Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
Records 1-30 (of 32 Records) |
Query Trace: Annor FB[original query] |
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Adverse childhood experiences module non-response: Behavioral Risk Factor Surveillance System, 2019 and 2021
Besera G , Annor FB , Swedo EA , Aslam MV , Massetti GM . Am J Prev Med 2024 INTRODUCTION: Data on adverse childhood experiences (ACEs) are key to understanding their burden and informing prevention programs and strategies. Population-based surveys that collect ACEs data may be affected by item non-response. This study examines differences in non-response to the optional Behavior Risk Factor Surveillance System (BRFSS) ACEs module overall, by sociodemographic characteristics, year, and question. METHODS: The study used BRFSS ACEs Module data from 21 states in 2019 and 16 states in 2021. Weighted proportions and 95% confidence intervals (95% CI) of responders and non-responders to the ACEs module by year and sociodemographic characteristics, and percentages of non-responders for each question were calculated. Chi-square tests were used to assess statistically significant (p<0.05) differences. Analyses were conducted in 2023. RESULTS: In 2019 and 2021, 1.2% (95% CI=1.1, 1.4) and 2.4% (95% CI=2.2, 2.5) of BRFSS participants were non-responders to the ACEs Module, respectively (p<0.01). Compared with responders, non-responders were more likely to be non-Hispanic Black (p=0.01) or non-Hispanic Asian (p=0.01), unemployed (p<0.01), have income <$15,000 (p<0.01), or report poor health (p<0.01). Non-response by question increased as the module progressed, and non-response was highest for sexual abuse questions. CONCLUSIONS: Overall, findings demonstrate that individuals are willing to respond to the ACEs module questions. Although low, non-response to the module increased from 2019 to 2021. Higher non-response for sexual abuse questions may be due to their sensitivity or potential survey fatigue due to placement at the end of the module. Higher non-response among racial/ethnic minorities and economically disadvantages groups highlight opportunities to improve existing surveillance systems. |
Social protection as a strategy for HIV prevention, education promotion and child marriage reduction among adolescents: a cross-sectional population-based study in Lesotho
Hertzog L , Cluver L , Banougnin BH , Saminathen MG , Little MT , McHenga M , Yates R , Rudgard W , Chiang L , Annor FB , Picchetti V , Massetti G , Foraci M , Sanaha R , Toska E . BMC Public Health 2024 24 (1) 1523 BACKGROUND: Lesotho's government has shown consistent efforts to implement social protection programmes. However, while recent evidence established a positive causal relationship between some of these programmes and food security there is little evidence on the extent to which these initiatives are associated with better educational and sexual and reproductive health outcomes among vulnerable adolescents in Lesotho. METHODS AND FINDINGS: The study uses cross-sectional, nationally representative data from the 2018 Lesotho Violence Against Children and Youth Survey. Our research examined the association between social protection receipt and educational and sexual and reproductive health outcomes among adolescents and young people (13-24 years) living in poverty. We employed multivariate logistic regression controlling for age, orphanhood, HIV status and sex. Social protection receipt was defined as household receipt of financial support from a governmental, non-governmental, or community-based program that provides income. Additionally, we fitted a marginal effects model by sex. Among the 3,506 adolescent females and males living in the two lowest poverty quintiles, receipt of social protection was associated with improvements in multiple adolescent outcomes: higher odds of consistent condom use (aOR 1.64, 95% CI 1.17-2.29), educational attainment (aOR 1.79, 95% CI 1.36-2.36), and school enrolment (aOR 2.19, 95% CI 1.44-3.34). Stratified analyses by sex showed that social protection receipt was also associated with reduced likelihood of child marriage among females (aOR 0.59, 95% CI 0.42-0.83) and higher odds of educational attainment and school enrolment among males (aOR 2.53, 95% CI 1.59-4.03 and aOR 3.11, 95% CI 1.56-6.19, respectively). CONCLUSIONS: Our study provides evidence that social protection programs are associated with improved educational, sexual and reproductive health and child marriage prevention outcomes among adolescents living in poverty. Implementing and expanding such social protection initiatives could prove instrumental in improving the well-being of vulnerable adolescents. CONTRIBUTIONS: Social protection programs have been increasing in sub-Saharan African countries, playing a pivotal role in poverty reduction, with Lesotho being no exception. Despite the optimistic outlook brought about by the implementation of the National Social Protection Strategy Lesotho I (2014-19) and II (2021-2031), the impact of these programs on some specific outcomes that concern the lives of the most vulnerable adolescents in Lesotho remains to some extent unexplored. Additionally, Lesotho grapples with high rates of HIV, adolescent pregnancy, child marriage and early school dropout, which can further contribute to poor long-term health and social outcomes among adolescents. In this study, we used data from the 2018 Lesotho Violence Against Children and Youth Survey (VACS) to examine the association between receiving social protection and multiple adolescent outcomes: educational, sexual and reproductive. The findings revealed that social protection programs, particularly the existing government-provided cash transfers, are significantly associated with multiple better outcomes among adolescents living in the poorest households in Lesotho. Such cash transfer schemes in Lesotho are associated with improved sexual and reproductive health outcomes for adolescent females, including reduced child marriage rates, and improved educational outcomes for males. These findings indicate that government-led social protection programmes are positively associated with favourable outcomes that can improve the quality of life for adolescents in resource-limited settings. |
Prevalence of functional disabilities and associations among disabilities, violence, and HIV among adolescents and young adults in Lesotho
Massetti GM , Stamatakis C , Charania S , Annor FB , Rice CE , Hegle J , Ramphalla P , Sechache M , Motheo M . J Epidemiol Glob Health 2024 INTRODUCTION: Lesotho has the second-highest prevalence of HIV. Despite progress in achieving HIV epidemic control targets, inequities persist among certain groups, particularly associations between disability, HIV, and violence. We assessed the prevalence of disability and examined associations between disability and HIV and violence using data from the 2018 Lesotho Violence Against Children and Youth Survey (VACS). METHODS: Lesotho VACS was a nationally representative survey of females and males ages 13-24. We assessed the associations between disability status and HIV, sexual risk behaviours, and violence using logistic regression, incorporating survey weights. RESULTS: Weighted functional disability prevalence was 14.1% for females (95% confidence interval [CI] 12.7-15.4) and 7.3% for males (5.3-9.2). Compared with females with no disabilities, females with disabilities had higher odds of being HIV positive (adjusted odds ratio [aOR] 1.92, 1.34-2.76), having transactional sex (aOR 1.79, 1.09-2.95), and experiencing any lifetime violence (aOR 2.20, 1.82-2.65), sexual violence (aOR 1.77, 1.36-2.31), emotional violence (2.02. 1.61-2.53), physical violence (aOR 1.85, 1.54-2.24), witnessing interparental violence (aOR 1.71, 1.46-2.01), and witnessing community violence (aOR 1.52, 1.26-1.84). Males with disabilities had higher odds of having transactional sex (aOR 4.30, 1.35-13.73), having recent multiple sex partners (aOR 2.31, 1.13-4.75), experiencing emotional violence (aOR 2.85, 1.39-5.82), and witnessing interparental violence (aOR 1.78, 1.12-2.84). HIV models for males did not converge due to low numbers. CONCLUSION: Findings emphasize the importance of inclusion and accessibility for adolescents and young adults with disabilities in prevention and services for violence and HIV. Ending HIV in Lesotho depends on addressing the vulnerabilities that lead to potential infection including violence and ensuring equitable services for all. |
Introduction to the child abuse and neglect special issue "epidemiology, risk factors, and impacts of adverse childhood experiences in low- and middle-income countries."
Gilbert LK , Annor FB , Brown C , Dube SR . Child Abuse Negl 2024 106748 |
Adverse childhood experiences, HIV and sexual risk behaviors - Five sub-Saharan countries, 2018-2020
Kanagasabai U , Thorsen V , Zhu L , Annor FB , Chiang L , McOwen J , Augusto A , Manuel P , Kambona C , Coomer R , Kamagate F , Ramphalla P , Denhard L , Cain M , Hegle J , de Barros RB , Saenz S , Kamami M , Patel P . Child Abuse Negl 2023 106541 BACKGROUND: Adverse childhood experiences (ACEs) have been shown to have negative, lasting effects on health including increasing the likelihood of engaging in sexual risk behaviors. OBJECTIVE: This study aimed to identify associations between exposures to ACEs and sexual risk behaviors and HIV service utilization among young people. PARTICIPANTS AND SETTING: A sample of 8023 sexually active young people (19-24 year olds) from five sub-Saharan African countries participated Violence Against Children and Youth Surveys (VACS). METHODS: Descriptive analysis of demographic variables, individual ACEs, cumulative ACEs, sexual risk behaviors, HIV testing, antiretroviral treatment (ART) and Antenatal Care (ANC) attendance were completed. Bivariate and multivariable logistic regression analyses were conducted to assess the associations between both individual and cumulative ACEs, sexual HIV risk behaviors, and service utilization while controlling for important covariates such as demographic, having ever been pregnant, had an STI, and used contraception. RESULTS: Exposure to three or more ACEs was higher among males (26.1 %) compared to females (21.3 %); p = 0.003. The most prominent sexual risk behavior for females was having sexual partners who were at least 5 years older (45.7 % compared to males 3.7 %; p < 0.0001) whereas in males it was no or infrequent condom use (45.3 % compared to females 30.1 %; p < 0.0001). Males and females exposed to childhood sexual violence had seven and four times the odds of engaging in transactional sex (aOR = 7.34, 95 % CI: [3.5-15.0]) and (aOR =3.75, 95 % CI: [2.3-6.2], respectively. Females exposed to three or more ACEs were four times more likely to engage in transactional sex (aOR = 4.85, 95 %, CI: [1.6-14.4]) compared to those who did not experience any ACEs. Males exposed to three or more ACEs were two times more likely to engage in early sexual debut (aOR = 2.2, 95 % CI: [1.3-3.4]),]) compared to those who did not experience any ACEs. Females who had witnessed IPV or violence in the community had significantly higher odds of getting tested for HIV (aOR = 2.16, 95 % CI: [1.63-2.87]) and (aOR = 1.36, 95 % CI: [1.03-1.81]), respectively. CONCLUSIONS: This study demonstrated that experiencing ACEs during childhood is associated with higher HIV risk behaviors in sub-Saharan Africa (SSA) with unique differences between males and females. |
Approaches for measuring cumulative childhood adversity: A study of youth from 5 sub-Saharan African countries
Gilbert LK , Matthews S , Dube SR , Annor FB . Child Abuse Negl 2023 106542 BACKGROUND: Adverse childhood experiences (ACEs) include forms of abuse, neglect, and household stressors that are potentially early life traumatic experiences. A summed integer count of ACEs is often used to examine cumulative childhood adversity (CCA) but has limitations. OBJECTIVES: The current study tests two additional methods for measuring CCA using large samples of youth in low- and middle-income countries. PARTICIPANTS AND SETTING: Pooled data were analyzed from a multi-country, nationally representative sample of youth aged 18-24 years (N = 11,498) who completed the Violence Against Children and Youth Surveys (VACS) in Lesotho, Cote d'Ivoire, Kenya, Namibia, and Mozambique. METHODS: ACE exposures included: physical, sexual, and emotional violence; witnessing interparental violence; witnessing community violence; orphanhood. CCA was operationalized using an ACE score, ACE impact (standardized regression coefficients from outcome severity), and ACE exposure context (household; intimate partner; peer; community). Associations between CCA with mental distress (MD) were examined by sex using p ≤ 0.05 as the significance level. RESULTS: Exposure to ≥3 ACEs was associated with MD (p < 0.05) for both sexes. Among females, all contexts contributed to MD except peer ACEs (p < 0.05). Among males, household and community ACEs contributed to MD. High-impact ACEs were associated with MD both sexes. ACE context was the best-fitting model for these data. CONCLUSIONS: The challenges operationalizing CCA warrant continued research to ensure adversity type, severity, and context lead to validly assessing ACEs impact on child wellbeing. |
Parental absence as an adverse childhood experience among young adults in sub-Saharan Africa
Annor FB , Amene EW , Zhu L , Stamatakis C , Picchetti V , Matthews S , Miedema SS , Brown C , Thorsen VC , Manuel P , Gilbert LK , Kambona C , Coomer R , Trika J , Kamuingona R , Dube SR , Massetti GM . Child Abuse Negl 2023 106556 BACKGROUND: Parental absence in childhood has been associated with multiple negative consequences, such as depression and anxiety in young adulthood. OBJECTIVE: To assess whether parental absence for six months or more in childhood is associated with poor mental health and substance use in young adulthood and whether parental absence accounts for additional variance beyond those explained by other adverse childhood experiences (ACEs) among youth in sub-Saharan Africa. PARTICIPANTS AND SETTINGS: We used combined Violence Against Children and Youth Survey (VACS) data from Cote d'Ivoire (2018), Lesotho (2018), Kenya (2019), Namibia (2019), and Mozambique (2019). Analyses were restricted to 18-24-year-olds (n(f) = 7699; n(m) = 2482). METHODS: We used logistic regression to examine sex-stratified relationships between parental absence in childhood (defined as biological mother or father being away for six months or more before age 18) and mental health problems and substance use and whether parental absence explained additional variance beyond those explained by other ACEs. RESULTS: In sub-Saharan Africa, parental absence in childhood was common (30.5 % in females and 25.1 % in males), significantly associated with poor mental health and substance use among females and males and accounted for additional variance beyond those explained by conventional ACEs. For example, after controlling for study covariates and other ACEs, females who experienced any parental absence had 1.52 (95 % CI = 1.02-2.26) higher odds of experiencing moderate/serious psychological distress compared with those who did not. CONCLUSION: The observed association between parental absence and poor mental health suggests that this experience has significant adverse consequences and merits consideration as an ACE. |
Adverse childhood experiences and associations with mental health, substance use, and violence perpetration among young adults in sub-Saharan Africa
Brown C , Nkemjika S , Ratto J , Dube SR , Gilbert L , Chiang L , Picchetti V , Coomer R , Kambona C , McOwen J , Akani B , Kamagate MF , Low A , Manuel P , Agusto A , Annor FB . Child Abuse Negl 2023 Background: Adverse childhood experiences (ACEs) can have debilitating effects on child well-being, with consequences persisting into adulthood. Most ACE studies have been conducted in high-income countries and show a graded relationship between multiple ACE exposures and adverse health outcomes. Less is known about the types and burden of ACEs in sub-Saharan Africa (SSA). Objective: To estimate the pooled prevalence of six individual and cumulative ACE exposures (physical, sexual, and emotional violence; orphanhood; witnessing interparental and community violence) and assess their association with mental health outcomes, substance use, and violence perpetration among young adults in SSA. Participants and setting: Aggregate data from the Violence Against Children and Youth Survey (VACS) in Cote d'Ivoire 2018, Kenya 2019, Lesotho 2018, Mozambique 2019, and Namibia 2019 included a sample of 11,498 young adults aged 18–24 years. Methods: Cumulative ACEs were defined by an integer count of the total number of individual ACEs (0 to 6). Weighted prevalence and adjusted odds ratios were estimated. Result: ACEs prevalence ranged from 7.8 % (emotional violence) to 55.0 % (witnessing community violence). Strong graded relationships between cumulative ACE exposure and all study outcomes for both males and females were observed. Among females, witnessing interparental violence was the only individual ACE risk factor significantly associated with increased odds of substance use; among males, emotional violence was significantly associated with all outcomes. Conclusion: ACEs are associated with adverse mental health, substance use, and violence perpetration in SSA. Gender-specific and culturally sensitive intervention strategies are needed to effectively mitigate ACEs in this population. © 2023 |
Parenting-related positive childhood experiences, adverse childhood experiences, and mental health-Four sub-Saharan African countries
Seya MS , Matthews S , Zhu L , Brown C , Lefevre A , Agathis N , Chiang LF , Annor FB , McOwen J , Augusto A , Manuel P , Kamagate MF , Nobah MT , Coomer R , Kambona C , Low A . Child Abuse Negl 2023 106493 BACKGROUND: Adverse Childhood Experiences (ACEs) are associated with poor mental health outcomes and risk-taking behaviors. Positive childhood experiences (PCEs) may mitigate these negative impacts. OBJECTIVE: This study 1) assessed the associations between ACEs and negative health outcomes and risk-taking behaviors among young adults, and 2) evaluated whether - and which - PCEs moderate the association between ACEs and these outcomes in sub-Saharan Africa. METHODS: This multi-country analysis combined cross-sectional representative survey data from young adults, ages 18-24 years, from the 2019 Kenya, 2018 Lesotho, 2019 Mozambique, and 2019 Namibia Violence Against Children and Youth Surveys. The association between experiencing any ACEs and each health outcome was assessed using Wald's chi-square tests. Multivariable logistic regression analyses assessed the association between each PCE and each outcome of interest. RESULTS: Females who experienced any ACEs had higher odds of experiencing moderate to severe mental distress (aOR = 2.7, 95%CI: 1.9, 3.9). Males who experienced any ACEs had higher odds of experiencing suicidal/self-harm behaviors (aOR = 6.7, 95%CI: 2.8, 16.0) and substance use (aOR = 2.5, 95%CI: 1.4, 4.2). In females, strong mother-child relationship was protective against moderate to severe mental distress (aOR = 0.7, 95%CI: 0.6, 0.9), suicidal/self-harm behaviors (aOR = 0.6, 95%CI: 0.4, 0.9), and substance use (aOR = 0.6, 95%CI: 0.4, 0.9). For males, a strong mother-child relationship was protective against suicidal/self-harm behaviors (aOR = 0.5, 95%CI: 0.2, 0.9), and a strong father-child relationship was protective against suicidal/self-harm behaviors (aOR = 0.4, 95%CI: 0.2, 0.7) and substance use (aOR = 0.6, 95%CI: 0.4, 0.8). CONCLUSIONS: Strong parenting programs may likely play an important role in improving the psychosocial health of young adults. |
Patterns of adverse childhood experiences and their associations with mental distress, substance use and sexual risk behaviors in Sub-Saharan Africa
Miedema SS , Stamatakis C , Tracy A , Hegle J , Kamagate MF , McOwen J , Augusto A , Manuel P , Coomer R , Kambona C , Ramphalla P , Niolon P , Patel P , Annor FB . Child Abuse Negl 2023 106494 BACKGROUND: Multiple adverse childhood experiences (ACEs) are associated with poor sexual and mental health outcomes in low- and middle-income countries (LMICs). Less well understood is how discrete and gendered clustering of ACEs may influence health. OBJECTIVE: To assess how multiple ACEs co-occur and how dominant patterns of co-occurrence are associated with mental distress, substance use, and sexual risk behaviors among young women and men in Sub-Saharan Africa. PARTICIPANTS AND SETTING: We used pooled data of young men and women aged 19-24 from comparable, nationally representative Violence Against Children and Youth Surveys (VACS) conducted in Cote d'Ivoire, Kenya, Lesotho, Mozambique, and Namibia (n(f) = 7183; n(m) = 2207). METHODS: We estimated sex-disaggregated latent classes of six ACEs among young women and men. We ran Bolck-Croon-Hagenaars (BCH) distal outcome analysis to test the sex-stratified relationships between ACEs latent classes and health outcomes. RESULTS: A six class solution best fit the female data. Classes included witnessing violence and experiencing physical violence (PV); experiencing PV; high ACEs; witnessing community violence; orphanhood; and low ACEs exposure. Among males, the best-fitting three-class solution included experiencing PV and witnessing community violence; high ACEs; and low ACEs exposure. Membership in the high ACEs class was associated with mental distress among females and males, and substance use among males. No differences in sexual risk behavior were identified by class membership among either females or males. CONCLUSIONS: Discrete clusters of co-occurring ACEs are associated with elevated odds of mental distress among females, and mental distress and substance use among males. Preventing ACEs may improve mental health among young women and men in LMICs in Sub-Saharan Africa. |
Service-seeking behaviors among male victims of violence in five African countries: The effects of positive and adverse childhood experiences
Denhard L , Brown C , Kanagasabai U , Thorsen V , Kambona C , Kamagate F , Ramphalla P , Benevides R , Kamami M , McOwen J , Augusto A , Manuel P , Coomer R , Matthews S , Patel P , Annor FB . Child Abuse Negl 2023 106452 BACKGROUND: Violence against boys and men is widely under-reported. Boys and men face unique and gendered barriers to accessing services following experiences of violence. PARTICIPANTS AND SETTING: The study is a secondary data analysis of five nationally representative population-based Violence Against Children and Youth Surveys (VACS) conducted in Kenya (2019), Côte d'Ivoire (2018), Lesotho (2018), Mozambique (2019), and Namibia (2019). Analysis was limited to males between 18 and 24 years who experienced lifetime physical or sexual violence. OBJECTIVE AND METHODS: We analyzed the association between positive and adverse childhood experiences (PCEs and ACEs), and seeking post-violence services among males using bivariate chi-squared tests and multivariable logistic regression. RESULTS: 8.02 % (5.55-10.50 %) of male victims between the ages of 18 and 24 sought services for any lifetime physical or sexual violence. Witnessing interparental violence and experiencing death of one or both parents were each associated with increased odds of having sought post-violence services (aOR 2.43; 95 % CI: 1.25-4.79; aOR 2.27; 95 % CI: 1.14-4.50), controlling for education, violence frequency, and violence type. High parental monitoring was associated with increased odds of service seeking (aOR 1.79; 95 % CI: 1.02-3.16), while strong father-child relationship was associated with lower odds (aOR 0.45; 95 % CI: 0.23-0.89). CONCLUSION: These findings contribute to limited research on service-seeking behaviors among men and boys. While some parent-youth relationship factors were associated with higher odds of service-seeking, the outcome remained rare. Age and gender-related barriers should be addressed where post-violence care services are offered. |
Strong father-child relationships and other positive childhood experiences, adverse childhood experiences, and sexual risk factors for HIV among young adults aged 19-24 Years, Namibia, 2019: A Cross-Sectional Study
Agathis NT , Annor FB , Xu L , Swedo E , Chiang L , Coomer R , Hegle J , Patel P , Forster N , O'Malley G , Ensminger AL , Kamuingona R , Andjamba H , Nshimyimana B , Manyando M , Massetti GM . Int J Environ Res Public Health 2023 20 (14) Using cross-sectional data from the 2019 Namibia Violence Against Children and Youth Survey and sex-stratified multivariable models, we assessed the associations between four different positive childhood experiences (PCEs) and having ≥3 adverse childhood experiences (ACEs), including ≥3 ACE-PCE interaction terms, and seven sexual risk factors for HIV acquisition among young adults aged 19-24 years. One PCE, having a strong father-child relationship, was inversely associated with two risk factors among women (lifetime transactional sex (OR, 0.4; 95% CI, 0.2-0.7) and recent age-disparate sexual relationships (OR, 0.3; 95% CI, 0.2-0.5)), and significantly interacted with having ≥3 ACEs for three risk factors among women (not knowing a partner's HIV status, infrequently using condoms, and ever having an STI) and one among men (having multiple sexual partners in the past year). The other PCEs were significantly associated with ≤1 HIV risk factor and had no significant interaction terms. Strong father-child relationships may reduce HIV acquisition risk and mitigate the effect of childhood adversity on HIV risk among young adults in Namibia. |
Prevalence of adverse childhood experiences in Sub-Saharan Africa: A multicounty analysis of the Violence Against Children and Youth Surveys (VACS)
Amene EW , Annor FB , Gilbert LK , McOwen J , Augusto A , Manuel P , N'Gouanma Nobah MTV , Massetti GM . Child Abuse Negl 2023 106353 BACKGROUND: Adverse Childhood Experiences are traumatic events early in life and have been associated with significant negative health outcomes. OBJECTIVE: To estimate the prevalence of ACEs in five low- and middle-income sub-Saharan African countries. PARTICIPANTS AND SETTING: Nationally representative data from the Cote d'Ivoire (2018), Kenya (2019), Lesotho (2018), Mozambique (2019), and Namibia (2019) Violence Against Children and Youth Surveys (VACS) were used. Analyses were restricted to youth ages 18-24 years (n = 8766 females and 2732 males). METHODS: VACS data were analyzed to generate sex-stratified weighted prevalence of individual ACEs (including sexual, physical, and emotional violence; witnessing interparental violence and violence in the community; and orphanhood) and aggregate ACEs (total ACEs; 0, 1-2, and 3 or more), for each country and combined. RESULTS: The most common type of ACEs among both females and males was witnessing physical violence (males: 55.0 % [95 % CI: 51.1-58.8] and females: 37.2 % [95 % CI = 34.3-40.1]) followed by experiencing physical violence (males: 49.7 % [95 % CI = 45.5-53.9] and in females: 36.5 % [95 % CI = 33.8-39.2]). Prevalence of sexual violence was significantly higher in females than in males (16.0 % [95 % CI = 13.9-18.2] vs 8.3 % [95 % CI = 7.0-9.8]; p < 0.001). About 72 % of females and 82 % of males have experienced at least one form of ACE with 20 % of females and 24.2 % of males experiencing 3 or more ACEs. CONCLUSION: This study demonstrated that majority of the children in countries in sub-Saharan Africa have experienced multiple ACEs in their lifetime. Understanding the extent of the problem will help design early interventions to reduce childhood exposure to ACEs or mitigate against the harmful impact of ACEs. |
Cross-time comparison of adverse childhood experience patterns among Kenyan youth: Violence Against Children and Youth Surveys, 2010 and 2019
Miedema SS , Chiang L , Annor FB , Achia T . Child Abuse Negl 2023 141 106153 BACKGROUND: Adverse childhood experiences (ACEs) are a global public health concern. Many children experience multiple ACEs. Patterning of multiple ACEs may change over time. OBJECTIVE: To assess latent classes of ACEs among male and female youth in Kenya and evaluate whether ACEs latent classes changed between surveys conducted in 2010 and 2019. PARTICIPANTS AND SETTING: We used data from Kenya Violence Against Children and Youth Survey, a repeated nationally representative survey of male and female youth aged 13-24: 2010 (n(f) = 1227; n(m) = 1456) and 2019 (n(f) = 1344; n(m) = 788). METHODS: Latent class analysis was used to estimate clustering of seven ACEs: orphanhood, experiencing physical intimate partner violence, physical violence by a parent/caregiver, physical violence by an adult community member, forced first sex, emotional (EV) and sexual violence (SV), stratified by sex and time. RESULTS: For females in 2010, identified classes included (1) SV only, (2) household and community physical violence (PV), EV and SV, (3) household and community PV only, (4) low ACEs, and (5) EV only. In 2019, classes included (1) SV only, (2) household and community PV only, and (3) low ACEs. Among males in 2010, the four-class model included (1) household and community PV with EV, (2) low ACEs, (3) household and community PV with SV, and (4) household and community PV only. In 2019, identified classes included (1) orphanhood and SV, (2) orphanhood and PV, (3) low ACEs, and (4) household and community PV only. For both males and females, across the two survey years, some classes demonstrated continuity (low ACEs and caregiver and community PV for both males and females, and SV for females). Orphanhood emerged as relevant to the ACEs latent class structure in 2019 compared to 2010 among males. CONCLUSION: Prevalence and changes in latent classes between 2010 and 2019 can point toward priority areas and subgroups for violence prevention and response in Kenya. |
How the Global Violence Against Children and Youth surveys help improve pediatric global health
Agathis NT , Annor FB , Mercy J , Chiang L , de Barros RB , Massetti GM . Pediatrics 2022 150 (5) Violence against children is a prevalent, impactful, yet preventable global public health problem. At least half of all children in the world experience violence (physical, sexual, or emotional) every year.1 Aside from its ethical implications and the immediate physical and emotional harm it causes, childhood violence is strongly associated with poor short- and long-term health: increased odds of mental health problems, noncommunicable diseases, sexual and reproductive health problems, health risk behaviors, and experiencing and perpetrating violence in adulthood.2 Childhood violence is also associated with increased risk of HIV acquisition and reduced odds of engagement in HIV clinical prevention services, testing, treatment, and care among youth in high HIV-incidence settings.3–5 |
Association between lifetime sexual violence victimization and selected health conditions and risk behaviors among 13-24-year-olds in Lesotho: Results from the Violence Against Children and Youth Survey (VACS), 2018
Picchetti V , Stamatakis C , Annor FB , Massetti GM , Hegle J . Child Abuse Negl 2022 134 105916 BACKGROUND: Sexual violence is a serious public health concern worldwide. In Lesotho, one in seven women and one in twenty men aged 18years and older experienced sexual violence during childhood. Sexual violence victimization may lead to long-term mental and physical health issues among victims, regardless of gender. OBJECTIVE: To estimate the prevalence of lifetime sexual violence victimization (SV) among 13-24-year-olds in Lesotho and assess its association with selected health conditions and risk behaviors. PARTICIPANTS AND SETTING: Data from 13 to 24-year-old participants (n=8568) of the 2018 Lesotho Violence Against Children and Youth Survey were analyzed. METHODS: SV was defined as reporting one or more types of sexual violence at any age. Logistic regression analyses measured associations between SV and selected health conditions (suicidal thoughts, self-harm behaviors, mental distress, STIs, and HIV), and risk behaviors (binge drinking in the past 30days, drug use in the past 30days, infrequent condom use in the past 12months, multiple sex partners in the past 12months, and transactional sex in the past 12months). RESULTS: After controlling for study covariates, SV was significantly associated with self-harm behaviors, suicidal thoughts, ever having an STI, binge drinking in the past 30days, infrequent condom use in the past 12months, and multiple sex partners in the past 12months for both males and females; and mental distress and transactional sex in the past 12months for females. CONCLUSIONS: Preventing SV against children and youth in Lesotho may improve their health and wellbeing. |
Experiences of participation in a population-based survey on violence: Emotional discomfort, disclosure concerns, and the perceived value of participation among adolescents and young adults
Zhu L , Seya MKS , Villaveces A , Conkling M , Trika BJ , Kamagate MFM , Annor FB , Massetti GM . J Trauma Stress 2022 35 (4) 1226-1239 The accurate measurement of violence depends on high-quality data collected using methods that ensure participant confidentiality, privacy, and safety. To assess survey participants' emotional distress, discomfort, and self-perceived value of participating in the Honduras (2017), El Salvador (2017), Cote d'Ivoire (2018), and Lesotho (2018) Violence Against Children and Youth Surveys, which include sensitive topics such as sexual, physical, and emotional violence, we investigated individual self-reported distress and perceived value of participation by age, sex, and other demographic factors. We also examined the associations between past experiences of violence and both self-reported distress and perceived value of survey participation. Few individuals reported distress or concerns about disclosure. Across countries, 82.9% (Cote d'Ivoire) to 96.1% (Honduras) of participants indicated they were not afraid that someone might overhear their answers, 82.5% (Cote d'Ivoire) to 98.0% (El Salvador) said participation was not upsetting or stressful, and 93.3% (Cote d'Ivoire) to 98.6% (Honduras) said participation was worthwhile. The value of these interviews may exceed the negative feelings that some questions potentially elicit and can contribute to improved responses to victims. |
Changes in prevalence of violence and risk factors for violence and HIV among children and young people in Kenya: a comparison of the 2010 and 2019 Kenya Violence Against Children and Youth Surveys
Annor FB , Chiang LF , Oluoch PR , Mang'oli V , Mogaka M , Mwangi M , Ngunjiri A , Obare F , Achia T , Patel P , Massetti GM , Dahlberg LL , Simon TR , Mercy JA . Lancet Glob Health 2021 10 (1) e124-e133 BACKGROUND: Previous research has shown a high prevalence of violence among young people in Kenya. Violence is a known risk factor for HIV acquisition and these two public health issues could be viewed as a syndemic. In 2010, Kenya became the third country to implement the Violence Against Children and Youth Survey (VACS). The study found a high prevalence of violence in the country. Led by the Government of Kenya, stakeholders implemented several prevention and response strategies to reduce violence. In 2019, Kenya implemented a second VACS. This study examines the changes in violence and risk factors for violence and HIV between 2010 and 2019. METHODS: The 2010 and 2019 VACS used a similar sampling approach and measures. Both VACS were cross-sectional national household surveys of young people aged 13-24 years, designed to produce national estimates of physical, sexual, and emotional violence. Prevalence and changes in lifetime experiences of violence and risk factors for violence and HIV were estimated. The VACS uses a three-stage cluster sampling approach with random selection of enumeration areas as the first stage, households as the second stage, and an eligible participant from the selected household as the third stage. The VACS questionnaire contains sections on demographics, risk and protective factors, violence victimisation, violence perpetration, sexual behaviour, HIV testing and services, violence service knowledge and uptake, and health outcomes. For this study, the main outcome variables were violence victimisation, context of violence, and risk factors for violence. All analyses were done with the entire sample of 13-24-year-olds stratified by sex and survey year. FINDINGS: The prevalence of lifetime sexual, physical, and emotional violence significantly declined in 2019 compared with 2010, including unwanted sexual touching, for both females and males. Experience of pressured and forced sex among females also decreased between the surveys. Additionally, significantly more females sought and received services for sexual violence and significantly more males knew of a place to seek help in 2019 than in 2010. The prevalence of several risk factors for violence and HIV also declined, including infrequent condom use, endorsement of inequitable gender norms, endorsement of norms justifying wife beating, and never testing for HIV. INTERPRETATION: Kenya observed significant declines in the prevalence of lifetime violence and some risk factors for violence and HIV, and improvements in some service seeking indicators between 2010 and 2019. Continued prioritisation of preventing and responding to violence in Kenya could contribute to further reductions in violence and its negative outcomes. Other countries in the region that have made substantial investments and implemented similar violence prevention programmes could use repeat VACS data to monitor violence and related outcomes over time. FUNDING: None. |
HIV Prevention Program Eligibility Among Adolescent Girls and Young Women - Namibia, 2019
Agathis NT , Annor FB , Coomer R , Hegle J , Patel P , Forster N , O'Malley G , Ensminger AL , Kamuingona R , Andjamba H , Manyando M , Massetti GM . MMWR Morb Mortal Wkly Rep 2021 70 (45) 1570-1574 The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) relies on comprehensive and reliable population data to implement interventions to reduce HIV transmission in high-incidence areas among populations disproportionately affected by the HIV epidemic. Adolescent girls and young women in sub-Saharan Africa account for a disproportionate number of new HIV infections compared with their male peers (1). The DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) program includes multisectoral, layered interventions aimed at reducing factors that contribute to vulnerability to HIV infection among adolescent girls and young women in PEPFAR-supported sub-Saharan African countries (1). Namibia, a southern African country with a population of approximately 2.55 million among whom approximately 8% live with HIV infection, had their DREAMS program first implemented in 2017* (2,3). Data from the 2019 Namibia Violence Against Children and Youth Survey (VACS), the most recent and comprehensive nationally representative data source available to study the epidemiology of violence and other HIV risk factors, were used to estimate the percentage of adolescent girls and young women aged 13-24 years who would be eligible for DREAMS program services. The prevalence of individual DREAMS eligibility criteria, which comprise known age-specific risk factors associated with HIV acquisition, were estimated by age group. Among all adolescent girls and young women in Namibia, 62% were eligible for DREAMS based on meeting at least one criterion. Common eligibility criteria included adverse childhood experiences, specifically exposure to physical, emotional, and sexual violence and being an orphan;(†) and high-risk behaviors, such as early alcohol use,(§) recent heavy alcohol use,(¶) and infrequent condom use.** Using VACS data to estimate the prevalence of HIV risk factors and identify adolescent girls and young women at elevated risk for HIV acquisition in countries like Namibia with high HIV-incidence can inform programs and policies aimed at improving the well-being of these adolescent girls and young women and help control the HIV epidemics in these countries. |
COVID-19-Associated Orphanhood and Caregiver Death in the United States
Hillis SD , Blenkinsop A , Villaveces A , Annor FB , Liburd L , Massetti GM , Demissie Z , Mercy JA , Nelson CA3rd , Cluver L , Flaxman S , Sherr L , Donnelly CA , Ratmann O , Unwin HJT . Pediatrics 2021 148 (6) BACKGROUND: Most coronavirus disease 2019 (COVID-19) deaths occur among adults, not children, and attention has focused on mitigating COVID-19 burden among adults. However, a tragic consequence of adult deaths is that high numbers of children might lose their parents and caregivers to COVID-19-associated deaths. METHODS: We quantified COVID-19-associated caregiver loss and orphanhood in the United States and for each state using fertility and excess and COVID-19 mortality data.We assessed burden and rates of COVID-19-associated orphanhood and deaths of custodial and coresiding grandparents, overall and by race and ethnicity. We further examined variations in COVID-19-associated orphanhood by race and ethnicity for each state. RESULTS: We found that fromApril 1, 2020, through June 30, 2021,>140 000 children in the United States experienced the death of a parent or grandparent caregiver. The risk of such losswas 1.1 to 4.5 times higher among children of racial and ethnicminority groups compared with non-Hispanic White children. The highest burden of COVID-19-associated death of parents and caregivers occurred in Southern border states for Hispanic children, in Southeastern states for Black children, and in stateswith tribal areas for American Indian and/or Alaska Native populations. CONCLUSIONS: We found substantial disparities in distributions of COVID-19-associated death of parents and caregivers across racial and ethnic groups. Children losing caregivers to COVID-19 need care and safe, stable, and nurturing families with economic support, quality child care, and evidence-based parenting support programs. There is an urgent need tomount an evidence-based comprehensive response focused on those children at greatest risk in the statesmost affected. © 2021 American Academy of Pediatrics. All rights reserved. |
Counties with High COVID-19 Incidence and Relatively Large Racial and Ethnic Minority Populations - United States, April 1-December 22, 2020.
Lee FC , Adams L , Graves SJ , Massetti GM , Calanan RM , Penman-Aguilar A , Henley SJ , Annor FB , Van Handel M , Aleshire N , Durant T , Fuld J , Griffing S , Mattocks L , Liburd L . MMWR Morb Mortal Wkly Rep 2021 70 (13) 483-489 Long-standing systemic social, economic, and environmental inequities in the United States have put many communities of color (racial and ethnic minority groups) at increased risk for exposure to and infection with SARS-CoV-2, the virus that causes COVID-19, as well as more severe COVID-19-related outcomes (1-3). Because race and ethnicity are missing for a proportion of reported COVID-19 cases, counties with substantial missing information often are excluded from analyses of disparities (4). Thus, as a complement to these case-based analyses, population-based studies can help direct public health interventions. Using data from the 50 states and the District of Columbia (DC), CDC identified counties where five racial and ethnic minority groups (Hispanic or Latino [Hispanic], non-Hispanic Black or African American [Black], non-Hispanic Asian [Asian], non-Hispanic American Indian or Alaska Native [AI/AN], and non-Hispanic Native Hawaiian or other Pacific Islander [NH/PI]) might have experienced high COVID-19 impact during April 1-December 22, 2020. These counties had high 2-week COVID-19 incidences (>100 new cases per 100,000 persons in the total population) and percentages of persons in five racial and ethnic groups that were larger than the national percentages (denoted as "large"). During April 1-14, a total of 359 (11.4%) of 3,142 U.S. counties reported high COVID-19 incidence, including 28.7% of counties with large percentages of Asian persons and 27.9% of counties with large percentages of Black persons. During August 5-18, high COVID-19 incidence was reported by 2,034 (64.7%) counties, including 92.4% of counties with large percentages of Black persons and 74.5% of counties with large percentages of Hispanic persons. During December 9-22, high COVID-19 incidence was reported by 3,114 (99.1%) counties, including >95% of those with large percentages of persons in each of the five racial and ethnic minority groups. The findings of this population-based analysis complement those of case-based analyses. In jurisdictions with substantial missing race and ethnicity information, this method could be applied to smaller geographic areas, to identify communities of color that might be experiencing high potential COVID-19 impact. As areas with high rates of new infection change over time, public health efforts can be tailored to the needs of communities of color as the pandemic evolves and integrated with longer-term plans to improve health equity. |
Associations between endorsement of inequitable gender norms and intimate partner violence and sexual risk behaviors among youth in Nigeria: Violence Against Children Survey, 2014
Gilbert LK , Annor FB , Kress H . J Interpers Violence 2020 37 NP8507-NP8533 The purpose of this study was to assess whether the endorsement of inequitable gender norms about intimate partner violence against women (IPVAW) and sexual behavior was associated with intimate partner violence (IPV) victimization, IPV perpetration, and sexual risk behavior. Nigerian youth aged 13-24 (n = 4,203) participated in the nationally representative, cross-sectional Nigeria Violence Against Children Survey (VACS) in 2014. Inequitable gender norms about IPVAW were assessed using six items from the Demographic and Health Surveys (DHS), and inequitable gender norms about sexual behavior were assessed using four items adapted from the Gender-Equitable Men (GEM) scale. The number of inequitable gender norms endorsed was summed and associations with having been a victim or perpetrator of IPV and sexual risk behaviors were assessed using logistic regression. Endorsing 3 or more inequitable gender norms about either IPVAW or sexual behavior were both associated with increased odds of IPV victimization, perpetration, and sexual risk behaviors, after adjustment for demographic characteristics, witnessing violence in childhood, and having been a victim of other forms of childhood violence. Demonstrating that endorsement of inequitable gender norms about sexual behavior was associated with violence and that inequitable gender norms about IPVAW were associated with sexual risk behaviors further highlights potential linkages between violence and HIV. |
Race, Ethnicity, and Age Trends in Persons Who Died from COVID-19 - United States, May-August 2020.
Gold JAW , Rossen LM , Ahmad FB , Sutton P , Li Z , Salvatore PP , Coyle JP , DeCuir J , Baack BN , Durant TM , Dominguez KL , Henley SJ , Annor FB , Fuld J , Dee DL , Bhattarai A , Jackson BR . MMWR Morb Mortal Wkly Rep 2020 69 (42) 1517-1521 During February 12-October 15, 2020, the coronavirus disease 2019 (COVID-19) pandemic resulted in approximately 7,900,000 aggregated reported cases and approximately 216,000 deaths in the United States.* Among COVID-19-associated deaths reported to national case surveillance during February 12-May 18, persons aged ≥65 years and members of racial and ethnic minority groups were disproportionately represented (1). This report describes demographic and geographic trends in COVID-19-associated deaths reported to the National Vital Statistics System(†) (NVSS) during May 1-August 31, 2020, by 50 states and the District of Columbia. During this period, 114,411 COVID-19-associated deaths were reported. Overall, 78.2% of decedents were aged ≥65 years, and 53.3% were male; 51.3% were non-Hispanic White (White), 24.2% were Hispanic or Latino (Hispanic), and 18.7% were non-Hispanic Black (Black). The number of COVID-19-associated deaths decreased from 37,940 in May to 17,718 in June; subsequently, counts increased to 30,401 in July and declined to 28,352 in August. From May to August, the percentage distribution of COVID-19-associated deaths by U.S. Census region increased from 23.4% to 62.7% in the South and from 10.6% to 21.4% in the West. Over the same period, the percentage distribution of decedents who were Hispanic increased from 16.3% to 26.4%. COVID-19 remains a major public health threat regardless of age or race and ethnicity. Deaths continued to occur disproportionately among older persons and certain racial and ethnic minorities, particularly among Hispanic persons. These results can inform public health messaging and mitigation efforts focused on prevention and early detection of infection among disproportionately affected groups. |
Sexual violence experience among Nigerian girls and young women: What are the roles of early sexual debut, multiple sex partnerships, and traditional gender role beliefs
De Veauuse Brown NF , Annor FB , Swahn MH , Self-Brown SR . J Interpers Violence 2020 37 NP2747-NP2767 In Nigeria, one in four females has experienced some form of sexual abuse. Therefore, it is imperative to examine risk factors associated with sexual violence victimization of Nigerian girls and young women to identify targets for prevention and help stakeholders prioritize response efforts. The present article focuses on secondary data analyses of 1,766 females, aged 13 to 24, interviewed in the population-based 2014 Nigeria Violence Against Children Survey. The outcome of interest is lifetime sexual violence (LSV). Several potential predictors were explored: beliefs about gender roles related to sex, early sexual debut (aged <16 years), and multiple sex partners in the past 12 months. Other risk factors assessed were age, ethnicity, religion, education, marital status, and employment. Logistic regression analyses estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results revealed that females who endorsed beliefs about patriarchal sexual decision-making (AOR = 2.1, 95% CI = [1.28, 3.32]) or ever attended school (AOR = 2.4, 95% CI = [1.35, 4.34]) were more likely to report experiencing LSV. Prevention programs that target traditional norm beliefs about gender and sexuality have the potential to influence sexual violence in Nigeria. In addition, school attendance may expose females to potential perpetrators. Thus, to prevent sexual violence of girls who attend school, implementing safety measures may be beneficial for protecting them while in and traveling to/from school. |
Emotional violence in childhood and health conditions, risk-taking behaviors, and violence perpetration among young adults in Nigeria
Annor FB , Gilbert LK , Davila EP , Massetti GM , Kress H , Onotu D , Ogbanufe O . Child Abuse Negl 2020 106 104510 BACKGROUND: Globally, over 1 billion children are victims of violence against children annually. Studies examining the health consequences of childhood violence have mostly focused on childhood physical violence (PV) and sexual violence (SV). Recent evidence suggests that childhood emotional violence (EV) may also be deleterious to the health and wellbeing of victims. OBJECTIVE: This study examines the independent association between EV and some health conditions, risk taking behaviors, and violence perpetration among Nigerian young adults ages 18-24 years. PARTICIPANTS AND SETTING: Data from 2014 Nigeria Violence Against Children Survey (n = 4,203), a nationally representative cross-sectional survey of individuals ages 13-24 were used. METHODS: Childhood EV was defined as EV victimization before age 18 perpetrated by a parent, adult caregiver or other adult relative. Logistic regression analyses assessed the association between EV in childhood and mental distress in the past 30 days, ever self-harm behaviors and history of sexually transmitted infections; risk behaviors such as having multiple sex partners in the past 12 months; and ever violence perpetration. RESULTS: After controlling for study covariates, EV in childhood was associated with mental distress in both males and females, and self-harm behaviors in females; excessive alcohol use and infrequent condom use in males, and multiple sexual partners in females; and PV perpetration in males and SV perpetration in females. CONCLUSION: EV in childhood is associated with some health conditions, risk taking behaviors, and violence perpetration. Implementing programs that address all forms of violence in childhood, including EV may benefit children. |
Trends in the incidence and lethality of suicidal acts in the United States, 2006 to 2015
Wang J , Sumner SA , Simon TR , Crosby AE , Annor FB , Gaylor E , Xu L , Holland KM . JAMA Psychiatry 2020 77 (7) 684-693 Importance: Understanding changes in the incidence rates and lethality of suicidal acts may explain increasing suicide rates. Objective: To examine trends in the incidence rates and lethality of suicidal acts from 2006 to 2015 among persons aged 10 to 74 years. Design, Setting, and Participants: This cross-sectional study was conducted from May 2, 2018, to January 30, 2019. Medically treated nonfatal suicide attempts were identified from the 2006 to 2015 Nationwide Inpatient Sample and Nationwide Emergency Department Sample databases. Suicides were identified from the 2006 to 2015 mortality files of the National Vital Statistics System. Main Outcomes and Measures: The incidence rate of suicidal acts was calculated by dividing the number of total suicidal acts by the US population. Lethality was measured through the case fatality rates (CFRs) of suicidal acts by dividing the number of suicides by the total number of suicidal acts. Results: A total of 1222419 (unweighted) suicidal acts, which included both suicides and nonfatal suicide attempts, were identified from 2006 to 2015. Overall, the incidence rates of total suicidal acts increased 10% from 2006 to 2015 (annual percentage change [APC], 0.8%; 95% CI, 0.3%-1.3%), and the CFRs of suicidal acts increased 13% during the 2006 to 2015 period (APC, 2.3%; 95% CI, 1.3%-3.3%). In subgroup analyses, incidence rates increased by 1.1% (95% CI, 0.6%-1.6%) per year for female individuals during the 2006 to 2015 period but remained stable for male individuals. The CFRs increased for both sexes (APC, 5.0% [95% CI, 3.1%-6.9%] since 2010 for female individuals; 1.6% [95% CI, 0.6%-2.5%] since 2009 for male individuals). Incidence rates increased among adolescents from 2011 to 2015 and among older adults aged 65 to 74 years throughout the 2006 to 2015 period. Conversely, the CFRs increased since 2009 among persons aged 20 to 44 years (APC, 3.7%; 95% CI, 2.5%-5.0%) and since 2012 for those aged 45 to 64 years (APC, 2.7%; 95% CI, 0.0%-5.4%). Persons aged 20 to 44 years and 45 to 64 years experienced increases in suicidal acts by more lethal means, whereas adolescents and older adults aged 65 to 74 years showed increased incidence by all means. Conclusions and Relevance: This study found increased suicidal acts among female persons, adolescents, and older adults aged 65 to 74 years, implying the need to address emerging or exacerbating suicide risk factors for these populations. The findings on the increased lethality particularly among persons aged 20 to 64 years highlighted the need to reduce access to materials that could be used as lethal means among persons at risk of suicide. These findings on population-level epidemiologic patterns can be used to guide the development of comprehensive suicide prevention strategies. |
Syndromic surveillance of suicidal ideation and self-directed violence - United States, January 2017-December 2018
Zwald ML , Holland KM , Annor FB , Kite-Powell A , Sumner SA , Bowen DA , Vivolo-Kantor AM , Stone DM , Crosby AE . MMWR Morb Mortal Wkly Rep 2020 69 (4) 103-108 Suicide is a growing public health problem in the United States, claiming approximately 47,000 lives in 2017 (1). However, deaths from suicide represent only a small part of a larger problem because each year millions of persons experience suicidal ideation and engage in suicidal and nonsuicidal self-directed violence, both risk factors for suicide (2). Emergency departments (EDs) are an important setting for monitoring these events in near real time (3-5). From 2001 to 2016, ED visit rates for nonfatal self-harm increased 42% among persons aged >/=10 years (1). Using data from CDC's National Syndromic Surveillance Program (NSSP), ED visits for suicidal ideation, self-directed violence, or both among persons aged >/=10 years during January 2017-December 2018 were examined by sex, age group, and U.S. region. During the 24-month period, the rate of ED visits for suicidal ideation, self-directed violence, or both increased 25.5% overall, with an average increase of 1.2% per month. Suicide prevention requires comprehensive and multisectoral approaches to addressing risk at personal, relationship, community, and societal levels. ED syndromic surveillance data can provide timely trend information and can support more targeted and prompt public health investigation and response. CDC's Preventing Suicide: A Technical Package of Policy, Programs, and Practices includes tailored suicide prevention strategies for health care settings (6). |
Update: Characteristics of patients in a national outbreak of e-cigarette, or vaping, product use-associated lung injuries - United States, October 2019
Moritz ED , Zapata LB , Lekiachvili A , Glidden E , Annor FB , Werner AK , Ussery EN , Hughes MM , Kimball A , DeSisto CL , Kenemer B , Shamout M , Garcia MC , Reagan-Steiner S , Petersen EE , Koumans EH , Ritchey MD , King BA , Jones CM , Briss PA , Delaney L , Patel A , Polen KD , Sives K , Meaney-Delman D , Chatham-Stephens K . MMWR Morb Mortal Wkly Rep 2019 68 (43) 985-989 CDC, the Food and Drug Administration, state and local health departments, and other public health and clinical stakeholders are investigating a national outbreak of electronic-cigarette (e-cigarette), or vaping, product use-associated lung injury (EVALI) (1). As of October 22, 2019, 49 states, the District of Columbia (DC), and the U.S. Virgin Islands have reported 1,604 cases of EVALI to CDC, including 34 (2.1%) EVALI-associated deaths in 24 states. Based on data collected as of October 15, 2019, this report updates data on patient characteristics and substances used in e-cigarette, or vaping, products (2) and describes characteristics of EVALI-associated deaths. The median age of EVALI patients who survived was 23 years, and the median age of EVALI patients who died was 45 years. Among 867 (54%) EVALI patients with available data on use of specific e-cigarette, or vaping, products in the 3 months preceding symptom onset, 86% reported any use of tetrahydrocannabinol (THC)-containing products, 64% reported any use of nicotine-containing products, and 52% reported use of both. Exclusive use of THC-containing products was reported by 34% of patients and exclusive use of nicotine-containing products by 11%, and for 2% of patients, no use of either THC- or nicotine-containing products was reported. Among 19 EVALI patients who died and for whom substance use data were available, 84% reported any use of THC-containing products, including 63% who reported exclusive use of THC-containing products; 37% reported any use of nicotine-containing products, including 16% who reported exclusive use of nicotine-containing products. To date, no single compound or ingredient used in e-cigarette, or vaping, products has emerged as the cause of EVALI, and there might be more than one cause. Because most patients reported using THC-containing products before symptom onset, CDC recommends that persons should not use e-cigarette, or vaping, products that contain THC. In addition, because the specific compound or ingredient causing lung injury is not yet known, and while the investigation continues, persons should consider refraining from the use of all e-cigarette, or vaping, products. |
Suicide among persons with dementia, Georgia, 2013 to 2016
Annor FB , Bayakly RA , Morrison RA , Bryan MJ , Gilbert LK , Ivey-Stephenson AZ , Holland KM , Simon TR . J Geriatr Psychiatry Neurol 2018 32 (1) 891988718814363 INTRODUCTION:: Findings from studies examining the relationship between dementia and suicide have been inconsistent. This study examined the characteristics, precipitants, and risk factors for suicide among persons with dementia. METHODS:: Data from the Georgia Alzheimer's Disease and Related Dementia registry were linked with 2013 to 2016 data from Georgia Vital Records and Georgia Violent Death Reporting System. Descriptive statistics were calculated and logistic regression was used to examine risk factors for suicide. RESULTS:: Ninety-one Georgia residents with dementia who died by suicide were identified. Among decedents with known circumstances, common precipitants included depressed mood (38.7%) and physical health problems (72.6%). Suicide rate among persons with dementia was 9.3 per 100 000 person-years overall and substantially higher among those diagnosed in the past 12 months (424.5/100 000 person-years). Being male, dementia diagnosis before age 65, and a recent diagnosis of dementia independently predicted suicide, but not depression or cardiovascular diseases. CONCLUSION:: Prevention strategies that identify at-risk individuals, provide support, and ensure continuity of care for persons diagnosed with dementia may help reduce suicide in this population. |
Suicidal ideation and attempts among students in grades 8, 10, and 12 - Utah, 2015
Zwald ML , Annor FB , Wilkinson A , Friedrichs M , Fondario A , Dunn AC , Nakashima A , Gilbert LK , Ivey-Stephenson A . MMWR Morb Mortal Wkly Rep 2018 67 (15) 451-454 Suicidal thoughts and behaviors among youths are important public health concerns in Utah, where the suicide rate among youths consistently exceeds the national rate and has been increasing for nearly a decade (1). In March 2017, CDC was invited to assist the Utah Department of Health (UDOH) with an investigation to characterize the epidemiology of fatal and nonfatal suicidal behaviors and identify risk and protective factors associated with these behaviors, among youths aged 10-17 years. This report presents findings related to nonfatal suicidal behaviors among Utah youths. To examine the prevalence of suicidal ideation and attempts among Utah youths and evaluate risk and protective factors, data from the 2015 Utah Prevention Needs Assessment survey were analyzed. Among 27,329 respondents in grades 8, 10, and 12, 19.6% reported suicidal ideation and 8.2% reported suicide attempts in the preceding 12 months. Significant risk factors for suicidal ideation and attempts included being bullied, illegal substance or tobacco use in the previous month, and psychological distress. A significant protective factor for suicidal ideation and attempts was a supportive family environment. UDOH, local health departments, and other stakeholders are using these findings to develop tailored suicide prevention strategies that address multiple risk and protective factors for suicidal ideation and attempts. Resources such as CDC's Preventing Suicide: A Technical Package of Policy, Programs, and Practices (2) can help states and communities identify strategies and approaches using the best available evidence to prevent suicide, which include tailored strategies for youths. |
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