Beyond its physical health impact, the COVID-19 pandemic also resulted in grief from loss of loved ones, isolation due to social distancing, stress, fear, and economic distress-all of which impacted mental health. How Right Now/Qué Hacer Ahora (HRN) is an award-winning, national campaign that provides emotional support to people disproportionately affected by COVID-19. We conducted a theory-based, culturally responsive evaluation to assess the campaign's effect on coping behaviors and resiliency between summer 2020 and spring 2021. We surveyed HRN's priority audiences (older adults/caregivers and those with preexisting health conditions, experiencing violence, or economic distress) in English and Spanish using NORC's national probability panel, AmeriSpeak, over three waves. We also analyzed social media data and monitored HRN website traffic and triangulated these data to understand the campaign's full impact. Campaign exposure was associated with people who were experiencing higher levels of stress and were more likely to seek information to support their emotional well-being. Campaign exposure was also positively associated with increased feelings of resilience and confidence in using coping strategies, especially for people experiencing violence or economic distress and people from racial and ethnic groups. Findings demonstrate the campaign's success in reaching its intended audiences with the mental health support they needed. Additionally, the HRN evaluation's design illustrates how the use of multiple data sources can elucidate a deeper understanding of campaign impact. Findings underscore that culturally responsive health communication interventions-like HRN-can provide needed mental health support and resources to disproportionately affected communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Social media has become a pervasive presence in everyday life, including among youths. In 2023, for the first time, CDC's nationally representative Youth Risk Behavior Survey included an item assessing U.S. high school students' frequency of social media use. Data from this survey were used to estimate the prevalence of frequent social media use (i.e., used social media at least several times a day) among high school students and associations between frequent social media use and experiences with bullying victimization, persistent feelings of sadness or hopelessness, and suicide risk. All prevalence estimates and measures of association used Taylor series linearization. Prevalence ratios were calculated using logistic regression with predicted marginals. Overall, 77.0% of students reported frequent social media use, with observed differences by sex, sexual identity, and racial and ethnic identity. Frequent social media use was associated with a higher prevalence of bullying victimization at school and electronically, persistent feelings of sadness or hopelessness, and some suicide risk among students (considering attempting suicide and having made a suicide plan), both overall and in stratified models. This analysis characterizes the potential harms of frequent social media use for adolescent health among a nationally representative sample of U.S. high school students. Findings might support multisectoral efforts to create safer digital environments for youths, including decision-making about social media policies, practices, and protections.

Sexting is associated with a range of negative outcomes among youth. While parents and caregivers can play a critical role in the prevention of youth risk behaviors, nationally representative research has yet to examine U.S. caregivers' perceptions of youth's sexting motivations to help inform sexting risk prevention efforts. Using 2018 and 2019 Fall ConsumerStyles online panel survey data (N = 1,034), this study estimated and examined U.S. caregivers' perceptions of youth's sexting motivations and the associations of such perceptions with concerns about their children (ages 10-17) getting and sharing sexts (sexual messages, photos, videos). Weighted percentages were calculated to describe caregivers' perceptions of youth's sexting motivations. Logistic regression analyses were performed to examine associations between caregivers' perceptions and concerns about youth's sexting. Results suggest that many caregivers perceive youth sext because they think it is harmless (72.79%), they want to be popular or boast (70.51%), they have low self-esteem (52.00%), and/or it is part of their sexual exploration process (49.05%). Fewer caregivers perceived that youth sext because they want revenge (21.80%) or to harm others (16.06%). Caregivers' concerns about their children getting and sharing sexts were related to perceiving that youth sext because of low self-esteem, sexual exploration processes, or to harm others. The perception that youth sext because they want to be popular or boast was related to concern about youth getting but not sharing sexts. Odds of concern were significantly higher among caregivers from some racial/ethnic subgroups. Findings can inform sexting prevention efforts that include caregivers.

Parents have an important role in the promotion of healthy adolescent behaviors that can influence positive developmental trajectories and health outcomes. Parental monitoring is a central component of the parent-child relationship with the potential to reduce adolescent risk behaviors. Data from CDC's 2021 nationally representative Youth Risk Behavior Survey were used to describe the prevalence of parental monitoring reported by U.S. high school students and examine associations between parental monitoring and adolescent behaviors and experiences. Behaviors and experiences included sexual behaviors, substance use, violence, and indicators of poor mental health. This report marks the first national assessment of parental monitoring among U.S. high school students. Point prevalence estimates and corresponding 95% CIs were generated in the bivariate analyses between parental monitoring and the outcomes, stratified by demographic characteristics (sex, race and ethnicity, sexual identity, and grade). Multivariable logistic regression analyses were conducted to estimate the main effects of parental monitoring (categorized as high = always or most of the time and low = never, rarely, or sometimes) for each outcome, controlling for all demographics. Overall, 86.4% of students reported that their parents or other adults in their family know where they are going or with whom they will be all or most of the time. Reports of high parental monitoring were protective for all risk behaviors and experiences, with models controlling for sex, race and ethnicity, sexual identity, and grade. Results highlight the need for public health professionals who develop public health interventions and programs to conduct further research on the relation between parental monitoring and student health outcomes.

The purpose of this study was to explore U.S. parents' and caregivers' understanding about children's bullying-what bullying is and how to address it. We analyzed 2017, 2018, and 2019 Fall ConsumerStyles online panel survey data from U.S. parents/caregivers of children ages 10 to 17 years (N = 1,516), including 20 items representing statements consistent or inconsistent with the bullying prevention evidence and best practices. Percentage of endorsement for each item and a summary measure of understanding about bullying were calculated. The association between low overall understanding about bullying and sociodemographic characteristics was explored. Most parents identified bullying as harmful (77%), repetitive (63%), and involving power imbalance (51%). At least half of parents answered 13 or more items (20 total) consistent with the bullying prevention evidence or best practices. Being male, non-Hispanic Black or Hispanic, having high school or less education, and small household size were associated with higher odds of low overall understanding about bullying. Awareness of parents' understanding about bullying and how to appropriately address it is vital for bullying prevention. Findings can inform the strategic development of bullying prevention health messages for parents.

BACKGROUND: Research shows associations between bullying victimization and substance use for teens. However, more research about this relationship for younger adolescents and across race/ethnicity is needed. METHODS: Prevalence and pooled logistic regression analyses of 2019 Middle School Youth Risk Behavior Survey data from 13 states (N = 74,059 students) examined associations between self-reported bulling victimization (at school, electronically, and both) and having ever tried cigarette smoking, alcohol, or marijuana; used an electronic vapor product; or misused prescription pain medicine. Regression analyses were adjusted by age and sex/race/ethnicity. RESULTS: All 3 measures of bullying victimization were significantly associated (p < .05) with the 5 substance use behaviors examined (adjusted prevalence ratios ranged from 1.29 to 2.32). These associations held across sexes. Significant associations were found within all 7 race/ethnicity categories, with the most associations reported for the non-Hispanic (NH) white, NH black or African American, Hispanic/Latino, and NH Asian groups. CONCLUSION: The association between bullying and substance use by middle school is a highly relevant issue to consider as students return to classrooms.

BACKGROUND AND OBJECTIVE: A national, longitudinal survey of US adolescents assessed adverse childhood experiences (ACEs) twice during the COVID-19 pandemic. Adolescents with more Wave 1 ACEs were expected to be more likely to experience additional ACEs at Wave 2. METHODS: Adolescents aged 13 to 18 (n = 727, Fall 2020; n = 569, Spring 2021) recruited via a national, probability-based panel (survey completion rate Wave 1, 62.1%; Wave 2, 78.3%) responded to questions about household challenges, violence or neglect, and community ACE exposure at Wave 1 and Wave 2 (since Wave 1). Unweighted frequencies and 95% confidence intervals of demographic characteristics and individual ACEs were calculated by using weighted data. Odds ratios examined associations between ACEs by Wave 1 and Wave 2. RESULTS: Among respondents of both survey waves (n = 506), 27.2% experienced violence or abuse, 50.9% experienced a household challenge, and 34.9% experienced a community ACE by Wave 1. By Wave 2, 17.6% experienced 1 new ACE, 6.1% experienced 2 new ACEs and 2.7% experienced 4 or more new ACEs. Those with ≥4 ACEs by Wave 1 were 2.71 times as likely as those with none to report a new ACE at Wave 2 (confidence interval: 1.18-6.24). CONCLUSIONS: This nationwide, longitudinal study of US adolescents measured exposure to ACEs early in and during the COVID-19 pandemic. Nearly one-third of adolescents experienced a new ACE between survey waves. Prevention and trauma-informed approaches in clinical, school, and community settings may be helpful.

INTRODUCTION: It is widely accepted that suicides-which account for more than 47 500 deaths per year in the United States-are undercounted by 10% to 30%, partially due to incomplete death scene investigations (DSI) and varying burden-of-proof standards across jurisdictions. This may result in the misclassification of overdose-related suicides as accidents or undetermined intent. METHODS: Virtual and in-person meetings were held with suicidologists and DSI experts from five states (Spring-Summer 2017) to explore how features of a hypothetical electronic DSI tool may help address these challenges. RESULTS: Participants envisioned a mobile DSI application for cell phones, tablets, or laptop computers. Features for systematic information collection, scene description, and guiding key informant interviews were perceived as useful for less-experienced investigators. DISCUSSION: Wide adoption may be challenging due to differences in DSI standards, practices, costs, data privacy and security, and system integration needs. However, technological tools that support consistent and complete DSIs could strengthen the information needed to accurately identify overdose suicides.

Participation in communities is essential to individual mental and physical health and can yield further benefits for members. With a growing amount of time spent participating in virtual communities, it's increasingly important that we understand how the community experience manifests in and varies across these online spaces. In this paper, we investigate Sense of Virtual Community (SOVC) in the context of live-streaming communities. Through a survey of 1,944 Twitch viewers, we identify that community experiences on Twitch vary along two primary dimensions: belonging, a feeling of membership and support within the group, and cohesion, a feeling that the group is a well-run collective with standards for behavior. Leveraging the Social-Ecological Model, we map behavioral trace data from usage logs to various levels of the social ecology surrounding an individual user's participation within a community, in order to identify which of these can be associated with lower or higher SOVC. We find that features describing activity at the individual and community levels, but not features describing the community member's dyadic relationships, aid in predicting the SOVC that community members feel within channels. We consider implications for the design of live-streaming communities and for fostering the well-being of their members, and we consider theoretical implications for the study of SOVC in modern, interactive online contexts, particularly those fostering large-scale or pseudonymized interactions. We also explore how the Social-Ecological Model can be leveraged in other contexts relevant to Computer-Supported Cooperative Work (CSCW), with implications for future work. © 2022 ACM.

BACKGROUND: Sexting is common among adolescents and is associated with numerous health risk behaviors and negative psychosocial constructs. This study examined the relationships between high school students' experiences with sexual violence victimization, dating violence victimization, and engagement in risky sexual behaviors with experiences of receiving sexts. METHODS: Cross-sectional data from the 2014 to 2016 data from Pennsylvania Youth Risk Behavior. Participants were selected using an independent 2-stage cluster sample design to produce a statewide population-based sample. The pencil and paper surveys were conducted in school. Participants included 6734 Pennsylvania high school students in grades 9-12. RESULTS: Overall, 29.0% of Pennsylvania high school students had received a sext, which varied by sex, race/ethnicity, school grade, and sexual identity. Students who engaged in sexual risk behaviors, experienced dating violence, or experienced lifetime sexual violence outside of the dating context had a significantly higher prevalence of receiving a sext than students who did not engage in those behaviors or have those experiences. CONCLUSIONS: Early screening and prevention efforts that include discussions about sexting behaviors may help prevent other negative outcomes, such as risky sexual behaviors and interpersonal violence. Addressing sexting in the education and health sectors may help to prevent other related harmful health and violence experiences during adolescence.

Video game content has evolved over the last six decades, from a basic focus on challenge and competition to include more serious and introspective narratives capable of encouraging critical contemplation within gamers. The "No Russian" mission from Call of Duty: Modern Warfare 2 casts players as terrorists responsible for the murder of innocent bystanders, sparking debate around how players engage and react to wanton violence in modern video games. Through thematic analysis of 649 Reddit posts discussing the mission, 10 themes emerged representing complexity in player experiences. Those themes were grouped into categories representing (descending order), (1) rote gameplay experiences, (2) dark humor, (3) comparing the mission to other games and real-world events, and (4) self-reflective eudaimonic reactions to the mission. Although less common, the presence of eudaimonic media effects (in at least 15% of posts) holds promise for the use of video games as reflective spaces for violence prevention.

OBJECTIVES: How Right Now (HRN) is an evidence-based, culturally responsive communication campaign developed to facilitate coping and resilience among US groups disproportionately affected by the COVID-19 pandemic. To inform the development of this campaign, we examined patterns in emotional health, stress, and coping strategies among HRN's audiences, focusing on differences among racial and ethnic groups. METHODS: We used a national probability panel, AmeriSpeak, to collect survey data from HRN's priority audience members in English and Spanish at 2 time points (May 2020 and May 2021). We conducted statistical testing to examine differences between time points for each subgroup (Hispanic, non-Hispanic Black, and non-Hispanic White) and differences among subgroups at each time point. RESULTS: We found disparities in COVID-19-related mental health challenges and differences in coping strategies. Non-Hispanic Black respondents were more likely than non-Hispanic White respondents to report challenges related to the social determinants of health, such as affording food and housing (26.4% vs 9.4% in May 2020) and experiencing personal financial loss (46.6% vs 29.2% in May 2020). In May 2021, 30.6% of Hispanic respondents reported being unable to meet basic food or housing needs versus 8.2% of non-Hispanic White respondents, and 51.6% reported personal financial loss versus 26.5% of non-Hispanic White respondents. CONCLUSIONS: Our study further illuminates what is needed to build emotional well-being pathways for people who historically have been economically and socially marginalized. Our findings underscore the need for public health interventions to provide culturally responsive mental health support to populations disproportionately affected by COVID-19 during the pandemic and into the future, with a focus on racial and ethnic disparities.

Bullying is a type of youth violence and an adverse childhood experience that can result in trauma and have immediate and long-term consequences for all involved. It can happen at school or elsewhere - including online entertainment and social and learning environments. Some children are at increased risk for bullying victimization, such as those targeted because of their racial/ethnic background or cultural identity. This study assessed U.S. parents and caregivers' self-reported changes in concern about their children's involvement in bullying during Fall 2020 compared to the prior year, which was marked by extraordinary historical circumstances (e.g., COVID-19 pandemic, heightened awareness of racial inequities, schools transitioning to virtual learning). Secondary analyses of data from the 2020 Fall ConsumerStyles and Estilos online panel surveys - designed to be representative of U.S. adults overall and U.S. Hispanic adults, respectively - were conducted. Differences by children's type of school attendance (i.e., physically at school or not) and parents' sociodemographic characteristics were explored. While findings suggest that U.S. parents' concern for their children being bullied during Fall 2020 compared to the prior year did not change, significant differences were found by the children's type of school attendance and the parents' race/ethnicity - with increased concern among parents of children who physically attended school, non-Hispanic Black parents and Hispanic parents. Among parents who reported being less concerned during Fall 2020 about their children being bullied compared to the prior year, not being physically at school is noted as the main reason why. Parents who reported being more concerned frequently noted racism as the reason why. It is imperative to understand what parents think about bullying, to best inform efforts to support their key role in bullying prevention.

Although research advocates for comprehensive cross sector youth violence prevention efforts, mobilizing across sectors to translate scientific recommendations into practice has proven challenging. A unifying framework may provide a foundational step towards building a shared understanding of the risk and protective factors that impact youth violence. We conducted two empirical tests of the nurturing environment framework on youth violence across ethnic and geographically diverse rural and urban adolescent samples. Results show that overall the characteristics of nurturing environments are associated with lower levels of aggression and violence. In addition, minimizing exposure to socially toxic conditions had the strongest associations with lower aggression and violence. Findings were supported across both samples, suggesting that this framework may apply in urban and rural, economically disadvantaged contexts.

Pandemics are stressful times, full of uncertainty and fear. During the COVID-19 pandemic, many Americans have experienced feelings of stress, grief, and loss. How Right Now (HRN) – and its Spanish-language counterpart, Qué Hacer Ahora (QHA) – is an evidence-based, culturally-relevant communication campaign designed to promote and strengthen the emotional well-being and resiliency of populations adversely affected by the COVID-19 pandemic and beyond. Developed by the Centers for Disease Control and Prevention (CDC) with support from the CDC Foundation, the campaign aims to help all Americans but has a specific focus on some of the disproportionately affected groups, including adults over 65 and their caregivers, individuals with pre-existing physical and mental health conditions, people experiencing violence, and those experiencing economic distress. Based on rapid, but robust, formative research, HRN offers audience-centric messages representing the real, everyday experiences and emotions that these audiences are having and addresses them in actionable ways. These include messages that address the social and structural barrier that disproportionately-affected groups have been facing long before the pandemic — and which are felt more acutely now. This paper provides an overview of the rapid, mixed-method, culturally-responsive formative research process undertaken to inform the development of HRN. Specifically, it describes how HRN’s disproportionately-affected audiences describe and discuss their emotiona well-being during COVID-19 through the lens of Social Determinants of Health (SDOH). We introduce a secondary theory, Vital Conditions for Health and Well-Being (VCHW), which conceptualizes holistic well-being and the conditions that give rise to it and identifies levers for community change and improvement. Data collection methods included an environmental scan (n≥700 publications); social listening (n≥1 million social media posts); partner needs-assessment calls (n=16); partner-convened listening sessions with community members (n=29), online focus groups (n=10), and a national probability survey (n=731), all in English and Spanish. Findings suggest that HRN’s priority audiences’ emotional well-being and SDOH are interconnected. Disruptions in SDOH du to the COVID-19 pandemic can lead to emotional well-being challenges (e.g., anxiety) for HRN’s priority audiences. While some disruptions may lead some people to adapt, connect with others, and be more resilient, there is a disparate impact of emotional well-being amid COVID-19 for those already experiencing disparities linked to SDOH. Understanding the perspectives and experiences of disproportionately affected populations through the lens of SDOH is vital to identifying the kinds of supports and services – like How Right Now/Qué Hacer Ahora – required for these populations. © 2021 Weston Medical Publishing. All rights reserved.

The How Right Now communication initiative (HRN) was developed to facilitate resilience amid the COVID-19 pandemic in the United States. HRN was designed as a conduit for promoting mental health and addressing feelings of grief, worry, and stress experienced during this time. This article provides an overview of the rapid, mixed-method, culturally responsive formative research process undertaken to inform the development of HRN. Specifically, it describes how HRN's disproportionately affected audiences (adults aged 65 and older and their caregivers, adults with preexisting physical and mental health conditions, adults experiencing violence, and adults experiencing economic distress) describe and discuss emotional resilience, what they need to be resilient, and what factors contribute to the perceptions of their ability to "bounce back" from the conditions caused by the COVID-19 pandemic. Data collection methods included an environmental scan (n >= 700 publications), social listening (n >= 1 million social media posts), partner needs-assessment calls (n = 16), partner-convened listening sessions with community members (n = 29), online focus groups (n = 58), and a national probability survey (n = 731), all in English and Spanish. Results revealed that HRN's audiences have diverse perceptions of what constitutes resilience. However, common factors were identified across populations to support resilience amid the COVID-19 pandemic, including informal and formal social support and access to services to meet basic needs, including food and housing resources. Stress, anxiety, depression, and experience with stigma and discrimination were also linked to resilience. Understanding the perspectives and experiences of disproportionately affected populations is vital to identifying supports and services, including the engagement of community stakeholders. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

The How Right Now communication initiative (HRN) was developed to facilitate resilience amid the COVID-19 pandemic in the United States. HRN was designed as a conduit for promoting mental health and addressing feelings of grief, worry, and stress experienced during this time. This article provides an overview of the rapid, mixed-method, culturally responsive formative research process undertaken to inform the development of HRN. Specifically, it describes how HRN's disproportionately affected audiences (adults aged 65 and older and their caregivers, adults with preexisting physical and mental health conditions, adults experiencing violence, and adults experiencing economic distress) describe and discuss emotional resilience, what they need to be resilient, and what factors contribute to the perceptions of their ability to "bounce back" from the conditions caused by the COVID-19 pandemic. Data collection methods included an environmental scan (n >= 700 publications), social listening (n >= 1 million social media posts), partner needs-assessment calls (n = 16), partner-convened listening sessions with community members (n = 29), online focus groups (n = 58), and a national probability survey (n = 731), all in English and Spanish. Results revealed that HRN's audiences have diverse perceptions of what constitutes resilience. However, common factors were identified across populations to support resilience amid the COVID-19 pandemic, including informal and formal social support and access to services to meet basic needs, including food and housing resources. Stress, anxiety, depression, and experience with stigma and discrimination were also linked to resilience. Understanding the perspectives and experiences of disproportionately affected populations is vital to identifying supports and services, including the engagement of community stakeholders. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Violence is a leading cause of death for youths aged 10 to 24 years in the United States.1 Consequently, violence among youths presents urgent challenges for communities. To address these, it can help to interrogate researchers’ understanding of interpersonal violence and how it influences the levers of change we identify when developing community-level violence-prevention strategies. In practice, this requires a shift in focus, from the individual behaviors traditionally recognized as violence to the social and structural determinants underlying interpersonal violence.2,3 Youth voices critically inform this process. In addition to assessing the youth perspective, it is vital to meaningfully engage youths in violence prevention and evaluate such efforts. | | For 20 years, the Centers for Disease Control and Prevention’s (CDC’s) Youth Violence Prevention Centers (YVPCs; https://bit.ly/36WRDgU) have engaged in academic–community collaborations for youth violence prevention. Currently focused on community-level strategies, these efforts have benefitted from youths who are from communities affected by violence. As they work alongside researchers as well as community, government and business leaders, YVPC-engaged youths provide expertise derived from their lived experience and other skillsets to develop violence-prevention strategies. They have been instrumental in shifting narratives about violence, leading equitable youth engagement, and influencing power entities to protect and uplift their communities.

Firearm homicide and suicide are the leading causes of violence-related injury deaths among U.S. youth. However, evaluations of the effectiveness of firearm violence prevention programs and strategies to reducing youth firearm violence are limited. To help inform and evaluate such efforts, this study aimed to identify risk and protective factors associated with youth firearm access, possession or carrying (for reasons other than hunting or target shooting) among a sample of U.S. urban youth in the Mountain West. Findings show the influence that youth violence risk (e.g., having friends engaged in delinquency; violence; drug sales; gang fights; exposure to violence; screening positive for violence risk) can have on youth firearm access, possession or carrying. Implications for prevention and intervention are discussed.

PURPOSE: The purpose of this study was to examine multiple ways youth may access firearms among a sample of urban, mountain west youth, and explore whether youth reporting various types of violence involvement and other behavioral or mental health factors have differential access to firearms compared with youth who do not report these issues. METHODS: A cross-sectional community-based survey was conducted among adolescents aged 10-17 years and one of their parents. The main outcomes were youth firearm access and possession and associated violence and behavioral and mental health factors. Bivariate and binomial logistic regression, controlling for demographic factors, was used to determine associations and predictors. RESULTS: One thousand one hundred youth and 730 parents participated. Nearly half of youth were male; 58.2% were Hispanic, 24.7% non-Hispanic black, 10.5% multiracial, 3.9% other, and 2.5% white. About 20% were categorized as having potential access to firearms (i.e., youth knows how and/or where to access firearms); 1.9% possessed a firearm. Analyses revealed that being physically aggressive (odds ratio [OR] 2.7), risk for future violence perpetration (OR 2.6), using alcohol (OR 2.0), having internalizing symptoms (OR 1.9), peer problems (OR 1.9), and older age (OR 1.26) predicted youth's possible access to firearms. Marijuana use (OR 9.9), parental gun ownership (OR 6.5), and reported delinquency (OR 8.3) predicted youth's firearm possession. CONCLUSIONS: Youth with potential firearm access demonstrate more violence risk and involvement, and other behavioral or mental health issues than youth without potential firearm access. Parental firearm ownership predicts youth firearm possession. It is important for both health-care providers and parents to recognize these potentially lethal associations to provide appropriate counseling.

Bullying is often ongoing during middle- and high-school. However, limited research has examined how cumulative experiences of victimization, perpetration, and bystander behavior impact adolescent behavioral and mental health and academic achievement outcomes at the end of high school. The current study used a sample of over 8000 middle- and high-school students (51% female; mean age 12.5 years) from the Rural Adaptation Project in North Carolina to investigate how cumulative experiences as a bullying victim and perpetrator over 5 years, and cumulative experiences of bystander behavior over 2 years impacted students’ aggression, internalizing symptoms, academic achievement, self-esteem, and future optimism. Following multiple imputation, analysis included a Structural Equation Model with excellent model fit. Findings indicate that cumulative bullying victimization was positively associated with aggression and internalizing symptoms, and negatively associated with self-esteem and future optimism. Cumulative bullying perpetration was positively associated with aggression and negatively associated with future optimism. Cumulative negative bystander behavior was positively associated with aggression and internalizing symptoms and negatively associated with academic achievement and future optimism. Cumulative prosocial bystander behavior was positively associated with internalizing symptoms, academic achievement, self-esteem, and future optimism. This integrative model brings together bullying dynamics to provide a comprehensive picture of implications for adolescent behavioral and mental health and academic achievement.

In the United States, youth have the highest burden of nonfatal self-inflicted injury (ie, deliberate physical harm against oneself, inclusive of suicidal and nonsuicidal intent) requiring medical attention.1 One study found that emergency department (ED) visits for these injuries during the 1993 to 2008 period varied by age group, ranging from 1.1 to 9.6 per 1000 ED visits, with adolescents aged 15 to 19 years exhibiting the highest rates.1 Self-inflicted injury is one of the strongest risk factors for suicide—the second-leading cause of death among those aged 10 to 24 years during 2015.2 This study examined trends in nonfatal self-inflicted injuries treated in hospital EDs among US children, adolescents, and young adults aged 10 to 24 years (hereafter referred to as youth).

Firearm homicide is the leading cause of violence-related youth mortality. To inform prevention efforts, we analyzed event-level data to identify unique precursors to firearm conflicts. Youth (ages:14-24) seeking Emergency Department (ED) treatment for assault or for other reasons and reporting past 6-month drug use were enrolled in a 2-year longitudinal study. Time-line follow-back substance use/aggression modules were administered at baseline and each 6-month follow-up. Violent non-partner conflicts were combined across time-points. Regression analyzed: a)antecedents of firearm-related conflicts (i.e., threats/use) as compared to non-firearm conflicts; and b)substance use on conflict (vs. non-conflict) days for those engaged in firearm conflict. During the 24-months, we found that 421-youth reported involvement in violent non-partner conflict (n=829-conflicts;197-firearm/632-non-firearm). Among firearm conflicts, 24.9% involved aggression and 92.9% involved victimization. Retaliation was the most common motivation for firearm-aggression (51.0%), while "shot for no reason" (29.5%) and conflicts motivated by arguments over "personal belongings" (24.0%) were most common for firearm-victimization. Male sex (AOR=5.14), Black race (AOR=2.75), a ED visit for assault (AOR=3.46), marijuana use before the conflict (AOR=2.02), and conflicts motivated by retaliation (AOR=4.57) or personal belongings (AOR=2.28) increased the odds that a conflict involved firearms. Alcohol (AOR=2.80), marijuana (AOR=1.63), and prescription drugs (AOR=4.06) had a higher association with conflict (vs. non-conflict) days among youth reporting firearm conflict. Overall, we found that firearm conflicts are differentially associated with substance use and violence motivations. Addressing substance use, interrupting the cycle of retaliatory violence, and developing conflict resolution strategies that address escalation over infringement on personal belongings may aid in decreasing and preventing adolescent firearm violence.

Objective: This study identified sociodemographic, substance use, and multiple opioid prescriber and dispenser risk factors among drug overdose decedents in Rhode Island, in response to an increase in overdose deaths (ODs) involving fentanyl. Methods: This cross-sectional investigation comprised all ODs reviewed by Rhode Island's Office of the State Medical Examiners (OSME) during January 2012 to March 2014. Data for 536 decedents were abstracted from OSME's charts, death certificates, toxicology reports, and Prescription Monitoring Program (PMP) databases. Decedents whose cause of death involved illicit fentanyl (N = 69) were compared with decedents whose causes of death did not involve fentanyl (other drug decedents; N = 467). Results: Illicit-fentanyl decedents were younger than other drug decedents ( P = 0.005). While more other-drug decedents than illicit fentanyl decedents had postmortem toxicological evidence of consuming heroin (31.9% vs 19.8%, P < 0.001) and various pharmaceutical substances ( P = 0.002-0.027), third party reports indicated more recent heroin use among illicit fentanyl decedents (62.3% vs 45.6%, P = 0.002). Approximately 35% of decedents filled an opioid prescription within 90 days of death; of these, one-third had a mean daily dosage greater than 100 morphine milligram equivalents (MME/day). Most decedents' opioid prescriptions were filled at one to two dispensers (83.9%) and written by one to two prescribers (75.8%). Notably, 29.2% of illicit fentanyl and 10.5% of other drug decedents filled prescriptions for buprenorphine, which is used to treat opioid use disorders. Conclusions: Illicit-fentanyl deaths frequently involved other illicit drugs (e.g., cocaine, heroin). The proportion of all decedents acquiring greater than 100 MME/day prescription dosages written and/or filled by few prescribers and dispensers is concerning. To protect patients, prescribers and dispensers should review PMP records and substance abuse history prior to providing opioids.

BACKGROUND: Drowning is the second leading cause of unintentional injury death among US children. Multiple studies describe decreased drowning risk among children possessing some swim skills. Current surveillance for this protective factor is self/proxy-reported swim skill rather than observed inwater performance; however, children's self-report or parents' proxy report of swim skill has not been validated. This is the first US study to evaluate whether children or parents can validly report a child's swim skill. It also explores which swim skill survey measure(s) correlate with children's inwater swim performance. METHODS: For this cross-sectional convenience-based sample, pilot study, child/parent dyads (N=482) were recruited at three outdoor public pools in Washington State. Agreement between measures of self-reports and parental-reports of children's swim skill was assessed via paired analyses, and validated by inwater swim test results. RESULTS: Participants were representative of pool's patrons (ie, non-Hispanic White, highly educated, high income). There was agreement in child/parent dyads' reports of the following child swim skill measures: 'ever taken swim lessons', perceived 'good swim skills' and 'comfort in water over head'. Correlation analyses suggest that reported 'good swim skills' was the best survey measure to assess a child's swim skill-best if the parent was the informant (r=0.25-0.47). History of swim lessons was not significantly correlated with passing the swim test. CONCLUSIONS: Reported 'good swim skills' was most correlated with observed swim skill. Reporting 'yes' to 'ever taken swim lessons' did not correlate with swim skill. While non-generalisable, findings can help inform future studies.