CONTEXT: In response to the COVID-19 pandemic, Congress passed the American Rescue Plan Act of 2021 (ARPA) that included a historic investment in the public health workforce. PROGRAM: Charged with implementing this investment, the U.S. Centers for Disease Control and Prevention (CDC) launched the Public Health Infrastructure Grant (PHIG). PHIG builds on CDC's experience working with state, local, and territorial public health departments and represents a new approach to strengthening the public health workforce. IMPLEMENTATION: Specifically, PHIG incorporates features that allow these public health departments to prioritize and tailor the funding to meet their communities' needs: 1) focus on workforce as core infrastructure, 2) streamlined programmatic and administrative requirements, 3) more equitable funding approach, and 4) enhanced support from national partners and CDC. DISCUSSION: The goal is to optimize the unprecedented opportunity afforded by ARPA and lead to a stronger public health workforce and infrastructure across the United States.

OBJECTIVES: The Centers for Disease Control and Prevention (CDC) needs leaders at all levels who can address technical and adaptive challenges in a changing public health landscape. We assessed the feasibility of implementing an enterprise-wide leadership development model. METHODS: In June 2023, we launched a pilot program, Learn and Lead, for nonsupervisory staff in early and mid-career levels. One hundred sixty-nine participants registered, and 149 completed at least 6 weeks of the 8-week program. We gathered quantitative and qualitative data through weekly electronic surveys and in-depth interviews. We calculated frequencies for closed-ended Likert-scale items and performed content analysis of open-ended items to assess most frequently mentioned themes. We based the pilot's design on CDC's leadership development framework to assess application of the framework and alignment of curriculum to the framework. RESULTS: Three themes emerged: logistics and facilitation, leadership development curriculum, and making connections with self and others. Findings for logistics and facilitation highlighted preferences for course length, small breakout groups, mixed weeks, and value of staff support. Findings for the leadership development curriculum underscored the relevance of the US Office of Personnel Management's fundamental competencies to leadership development. Findings for making connections with self and others supported the cohort model and the importance of networking. CONCLUSIONS: The pilot curriculum aligned well with the CDC leadership development framework. Feedback provided by pilot participants is being used to help shape CDC's ongoing leadership development efforts.

In the last decade, there has been an increasing awareness of the importance of addressing the social determinants of health (SDOH), the nonmedical conditions that influence health outcomes,1 as a systemic strategy for improving health, particularly among groups that are disproportionally affected by SDOH.2 While health care is important, it is estimated that these conditions, ranging from structural racism to socioeconomic factors, drive as much as 50% of health outcomes.3

In 2021, an estimated more than 108 000 drug overdose deaths occurred in the United States, the highest number of overdose deaths predicted for a calendar year, according to recent provisional data from the Centers for Disease Control and Prevention (CDC.) The drug overdose crisis, previously driven by heroin and prescription opioids, since 2013 has been driven by synthetic opioids (primarily, illicit manufactured fentanyl). From 2020 to 2021, drug overdose deaths involving synthetic opioids increased by nearly 25%, and in 2021, nearly 70% of all drug overdose deaths involved these highly potent and lethal opioids.

The COVID-19 pandemic has been a long and tragic public health crisis. More than 1 million people have died in the United States. Some segments of our population, including those who are African American, Hispanic, American Indian/Alaska Native, and living in low socioeconomic areas, have borne a disproportionate burden of morbidity and mortality. 1 Preexisting health disparities have been exacerbated as people delayed care, deferred prevention, and isolated at home.

Firearm-related violence is a significant public health problem that requires a comprehensive approach to prevention that includes engagement and action by clinicians and health care systems. The effects of firearm-related violence on health care include immediate treatment for injuries, long-term care (eg, for spinal cord injuries and trauma), and a substantial toll on clinicians related to secondary traumatic stress. Firearms are the method of injury for most homicides and suicides (79% and 53%, respectively, in 2020).1 The circumstances of 2020, including the COVID-19 pandemic and community–law enforcement tensions related to law enforcement use of force, have potentially contributed to increased risks for homicide and suicide, including exacerbating the social and structural factors that drive racial and ethnic inequities.1

Recent attention has focused on the growing role of psychostimulants, such as methamphetamine in overdose deaths. Methamphetamine is an addictive and potent stimulant, and its use is associated with a range of physical and mental health harms, overdose, and mortality. Adding to the complexity of this resurgent methamphetamine threat is the reality that the increases in methamphetamine availability and harms are occurring in the midst of and intertwined with the ongoing opioid overdose crisis. Opioid involvement in psychostimulant-involved overdose deaths increased from 34.5% of overdose deaths in 2010 to 53.5% in 2019-an increase of more than 50%. This latest evolution of the nation's overdose epidemic poses novel challenges for prevention, treatment, and harm reduction. This narrative review synthesizes what is known about changing patterns of methamphetamine use with and without opioids in the United States, other characteristics associated with methamphetamine use, the contributions of the changing illicit drug supply to use patterns and overdose risk, motivations for couse of methamphetamine and opioids, and awareness of exposure to opioids via the illicit methamphetamine supply. Finally, the review summarizes illustrative community and health system strategies and research opportunities to advance prevention, treatment, and harm reduction policies, programs, and practices.

Recent data indicate a resurgence of stimulant use and harms in the United States; thus, there is a need to identify risk factors to inform development of effective prevention strategies. Prior research suggests adverse childhood experiences (ACEs) are common among individuals using stimulants and may be an important target for prevention. National Epidemiological Survey on Alcohol and Related Conditions was used to estimate prevalence of ACEs among U.S. adults using amphetamine-type stimulants (ATS), cocaine, or both. Multivariable logistic regression examined associations between ACEs and stimulant use and use disorders. Among adults reporting lifetime ATS use, 22.1% had ≥4 ACEs, 24.9% had 2-3 ACEs, 22.4% had 1 ACE, 30.6% reported no ACEs. Among adults with lifetime ATS use disorder, 29.3% reported ≥4 ACEs, 28.7% reported 2-3 ACEs, 21.6% reported 1 ACE, and 20.4% reported no ACEs. Multivariable logistic regression found a significant relationship between number of ACEs and stimulant use and use disorders. In conclusion, we found a strong relationship between increasing ACE exposures and stimulant use and use disorders. Advancing comprehensive strategies to prevent ACEs and treating underlying trauma among those using stimulants holds great promise to reduce stimulant use and its health and social consequences in the United States.

IMPORTANCE: The coronavirus disease 2019 (COVID-19) pandemic, associated mitigation measures, and social and economic impacts may affect mental health, suicidal behavior, substance use, and violence. OBJECTIVE: To examine changes in US emergency department (ED) visits for mental health conditions (MHCs), suicide attempts (SAs), overdose (OD), and violence outcomes during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the Centers for Disease Control and Prevention's National Syndromic Surveillance Program to examine national changes in ED visits for MHCs, SAs, ODs, and violence from December 30, 2018, to October 10, 2020 (before and during the COVID-19 pandemic). The National Syndromic Surveillance Program captures approximately 70% of US ED visits from more than 3500 EDs that cover 48 states and Washington, DC. MAIN OUTCOMES AND MEASURES: Outcome measures were MHCs, SAs, all drug ODs, opioid ODs, intimate partner violence (IPV), and suspected child abuse and neglect (SCAN) ED visit counts and rates. Weekly ED visit counts and rates were computed overall and stratified by sex. RESULTS: From December 30, 2018, to October 10, 2020, a total of 187 508 065 total ED visits (53.6% female and 46.1% male) were captured; 6 018 318 included at least 1 study outcome (visits not mutually exclusive). Total ED visit volume decreased after COVID-19 mitigation measures were implemented in the US beginning on March 16, 2020. Weekly ED visit counts for all 6 outcomes decreased between March 8 and 28, 2020 (March 8: MHCs = 42 903, SAs = 5212, all ODs = 14 543, opioid ODs = 4752, IPV = 444, and SCAN = 1090; March 28: MHCs = 17 574, SAs = 4241, all ODs = 12 399, opioid ODs = 4306, IPV = 347, and SCAN = 487). Conversely, ED visit rates increased beginning the week of March 22 to 28, 2020. When the median ED visit counts between March 15 and October 10, 2020, were compared with the same period in 2019, the 2020 counts were significantly higher for SAs (n = 4940 vs 4656, P = .02), all ODs (n = 15 604 vs 13 371, P < .001), and opioid ODs (n = 5502 vs 4168, P < .001); counts were significantly lower for IPV ED visits (n = 442 vs 484, P < .001) and SCAN ED visits (n = 884 vs 1038, P < .001). Median rates during the same period were significantly higher in 2020 compared with 2019 for all outcomes except IPV. CONCLUSIONS AND RELEVANCE: These findings suggest that ED care seeking shifts during a pandemic, underscoring the need to integrate mental health, substance use, and violence screening and prevention services into response activities during public health crises.

Objectives. To report trends in sexual violence (SV) emergency department (ED) visits in the United States.Methods. We analyzed monthly changes in SV rates (per 100 000 ED visits) from January 2017 to December 2019 using Centers for Disease Control and Prevention's National Syndromic Surveillance Program data. We stratified the data by sex and age groups.Results. There were 196 948 SV-related ED visits from January 2017 to December 2019. Females had higher rates of SV-related ED visits than males. Across the entire time period, females aged 50 to 59 years showed the highest increase (57.33%) in SV-related ED visits, when stratified by sex and age group. In all strata examined, SV-related ED visits displayed positive trends from January 2017 to December 2019; 10 out of the 24 observed positive trends were statistically significant increases. We also observed seasonal trends with spikes in SV-related ED visits during warmer months and declines during colder months, particularly in ages 0 to 9 years and 10 to 19 years.Conclusions. We identified several significant increases in SV-related ED visits from January 2017 to December 2019. Syndromic surveillance offers near-real-time surveillance of ED visits and can aid in the prevention of SV. (Am J Public Health. Published online ahead of print January 21, 2021: e1-e9. https://doi.org/10.2105/AJPH.2020.306034).

BACKGROUND: Posttraumatic stress disorder (PTSD) is linked to a specific event, providing the opportunity to intervene in the immediate aftermath of trauma to prevent the development of this disorder. A previous trial demonstrated that trauma survivors who received three sessions of modified prolonged exposure therapy demonstrated decreased PTSD and depression prospectively compared to assessment only. The present study investigated the optimal dosing of this early intervention to test one versus three sessions of exposure therapy in the immediate aftermath of trauma. METHODS: Participants (n = 95) recruited from a Level 1 Trauma Center were randomly assigned in a 1.5:1.5:1 ratio in a parallel-group design to the three conditions: one-session exposure therapy, three-session exposure therapy, and assessment only. Follow-up assessments were conducted by study assessors blind to study condition. RESULTS: Mixed-effects model results found no significant differences in PTSD or depression symptoms between the control condition and those who received one or three exposure therapy sessions across 1-12-month follow-up assessment. Results indicate that the intervention did not interfere with natural recovery. Receiver operating characteristic curve analyses on the screening measure used for study inclusion (Predicting PTSD Questionnaire; PPQ) in the larger sample from which the treatment sample was drawn (n = 481) found that the PPQ was a poor predictor of likely PTSD at all follow-up time points (Area under the curve's = 0.55-0.62). CONCLUSIONS: This likely impacted study results as many participants demonstrated natural recovery. Recommendations for future early intervention research are reviewed, including strategies to identify more accurately those at risk for PTSD and oversampling more severe trauma types.

This study used data from the National Vital Statistics System Mortality to evaluate trends in US drug overdose deaths involving opioids certified as unintentional, suicide, or undetermined intent.

Adverse childhood experiences, commonly referred to as ACEs, are potentially traumatic events that occur in childhood and adolescence, such as experiencing physical, emotional, or sexual abuse; witnessing violence in the home; having a family member attempt or die by suicide; and growing up in a household with substance use, mental health problems, or instability due to parental separation, divorce, or incarceration.1 Since the publication of the ACES Study by the Centers for Disease Control and Prevention and Kaiser Permanente in 1998,2 more than 2 decades of research have documented the association of ACEs with health and well-being across the life span.1-3

On September 6, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). As of August 27, 2019, 215 possible cases of severe pulmonary disease associated with the use of electronic cigarette (e-cigarette) products (e.g., devices, liquids, refill pods, and cartridges) had been reported to CDC by 25 state health departments. E-cigarettes are devices that produce an aerosol by heating a liquid containing various chemicals, including nicotine, flavorings, and other additives (e.g., propellants, solvents, and oils). Users inhale the aerosol, including any additives, into their lungs. Aerosols produced by e-cigarettes can contain harmful or potentially harmful substances, including heavy metals such as lead, volatile organic compounds, ultrafine particles, cancer-causing chemicals, or other agents such as chemicals used for cleaning the device (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis, or other drugs; for example, "dabbing" involves superheating substances that contain high concentrations of THC and other plant compounds (e.g., cannabidiol) with the intent of inhaling the aerosol. E-cigarette users could potentially add other substances to the devices. This report summarizes available information and provides interim case definitions and guidance for reporting possible cases of severe pulmonary disease. The guidance in this report reflects data available as of September 6, 2019; guidance will be updated as additional information becomes available.

Despite encouraging news, our country remains amidst an opioid overdose epidemic, and emergency physicians have a front line view and opportunity to continue progress in reducing overdoses. Although recent data in the United States indicate a slowing in overdose fatalities1, decreased opioid prescribing and opioid misuse2,3, and a decreased number of people initiating heroin use3, it is too early to declare success. Although initially linked to prescription opioids, the opioid overdose epidemic now is largely fueled by highly potent illicit agents such as illicitly manufactured fentanyl and various fentanyl analogs; alongside of this are increases in psychostimulant and cocaine overdoses4. What does all of this mean for emergency physicians? We seek to highlight successes achieved in recent years, but also call for more ongoing action by emergency physicians with specific patient-centered actions.

From 2005 to 2009, children made more than 2 million outpatient visits and almost 3 million emergency department (ED) visits for mild traumatic brain injury.1 The actual number of mild traumatic brain injury cases is difficult to assess because patients may seek treatment in a variety of medical or school settings, or not at all. However, there is evidence that these numbers are increasing; in 2007, there were 461,000 ED visits for traumatic brain injury among children aged 14 years and younger; by 2013, that number had increased to 642,000.2,3

Consider “Jane,” a 30-year-old female patient brought in by emergency medical services (EMS) to the emergency department (ED), reflecting just one of more than 100,000 opioid overdose patients treated in EDs each year. Naloxone, an opioid antagonist and overdose reversal drug, was administered in the field by EMS; however, additional rounds of naloxone were required in the ED because of high opioid potency. Once she was stabilized, a quick review of her chart revealed several recent visits for opioid-related overdoses. A review of her history revealed that she was prescribed opioids initially in the ED 5 years earlier after sustaining minor injuries in a motor vehicle crash. She began misusing prescription opioids during the following year, receiving prescriptions from multiple providers in primary care clinics and EDs. Yet, because a check of the state’s prescription drug monitoring program was not completed before any prescription, her use of multiple providers and high dosages was not identified, and opioids continued to be prescribed in different clinical settings for pain management. Soon thereafter, Jane initiated heroin use and presented to the ED several times with cellulitis from injection drug use, as well as after an overdose of prescription and illicit opioids. Each time, she was discharged without a referral to substance use treatment or without a naloxone kit.

Drug overdose accounted for 52 404 deaths in the United States in 2015,1 which are more deaths than for AIDS at its peak in 1995. Provisional data from the US Centers for Disease Control and Prevention (CDC) indicate drug overdose deaths increased again from 2015 to 2016 by more than 20% (from 52 898 deaths in the year ending in January 2016 to 64 070 deaths in the year ending in January 2017).2 Increases are greatest forover-doses related to the category including illicitly manufactured fentanyl (ie, synthetic opioids excluding methadone), which more than doubled, accounting for more than 20 000 overdose deaths in 2016 vs less than 10 000 deaths in 2015. This difference is enough to account for nearly all the increase in drug overdose deaths from 2015 to 2016.2 | Since 2010, overdose deaths involving predominantly illicit opioids (heroin, synthetic nonmethadone opioids, or both) have increased by more than 200% (Figure). Why have overdose deaths related to illicit opioids increased so substantially? Data from the National Survey on Drug Use and Health reveal moderate increases in people reporting past-year heroin use from 2010 to 2015 (Figure). Increasing numbers of individuals who use heroin are younger, might be less experienced, and might use heroin in riskier ways that are difficult to measure (eg, using it alone, using more heroin, using it more often, or combining drugs).

As an emergency physician who has treated the types of injuries described by Berkowitz too many times, I appreciate the clinical review regarding physical abuse in children. However, clinical presentations represent only a small fraction of the child abuse and neglect that occur in the United States. Self-reported survey data from children and caregivers indicate that one in seven children were victims of abuse or neglect in the preceding year.1 Each adverse childhood experience can result in lifelong health issues, such as obesity, depression, drug abuse, and suicide. The Centers for Disease Control and Prevention (CDC) recently released the guide Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities, which provides effective strategies for preventing violence against children.2 Several model medical programs are highlighted, such as enhanced primary care programs that identify and address risk factors for child abuse and neglect, early childhood homevisitation programs that provide caregiver training, and trauma-focused cognitive behavioral therapy to lessen the harms of abuse. Although diagnosis and treatment are crucial, physicians also play a critical role in the prevention of child abuse and adverse childhood experiences.

The United States is in the midst of an opioid overdose epidemic. Between 1999 and 2010, prescription opioid–related overdose deaths increased substantially in parallel with increased prescribing of opioids.1 In 2015, opioid-involved drug overdoses accounted for 33 091 deaths, approximately half involving prescription opioids.2 Additionally, an estimated 2 million individuals in the United States have opioid use disorder (addiction) associated with prescription opioids, accounting for an estimated $78.5 billion in economic costs annually.3 Proven strategies are available to manage chronic pain effectively without opioids, and changing prescribing practices is an important step in addressing the opioid overdose epidemic and its adverse effects on US communities. | On July 6, 2017, the US Centers for Disease Control and Prevention reported that between 2006 and 2015 the amount of opioids prescribed in the United States peaked in 2010 at 782 morphine milligram equivalents (MME) per capita and then decreased each year through 2015 to 640 MME per capita. Prescribing rates increased from 72.4 to 81.2 prescriptions per 100 persons between 2006 and 2010, were constant between 2010 and 2012, and then declined to 70.6 per 100 persons from 2012 to 2015, a 13.1% decline.1 Yet the amount of opioids prescribed in 2015 remains more than 3 times higher than in 1999, when the amount prescribed was 180 MME per capita, and is nearly 4 times higher than in Europe in 2015.

Injury is the leading cause of death for people aged 1–44 in the USA. CDC’s National Center for Injury Prevention and Control—the Injury Center—is uniquely poised to measure the toll of injury and violence on the lives of Americans and reduce factors that increase their risk. For more than 20 years, Injury Center scientists and partners in the field have tracked trends in injury and violence burden, investigated risk factors through surveillance and research and translated findings into evidence-based strategies and interventions. | | The Injury Center has two CDC agency-wide priorities: (1) motor vehicle injury and (2) prescription drug overdose, and has identified the topics of child abuse and neglect, older adult falls, sexual violence, and youth sports concussion as important growth areas. In 2015, the Injury Center updated its research priorities in these areas to help guide intramural and extramural investments to accelerate impact at the population level over the next 3–5 years. | | CDC funds 10 Injury Control Research Centers (ICRCs) at universities and medical centres to form a national network of academic, public health, and community partners to conduct prevention research, train the next generation of injury prevention researchers and practitioners, and develop and evaluate violence and injury interventions.

Each and every day in the U.S., more than 160 people die as a result of violence due to homicides and suicides.1 These violent deaths constitute an urgent public health problem. Homicide and suicide, taken together, were the fourth leading cause of years of potential life lost in the U.S. in 2014.2 Each year, more than 55,000 people die in the U.S. as a result of violence-related injuries.3 In 2014, suicide was the tenth leading cause of death, claiming more than 42,000 lives1 and resulting in an economic cost estimated to be $53.2 billion, largely associated with lost work productivity.4,5 From 2005 to 2014, the national suicide rate rose for 9 straight years from 10.9 per 100,000 in 2005 to 13.0 per 100,000 in 2014, an increase of more than 18%,6 and now ranks as the second leading cause of death among adolescents and young adults.7,8 Homicide rates in the U.S. have declined over the long term, but are still a major problem resulting in an economic cost estimated at $26.4 billion.2,5 Among high-income nations, the U.S. historically has the highest homicide rate.9 Homicides disproportionately affect boys and men, adolescents and young adults, and certain racial/ethnic groups, such as non-Hispanic blacks, non-Hispanic American Indian/Alaska Natives, and Hispanics.10 These groups have not experienced the same level of decline and, in some cases, rates have increased.11 Homicide is the third leading cause of death for 10- to 24-year-olds in the U.S. and the leading cause of death for male and female African Americans aged 10–34 years.1 Suicide and homicide are preventable, but to address this problem as efficiently and effectively as possible, practitioners need data that are both timely and provide information that is useful in guiding preventive actions.

This guideline provides recommendations for primary care providers who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses: (a) when to initiate or continue opioids for chronic pain; (b) opioid selection, dosage, duration, follow-up, and discontinuation; and (c) assessing risk and addressing harms of opioid use. This guideline is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including abuse, dependence, overdose, and death.

Emergency physicians witness the effects of injury and violence every day. Traumatic brain injury, assault-related trauma, motor vehicle crashes, and opioid overdoses make up only some of these injuries-many of which can be prevented and better understood. The Centers for Disease Control and Prevention's National Center for Injury Prevention and Control (Injury Center) is uniquely poised to measure the toll of injury and violence on the lives of Americans, to communicate this public health burden, and to reduce the factors that increase their risk. Injury is the leading cause of death for persons aged 1 to 44 years in the United States. The Injury Center seeks to prevent violence and injuries and to reduce their consequences. For more than 20 years, Injury Center researchers have investigated factors that put Americans at risk through surveillance and research and translated these findings into evidence-based strategies and interventions. Many of these efforts are directly relevant to emergency medicine through preventing injuries and violence to save lives.

The annual number of deaths from prescription-opioid overdose has quadrupled in the United States in the past 15 years, driving dramatic increases in mortality. Efforts to improve pain management resulted in a quadrupling of rates of opioid prescribing, which propelled a tightly correlated epidemic of addiction, overdose, and death from prescription opioids that is now further evolving to include increasing use and overdoses of heroin and illicitly produced fentanyl. | The pendulum of opioid use in pain management has swung back and forth several times over the past 100 years. Beginning in the 1990s, efforts to improve treatment of pain failed to adequately take into account opioids’ addictiveness, their low therapeutic ratio, and their lack of documented effectiveness in the treatment of chronic pain. Increased prescribing was also fueled by aggressive and sometimes misleading marketing of long-acting opioids to physicians.1 It has become increasingly clear that opioids carry substantial risks and uncertain benefits, especially as compared with other treatments for chronic pain. | On March 15, 2016, the Centers for Disease Control and Prevention (CDC) released a “Guideline for Prescribing Opioids for Chronic Pain” to chart a safer, more effective course.2 The guideline is designed to support clinicians caring for patients outside the context of active cancer treatment or palliative or end-of-life care. More research is needed to fill in critical evidence gaps regarding the effectiveness, safety, and economic efficiency of long-term opioid therapy. However, given what we know about the risks associated with long-term opioid therapy and the availability of effective nonpharmacologic and nonopioid pharmacologic treatment options, the guideline uses the best available scientific data to provide information and recommendations to support patients and clinicians in balancing the risks of addiction and overdose with limited evidence of benefits of opioids for chronic pain.

OBJECTIVES: To assess gender differences in the proportion of adolescents reporting teen dating violence (TDV) and the frequency of TDV at multiple age points across adolescence in a high-risk sample of youth with previous exposure to violence. METHODS: A cross-sectional, high-risk sample of boys and girls (n = 1149) ages 11 to 17 years completed surveys assessing TDV and self-defense. Indices of TDV included perpetration and victimization scales of controlling behaviors, psychological TDV, physical TDV, sexual TDV, fear/intimidation, and injury. RESULTS: More girls reported perpetrating psychological and physical TDV, whereas twice as many boys reported sexual TDV perpetration. More girls reported fear/intimidation victimization than boys. When comparing the frequency of TDV across adolescence, boys reported more sexual TDV victimization at younger ages, and girls demonstrated a trend toward more victimization at older ages. Likewise, younger boys reported more fear/intimidation and injury perpetration and injury victimization than younger girls. However, by age 17, girls reported more injury perpetration than boys, and reports of injury victimization and use of self-defense did not differ. Notably, despite potential parity in injury, girls consistently reported more fear/intimidation victimization associated with TDV. CONCLUSIONS: Contrary to data suggesting that girls experience far more sexual TDV and injury, these data suggest that at specific times during adolescence, boys among high-risk populations may be equally at risk for victimization. However, the psychological consequences (fear) are greater for girls. These findings suggest a need to tailor strategies to prevent TDV based on both age- and gender-specific characteristics in high-risk populations.