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Social and educational disruptions during the COVID-19 pandemic have exacerbated concerns about adolescents' mental health and suicidal behavior. Data from the 2021 Adolescent Behaviors and Experiences Survey (ABES) indicate that 37.1% of U.S. high school students reported poor mental health during the COVID-19 pandemic, with 19.9% considering and 9.0% attempting suicide in the preceding year (1). Adverse childhood experiences (ACEs)* are associated with poor mental health and suicidal behaviors (2,3), and high prevalence of some ACEs have been documented during the pandemic (4). ACEs are preventable, potentially traumatic events that occur in childhood (ages 0-17 years) such as neglect, experiencing or witnessing violence, or having a family member attempt or die by suicide. Also included are aspects of a child's environment that can undermine their sense of safety, stability, and bonding. Associations between ACEs occurring during the pandemic and mental health or suicidal behaviors among U.S. high school students were examined using ABES data. Experience of one to two ACEs was associated with poorer mental health and increased suicidal behaviors, and these deleterious outcomes increased with additional ACE exposure. After adjusting for demographic characteristics, adolescents who reported four or more ACEs during the pandemic had a prevalence of poor current mental health four times as high as, and a prevalence of past-year suicide attempts 25 times as high as, those without ACEs during the pandemic. Experience of specific ACE types (e.g., emotional abuse) was associated with higher prevalences of poor mental health and suicidal behaviors. Prevention and intervention strategies (5), including early identification and trauma-informed mental health service and support provision, for ACEs and their acute and long-term impacts could help address the U.S. child and adolescent mental health and suicide crisis.

The COVID-19 pandemic created an environment of disruption and adversity for many adolescents. We sought to establish the prevalence of non-dating sexual violence, sexual dating violence, and physical dating violence victimization among adolescents during the COVID-19 pandemic and to investigate whether experiences of disruption and adversity placed adolescents at greater risk for these forms of interpersonal violence. We conducted a secondary analysis of data from the Adolescent Behavior and Experiences Survey, collected January to June 2021 from a nationally representative sample of U.S. high school students ( N = 7,705). Exposures included abuse by a parent; economic, housing, and food and nutrition insecurity; interpersonal connectedness; and personal well-being. Among female students, 8.0% experienced non-dating sexual violence; 12.5% experienced sexual dating violence; and 7.7% experienced physical dating violence. Among male students, 2.2% experienced non-dating sexual violence; 2.4% experienced sexual dating violence; and 4.9% experienced physical dating violence. Among female students, both emotional and physical abuse by a parent was related to non-dating sexual violence, emotional abuse was related to sexual dating violence, and physical abuse was related to physical dating violence. Among males, emotional abuse by a parent was related to physical dating violence and physical abuse by a parent was related to sexual dating violence. Hunger was associated with sexual and physical dating violence among female students and homeless was associated with physical dating violence among male students. Although there were differences by sex, abuse by a parent, hunger, and homelessness created precarity that may have increased the likelihood that adolescents would be exposed to risky peer or dating relationships. Adolescents need support that stops and prevents experiences of non-dating sexual and dating violence connected to interventions that address adversities experienced during the COVID-19 pandemic.

Surveillance data are used for public health action, but the practice of analyzing data by single demographic characteristics may produce findings that reflect abstract categories rather than a person's lived experience. Intersectionality is a theoretical framework that advocates for individuals to be recognized as the whole of their identity and within context of power structures. Using the national Youth Risk Behavior Survey 2015-2019, we examined 5-year trends in experiencing violence, poor mental health, and suicidal risk behavior among US high school students using intersections of race/ethnicity and sex.We used SUDAAN to calculate prevalence estimates and logistic regression models to assess for linear trends while accounting for the weighting and complex survey design.Among all students in aggregate, experiencing dating violence decreased while being threatened with a weapon at school and feeling persistently sad or hopeless increased over time; however, these trends did not apply to most students when stratified by identity. The one near-universal experience was that students in aggregate and almost all identities had an increased trend of skipping school because they felt unsafe there.By focusing on identities defined by two main drivers of health disparities-race/ethnicity and sex-we found that changes in risk behaviors did not occur equally among students and that prevalence estimates were highest among Black males, Black females, and Hispanic females. We outlined the power structures that frame the current educational environment. Patterns of health disparities can be highlighted by analyzing surveillance data through an intersectional lens.

The incidence of neonatal abstinence syndrome (NAS), a withdrawal syndrome associated with prenatal opioid or other substance exposure (1), has increased as part of the U.S. opioid crisis (2). No national NAS surveillance system exists (3), and data about the accuracy of state-based surveillance are limited (4,5). In February 2018, the Pennsylvania Department of Health began surveillance for opioid-related NAS in birthing facilities and pediatric hospitals* (6). In March 2019, CDC helped the Pennsylvania Department of Health assess the accuracy of this reporting system at five Pennsylvania hospitals. Medical records of 445 infants who possibly had NAS were abstracted; these infants had either been reported by hospital providers as having NAS or assigned an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) hospital discharge code potentially related to NAS.† Among these 445 infants, 241 were confirmed as having NAS. Pennsylvania's NAS surveillance identified 191 (sensitivity = 79%) of the confirmed cases. The proportion of infants with confirmed NAS who were assigned the ICD-10-CM code for neonatal withdrawal symptoms from maternal use of drugs of addiction (P96.1) was similar among infants reported to surveillance (71%) and those who were not (78%; p = 0.30). Infants with confirmed NAS who were not assigned code P96.1 typically had less severe signs and symptoms. Accurate NAS surveillance, which is necessary to monitor changes and regional differences in incidence and assist with planning for needed services, includes and is strengthened by a combination of diagnosis code assessment and focused medical record review.

This systematic review of reviews synthesizes evidence on the impact of interventions to prevent violence against adolescent girls and young women 10–24 years (VAWG) in low- and middle-income countries (LMICs). Theories of women's empowerment and the social ecology of multifaceted violence frame the review. Child abuse, female genital mutilation/cutting (FGMC), child marriage, intimate partner violence (IPV), and sexual violence were focal outcomes. Our review followed the Assessment of Multiple Systematic Reviews (AMSTAR) for the systematic review of reviews, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for a systematic review of recent intervention studies. Of 35 reviews identified between June 7 and July 20, 2016, 18 were non-duplicate systematic reviews of medium-to-high quality. Half of these 18 reviews focused on interventions to prevent IPV. Only four focused on adolescents, of which three focused on child marriage and one compared findings across early and late adolescence. None focused on interventions to prevent child abuse or sexual violence in adolescent/young women. From these 18 reviews and the supplemental systematic review of intervention studies, data were extracted on 34 experimental or quasi-experimental intervention studies describing 28 interventions. Almost all intervention studies measured impacts on one form of VAWG. Most studies assessed impacts on child marriage (n = 13), then IPV (n = 8), sexual violence (n = 4), child abuse (n = 3), and FGMC (n = 3). Interventions included 1–6 components, involving skills to enhance voice/agency (n = 17), social networks (n = 14), human resources like schooling (n = 10), economic incentives (n = 9), community engagement (n = 11) and community infrastructure development (n = 6). Bundled individual-level interventions and multilevel interventions had more favorable impacts on VAWG. Interventions involving community engagement, skill-building to enhance voice/agency, and social-network expansion show promise to reduce VAWG. Future interventions should target poly-victimization, compare impacts across adolescence, and include urban, out-of-school, married, and displaced/conflict-affected populations in LMICs, where VAWG may be heightened.

Introduction The purpose of this study was to examine the perceptions of institutional policies and practices for the prevention of and response to gender inequities as experienced by female faculty working in the health sciences at a US research university. Methods Data from the institution's Faculty Campus Climate Survey (n = 260 female faculty) were coupled with qualitative interviews (n = 14) of females in leadership positions, exploring campus climate, and institutional policies and practices aimed at advancing women. Results Two-thirds (59%) of the female faculty respondents indicated witnessing sexual harassment and 28% reported experiencing sexual harassment. Several organizational themes emerged to address this problem: culture, including cultural change, transparency, and accountability. Conclusions The findings reveal the ways in which university culture mimics the larger societal context. At the same time, the distinct culture of higher education processes for recruitment, career advancement – specifically tenure and promotion – are identified as important factors that require modifications in support of reductions in gender inequalities.

Addressing sexual assault on university and college campuses in the United States is a national priority. To date, research on campus sexual assault overwhelmingly focuses on students as objects of study: as survivors, perpetrators, and bystanders of sexual assault. This focus has largely overlooked students who act as agents of change, mobilizing to alter campus norms around consent, prevention, survivor support, and institutional response. In this article, we encourage feminist scholars to incorporate students as advocates against sexual assault and to invite students to be collaborators in research. We discuss a student-led organization and our ongoing collaborative study with the organization to illustrate how feminist researchers can feature student engagement with campus sexual assault at the grass roots. We conclude with recommendations to expand the national research agenda on campus sexual assault.

Objective To provide the first study in Vietnam of how gendered social learning about violence and exposure to non-family institutions influence women's attitudes about a wife's recourse after physical IPV. Method A probability sample of 532 married women, ages 18-50 years, was surveyed in July-August, 2012 in Mỹ Hao district. We fit a multivariate linear regression model to estimate correlates of favoring recourse in six situations using a validated attitudinal scale. We split attitudes towards recourse into three subscales (disfavor silence, favor informal recourse, favor formal recourse) and fit one multivariate ordinal logistic regression model for each behavior to estimate correlates of favoring recourse. Results On average, women favored recourse in 2.8 situations. Women who were older and had witnessed physical IPV in childhood had less favorable attitudes about recourse. Women who were hit as children, had completed more schooling, worked outside agriculture, and had sought recourse after IPV had more favorable attitudes about recourse. Conclusions Normative change among women may require efforts to curb family violence, counsel those exposed to violence in childhood, and enhance women's opportunities for higher schooling and non-agricultural wage work. The state and organizations working on IPV might overcome pockets of unfavorable public opinion by enforcing accountability for IPV rather than seeking to alter ideas about recourse among women.

Background Our objective was to examine the multilevel correlates of women9s justification of wife beating in Bangladesh, a form of intimate partner violence (IPV). We focus on individual-level schooling, community-level media exposure among women and their interaction. Methods A cross-sectional study using data from the 2011 Bangladesh Demographic and Health Survey. Our sample included 17 749 ever-married women 15–49 years in 600 communities. We fit 6 multilevel logistic regression models to examine factors associated with justifying IPV; focusing on a woman9s completed grades of schooling; frequent (at least once weekly) community-level media exposure among women via newspaper/magazine, television and radio; and their cross-level interaction. Results At the individual level, completing more grades of schooling than the community average was negatively associated with justifying IPV (0.95, 95% CI 0.94 to 0.97). The main effects of women9s community-level media exposure were not significant, but suggested that frequent exposure to newspaper/magazine or television was negatively associated with justifying IPV, while exposure to radio was positively associated. In cross-level interactions, a woman9s completed grades of schooling above the community average was protective against justifying IPV, even in communities where women9s exposure to radio would otherwise increase the odds of justifying IPV. Conclusions Different forms of media likely send different messages about gender and IPV. Girls9 schooling should remain a priority, given its protective effect against justifying wife beating. Targeting girls and women who do not receive any schooling for intervention may yield the most benefit in terms of normative change regarding IPV against women.

Intimate partner violence (IPV) harms the health of women and their children. In Vietnam, 31% of women report lifetime exposure to physical IPV, and surprisingly, women justify physical IPV against wives more often than do men. We compare men’s and women’s rates of finding good reason for wife hitting and assess whether differences in childhood experiences and resources and constraints in adulthood account for observed differences. Probability samples of married men ( n = 522) and women ( n = 533) were surveyed in Vietnam. Ordered logit models assessed the proportional odds for women versus men of finding more “good reasons” to hit a wife (never, 1-3 situations, 4-6 situations). In all situations, women found good reason to hit a wife more often than did men. The unadjusted odds for women versus men of reporting more good reasons to hit a wife were 6.55 (95% confidence interval [CI] = [4.82, 8.91]). This gap disappeared in adjusted models that included significant interactions of gender with age, number of children ever born, and experience of physical IPV as an adult. Having children was associated with justifying wife hitting among women but not men. Exposure to IPV in adulthood was associated with justifying wife hitting among men, but was negatively associated with justification of IPV among women. Further study of the gendered effects of resources and constraints in adulthood on attitudes about IPV against women will clarify women’s more frequent reporting than men’s that IPV against women is justified.

Creating a normative campus environment intolerant to sexual violence is important for prevention. While prevention initiatives focusing on students are vital, faculty and staff have a central role in supporting and sustaining a comprehensive strategy for preventing campus sexual violence. Nationwide, colleges and universities recently implemented campus climate surveys. At Emory, we decided to survey faculty and staff as well as students, motivated by our use of an ecological framing of campus sexual violence. Faculty and staff are long-term members of the community, and can provide stability and continuity that reinforces prevention efforts prioritized for students. We recommend that schools use a trauma-informed approach to guide the involvement of faculty and staff in prevention. We encourage colleges and universities to consider the experiences and needs of their faculty and staff, as professionals who serve as leaders on campus and as those who guide students through their academic experiences.

Using the survey responses of 522 married men (eighteen to fifty-one years) in Vietnam, we explored how gendered social learning in boyhood and challenges to men’s expected status in marriage may increase the risk that men perpetrate intimate partner violence (IPV) against their wives. Over one-third (36.6 percent) of the participants reported having ever perpetrated psychological, physical, or sexual IPV against their current wife. Accounting for other characteristics of men in the sample, witnessing IPV as a boy, being physically maltreated as a boy, and being the same age or younger than one’s wife were associated with almost two to three times higher odds of perpetrating any IPV. Men with thirteen to eighteen completed grades of schooling had about half the adjusted odds of ever perpetrating any IPV than men with twelve or fewer completed grades (aOR = 0.56). The determinants of men’s perpetration of physical IPV and psychological IPV were, largely, similar. Programs to prevent men’s perpetration of IPV should address the parenting practices of boys that legitimize men’s aggression and gendered status expectations in marriage, which when challenged, may lead husbands to respond with violence. Engaging men to endorse nonviolent masculinities is an important consideration for future intervention.

Purpose: We assess the association of men’s exposure to violence in childhood—witnessing physical violence against one’s mother and being hit or beaten by a parent or adult relative—with their attitudes about intimate partner violence (IPV) against women. We explore whether men’s perpetration of IPV mediates this relationship and whether men’s attitudes about IPV mediate any relationship of exposure to violence in childhood with perpetration of IPV.Methods: Five hundred twenty-two married men 18-51 years in Vietnam were interviewed. Multivariate regressions for ordinal and binary responses were estimated to assess these relationships.Results: Compared with men experiencing neither form of violence in childhood, men experiencing either or both had higher adjusted odds of reporting more reasons to hit a wife (aOR, 1.43; 95% CI, 1.03-2.00 and aOR, 1.66; 95% CI, 1.05-2.64, respectively). Men’s lifetime perpetration of IPV accounted fully for these associations. Compared with men experiencing neither form of violence in childhood, men experiencing either or both had higher adjusted odds of ever perpetrating IPV (aOR, 3.28; 95% CI, 2.15-4.99 and aOR, 4.56; 95% CI, 2.90-7.17, respectively). Attitudes about IPV modestly attenuated these associations.Conclusions: Addressing violence in childhood is needed to change men’s risk of perpetrating IPV and greater subsequent justification of it.

Background Comprehensive data that address current HIV nonoccupational postexposure prophylaxis (nPEP) practices in the emergency care of sexual assault patients are limited. The U.S. Centers for Disease Control and Prevention released HIV nPEP guidelines in 2005 and updated guidelines for Sexually Transmitted Disease Treatment in 2006 and 2010, each of which support providing nPEP to sexual assault patients. This study examined the offer, acceptance, and adherence rates of nPEP among sexual assault patients treated at an emergency department (ED). Methods We conducted a retrospective review between January 1, 2008, and December 31, 2011, of women, aged 16 years and older, treated for sexual assault in an academic ED that participates in the sexual assault nurse examiner program. Findings One hundred seventy-one female patients were treated in the ED for 179 sexual assault events. nPEP was not indicated in 19 cases and was offered to all 138 of patients for whom nPEP was appropriate. Five patient cases that exceeded the 72-hour exposure window were offered nPEP. Of the 143 patient cases offered nPEP, 124 (86.7%) initiated nPEP. Of the 124 who accepted PEP, 34 (27.4%) had documented completion of the 28-day course. Conclusions nPEP was offered in all 138 cases where patients were eligible for treatment. Of patients who accepted nPEP, a minority are documented to have completed a course of treatment. Systems to improve postassault follow-up care should be considered.

Background. We report the first-in-human safety and immunogenicity assessment of a prototype Ad26 vector-based human immunodeficiency virus (HIV) vaccine in humans. Methods. Sixty Ad26-seronegative, healthy, HIV-uninfected subjects were enrolled in a randomized, double-blinded, placebo-controlled, dose-escalation phase 1 study. Five groups of 12 subjects received 109–1011 vp of the Ad26-EnvA vaccine (N = 10/group) or placebo (N = 2/group) at weeks 0 and 24 or weeks 0, 4, and 24. Safety and immunogenicity were assessed. Results. Self-limited reactogenicity was observed after the initial immunization at the highest (1011 vp) dose. No product-related SAEs were observed. All subjects who received the Ad26-EnvA vaccine developed Ad26 NAb titers, EnvA-specific enzyme-linked immunosorbent assays (ELISA) titers, and EnvA-specific enzyme-linked immunospot assays (ELISPOT) responses. These responses persisted at week 52. At week 28 in the 109, 1010, 1011 vp 3-dose and the 1010 and 5 × 1010 vp 2-dose groups, geometric mean EnvA ELISA titers were 6113, 12 470, 8545, 3470, and 9655 and mean EnvA ELISPOT responses were 397, 178, 736, 196, and 1311 SFC/106 peripheral blood mononuclear cells, respectively. Conclusion. This Ad26 vectored vaccine was generally safe and immunogenic at all doses tested. Reactogenicity was minimal with doses of 5 × 1010 vp or less. Ad26 is a promising new vaccine vector for HIV-1. Clinical Trials Registration. {"type":"clinical-trial","attrs":{"text":"NCT00618605","term_id":"NCT00618605"}}NCT00618605.

Methods Recombinant Ad5 with seven HVRs derived from Ad48 and expressing the VRC EnvA test antigen (rAd5HVR48. ENVA) was made. 48 healthy volunteers who were seronegative to Ad5, Ad48, HIV-1, and HIV-2 were enrolled in a randomized, double-blind, placebo-controlled, doseescalation phase 1 study. The first three groups of 12 subjects received doses of 10, 10, or 10 vp of rAd5HVR48.ENVA vector (n=10/group) or placebo (n=2/ group) at weeks 0, 4, and 24 and the fourth group received a single injection of 10 vp or placebo. We performed pre-specified blinded immunogenicity analyses at day 56 and day 196 after the first immunization.