the proportion of students who experienced severe health-related academic role impairment. Although low-cost scalable interventions exist to address student mental health problems, pragmatic trials are needed to evaluate the effectiveness of these interventions in reducing academic role impairment., Competing Interests: Declaration of competing interest Dr. Ebert reports to have received consultancy fees/served on the scientific advisory board for Sanofi, Novartis, Minddistrict, Lantern, Schoen Kliniken, and two German health insurance companies (BARMER, Techniker Krankenkasse). He is also a stakeholder in the Institute for health training online (GET.ON), which aims to implement scientific findings related to digital health interventions into routine care. In the past 3 years, Dr. Kessler received support for his epidemiological studies from Sanofi Aventis; was a consultant for Datastat, Inc., Johnson & Johnson Wellness and Prevention, Sage Pharmaceuticals, Shire, Takeda; and served on an advisory board for the Johnson & Johnson Services Inc. Lake Nona Life Project. The remaining authors have no conflicts to declare., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Among students receiving behavioral health and special education services, racial/ethnic minority students are consistently overrepresented in settings separate from general classrooms. Once separated, many young people struggle to improve academically and face significant difficulty upon trying to return to a general education setting. Given the complex, ongoing, and multifaceted nature of this challenge, racial/ethnic disproportionality can be identified as a "wicked problem," for which solutions are not easily identified. Here, we describe our community-engaged research efforts, eliciting perspectives from relevant partners in an ongoing dialogue, to better integrate diverse stakeholders' perspectives when attempting to address such disparities. We conducted focus groups and qualitative interviews with members of three stakeholder groups: community-serving organizations, individuals with lived experience of behavioral health conditions, and state-level policymakers, with a shared interest in addressing racial and ethnic disparities. Participant responses illustrated the "wickedness" of this problem and highlighted the need for additional supports for students, families, and school personnel, increased collaboration across relevant systems and agencies, and reduced barriers related to funding. Overall, this methodology bridged differing perspectives to develop, in concert with our partners, a shared language of the problem and a core set of issues to consider when seeking to effect change., (© 2019 Society for Community Research and Action.)

Background: Binge eating and purging behaviors (BPB) are common among college students, but evidence is scant on prevalence and associations of BPB with mental health problems and objective academic performance. This study aims to investigate: (a) 12-month prevalence of BPB among college first-year students, (b) comorbidity patterns of BPB with various mental health problems, and (c) the association of BPB with objective academic functioning., Methods: Using data from the Leuven College Surveys (Belgium), as part of the World Mental Health Surveys International College Student initiative, we cross-sectionally assessed 12-month BPB and mental health problems among college first-year students (n = 4,889; response rate = 73.2%) at the beginning of the academic year. Objective measures of academic functioning (final grades, expressed in academic year percentage "AYP" [0-100%] and academic failure) were obtained from administrative records at the end of the academic year., Results: Twelve-month prevalence of BPB was 7.6% (7.3%binge eating and 1.0%purging), with higher rates among females than males. Bivariate models showed an association between BPB and numerous mental health problems (ORs = 3.4-18.4). Multivariate models showed associations with non-suicidal self-injury, post-traumatic stress, internalizing/externalizing problems and suicidal ideation. After controlling for sociodemographic characteristics and comorbid mental health problems, BPB were still associated with lower AYP (-4.1 to -11.2% range) and elevated odds of academic year failure (ORs = 1.4-4.2)., Conclusions: BPB (especially binge eating) are relatively common and associated with mental health problems, comparatively low academic performance, and higher risk of academic failure among college first-year students. Further study is needed to examine the causal dynamics underlying these associations., (© 2019 Wiley Periodicals, Inc.)