The Concrete Jungle: City Stress and Substance Abuse among Young Adult African American Men

Substance use is prevalent among African American men living in urban communities. The impact of substance use on the social, psychological, and physical health of African American men has important public health implications for families, communities, and society. Given the adverse consequences of alcohol and drug abuse within communities of color, this study evaluated the relationship between city stress, alcohol consumption, and drug use among African American men. Eighty heterosexual, African American men, 18 to 29 years old, completed psychosocial risk assessments that assessed substance use and city stress. Multiple logistic regression analyses, controlling for age, indicated that participants reporting high levels of urban stress, relative to low levels of urban stress, were more likely to report a history of marijuana use (AOR = 5.19, p = .05), history of ecstasy and/or GHB use (AOR = 3.34, p = .04), having family/friends expressing strong concerns about their illicit drug use (AOR = 4.06, p = .02), and being unable to remember what happened the night before due to drinking (AOR = 4.98, p = .01). African American men living within the confines of a stressful urban environment are at increased risk for exposure to and utilization of illicit substances. Culturally competent public health interventions for substance use/abuse should address psychological factors, such as stress and neighborhood violence.     

Is the Association between Neighborhood Drug Prevalence and Marijuana use Independent of Peer Drug and Alcohol Norms? Results from a Household Survey of Urban Youth

To inform policy debates surrounding marijuana decriminalization and add to our understanding of social and structural influences on youth drug use, we sought to determine whether there was an independent association between neighborhood drug prevalence and individual-level marijuana use after controlling for peer drug and alcohol norms. We analyzed cross-sectional data from a household survey of 563 youth aged 15–24 in Baltimore, Maryland. The study population was 88 % African-American. Using gender-stratified, weighted, multilevel logistic regression, we tested whether neighborhood drug prevalence was associated with individual-level marijuana use after controlling for peer drug and alcohol norms. Bivariate analyses identified a significant association between high neighborhood drug prevalence and marijuana use among female youth (AOR = 1.76, 95 % CI = 1.26, 2.47); the association was in a similar direction but not significant among male youth (AOR = 1.26, 95 % CI = 0.85, 1.87). In multivariable regression controlling for peer drug and alcohol norms, high neighborhood drug prevalence remained significantly associated among female youth (AOR = 1.59, 95 % CI = 1.12, 2.27). Among male youth, the association was attenuated toward the null (AOR = 0.95, 95 % CI = 0.63, 1.45). In the multivariable model, peer drug and alcohol norms were significantly associated with individual-level marijuana use among female youth (AOR = 1.54, 95 % CI = 1.17, 2.04) and male youth (AOR = 2.59, 95 % CI = 1.65, 4.07). This work suggests that individual-level marijuana use among female youth is associated with neighborhood drug prevalence independent of peer norms. This finding may have important implications as the policy landscape around marijuana use changes.     

Homies with Aspirations and Positive Peer Network Ties: Associations with Reduced Frequent Substance Use among Gang-Affiliated Latino Youth

In marginalized urban neighborhoods across the USA, Latino youth are disproportionately represented among the growing number of youth gangs. Substance use among gang-involved youth poses both immediate and long-term health risks and can threaten educational engagement, future socioeconomic stability, and desistance. Conventional assessments of gang-affiliated youth and their peer network overlook the possibility that positive peer ties may exist and can foster health promoting behavior norms. Drawing on a positive deviance framework, in this study, we examine the relationship between positive peer network characteristics tied to post-secondary educational aspirations and frequent alcohol and marijuana use among Latino, gang-affiliated youth from a neighborhood in San Francisco. Using generalized estimating equations regression models across 72 peer network clusters (162 youth), we found that having close friends who plan to go to a 4-year college was associated with a lower odds of frequent marijuana and alcohol use (OR 0.27, p = 0.02; OR 0.29, p = 0.14, respectively) and that this association persisted when adjusting for risk characteristics (OR 0.19, p < 0.01; OR 0.25, p = 0.12). Public health can advance gang intervention efforts by identifying protective and risk factors associated with non-criminal health outcomes to inform participatory research approaches and asset-based interventions that contribute to building healthy communities.     

Household- and employment-related risk factors for depressive symptoms during the COVID-19 pandemic

ObjectivesThe COVID-19 pandemic has generated multiple psychological stressors, which may increase the prevalence of depressive symptoms. Utilizing Canadian survey data, this study assessed household- and employment-related risk factors for depressive symptoms during the pandemic.MethodsA sample of 1005 English-speaking Canadian adults aged 18+ years completed a web-based survey after physical distancing measures were implemented across Canada. Hierarchical binary logistic regression analyses were conducted to examine the associations of depressive symptoms with household- (household size, presence of children, residence locale) and employment-related (job with high risk of COVID-19 exposure, working from home, laid off/not working, financial worry) risk factors, controlling for demographic factors (gender, age, education, income).ResultsAbout 20.4% of the sample reported depressive symptoms at least 3 days per week. The odds of experiencing depressive symptoms 3+ days in the past week were higher among women (AOR = 1.67, p = 0.002) and younger adults (18–29 years AOR = 2.62, p < 0.001). After adjusting for demographic variables, the odds of experiencing depressive symptoms were higher in households with 4+ persons (AOR = 1.88, p = 0.01), in households with children aged 6 to 12 years (AOR = 1.98, p = 0.02), among those with a job at high risk for exposure to COVID-19 (AOR = 1.82, p = 0.01), and those experiencing financial worry due to COVID-19 (‘very worried’ AOR = 8.00, p < 0.001).ConclusionPandemic responses must include resources for mental health interventions. Additionally, further research is needed to track mental health trajectories and inform the development, targeting, and implementation of appropriate mental health prevention and treatment interventions.     

Associations Between Perceptions and Involvement in Neighborhood Violence and Intimate Partner Violence Perpetration Among Urban,African American Men

Violence disproportionately affects African American men and their communities. Research is needed to inform programming efforts to reduce racial/ethnic disparities in violence exposure, involvement, and victimization. The current study examined involvement in and perceptions of neighborhood violence and relation to perpetration of intimate partner violence (IPV) among a sample of urban, African American men. Participants of this cross-sectional study were sexually active African American men (n = 703) between the ages of 18 and 65 years, recruited from urban community health centers. Age-adjusted logistic regression models were used to assess associations between neighborhood violence variables and perpetration of IPV. In age-adjusted logistic regression models, involvement with street violence in the previous 6 months (Odds Ratio (OR) = 3.0; 95% Confidence Interval (CI): 1.9–4.6), ever being involved with gangs (OR = 2.0; 95% CI: 1.3–3.2), and perceptions/beliefs that violence occurs in one’s neighborhood (ORs = 2.0–3.1) were found to be significantly associated with IPV perpetration. Findings demonstrate that involvement in neighborhood violence as well as perceptions/beliefs that violence occurs in one’s neighborhood are associated with increased likelihood of IPV perpetration among urban, African American men. While socioeconomics and substance use contribute to high rates of these forms of violence, the relation between these forms of violence and perpetration of IPV was significant beyond the influences of these factors. Findings suggest that future violence prevention and treatment efforts will be most successful by addressing multiple forms of violence.     

Assessing the Connection Between Health and Education: Identifying Potential Leverage Points for Public Health to Improve School Attendance

Objectives. We examined multiple variables influencing school truancy to identify potential leverage points to improve school attendance.Methods. A cross-sectional observational design was used to analyze inner-city data collected in Los Angeles County, California, during 2010 to 2011. We constructed an ordinal logistic regression model with cluster robust standard errors to examine the association between truancy and various covariates.Results. The sample was predominantly Hispanic (84.3%). Multivariable analysis revealed greater truancy among students (1) with mild (adjusted odds ratio [AOR] = 1.57; 95% confidence interval [CI] = 1.22, 2.01) and severe (AOR = 1.80; 95% CI = 1.04, 3.13) depression (referent: no depression), (2) whose parents were neglectful (AOR = 2.21; 95% CI = 1.21, 4.03) or indulgent (AOR = 1.71; 95% CI = 1.04, 2.82; referent: authoritative parents), (3) who perceived less support from classes, teachers, and other students regarding college preparation (AOR = 0.87; 95% CI = 0.81, 0.95), (4) who had low grade point averages (AOR = 2.34; 95% CI = 1.49, 4.38), and (5) who reported using alcohol (AOR = 3.47; 95% CI = 2.34, 5.14) or marijuana (AOR = 1.59; 95% CI = 1.06, 2.38) during the past month.Conclusions. Study findings suggest depression, substance use, and parental engagement as potential leverage points for public health to intervene to improve school attendance.Truancy, defined as any intentional unauthorized or illegal absence from school, is associated with a variety of adverse behavioral and health outcomes, including school dropout, crime, violence, incarceration, adolescent pregnancy, and substance abuse.1,2 Truancy is a major problem in the United States. Nationally, 11% of students report skipping school in the past month.3 In California, the truancy rate—the percentage of students who missed more than 30 minutes of instruction without an excuse for 3 or more days in a given school year—was 28% during the 2009–2010 school year.4 Truancy rates are frequently higher among Black and Hispanic youths, as compared with Whites, and among youths from lower-income households.3School truancy is a complex phenomenon often resulting from a variety of factors including (1) community and home environments; (2) social relationships, including relationships with parents, teachers, and peers; (3) school variables such as student-to-teacher ratio, educational style, safety, and disciplinary procedures; and (4) individual characteristics such as students’ level of engagement with learning, academic performance, risk behaviors (e.g., substance abuse), and mental health problems.2,5,6 The multifaceted nature of this phenomenon has attracted a number of researchers, as well as professionals, from different sectors (e.g., criminal justice, education, and community-based organizations) to study this problem. However, public health representation is often missing from this important dialogue. In spite of emerging evidence suggesting the interdependence between education and health, only a paucity of public health authorities have regularly engaged school districts, local law enforcement, or the courts to address this social determinant of health.5,7Despite significant investments by researchers, practitioners, schools, and policymakers to address truancy over the past several decades, there is little evidence that any positive impact has been made to improve school attendance.8 Many non-health sector researchers have called for the use of interdisciplinary models to reduce school truancy. Beyond modifying student factors, these models focus on a broader catchment, to include family, school, and community interventions.9,10 However, in spite of growing interest, much remains unknown about the key steps, design, or program features that are necessary to effectively implement cross-sector strategies. Identifying leverage points where nontraditional, noneducation partners (e.g., public health) can intervene represents a critical need.Although previous research has examined the association between truancy and a variety of modifiable school, student, and health characteristics, most have collected data only on a narrowly defined set of risk factors, independent from one another.3,11,12 Even among studies that have concurrently considered multiple risk factors for truancy, the analyses have often excluded important information about leverage points for nontraditional partners to act.13,14 The present study helps fill these gaps in public health research and practice, examining the relative importance of different school, student, and health-related variables in influencing school truancy. This study focused on inner-city, low-income youths, a group that is particularly vulnerable to being chronically truant, dropping out of school, and experiencing health disparities.4,15     

Neighborhood Crime-Related Safety and Its Relation to Children’s Physical Activity

Crime is both a societal safety and public health issue. Examining different measures and aspects of crime-related safety and their correlations may provide insight into the unclear relationship between crime and children’s physical activity. We evaluated five neighborhood crime-related safety measures to determine how they were interrelated. We then explored which crime-related safety measures were associated with children’s total moderate-to-vigorous physical activity (MVPA) and MVPA in their neighborhoods. Significant positive correlations between observed neighborhood incivilities and parents’ perceptions of general crime and disorder were found (r = 0.30, p = 0.0002), as were associations between parents’ perceptions of general crime and disorder and perceptions of stranger danger (r = 0.30, p = 0.0002). Parent report of prior crime victimization in their neighborhood was associated with observed neighborhood incivilities (r = 0.22, p = 0.007) and their perceptions of both stranger danger (r = 0.24, p = 0.003) and general crime and disorder (r = 0.37, p < 0.0001). After accounting for covariates, police-reported crime within the census block group in which children lived was associated with less physical activity, both total and in their neighborhood (beta = −0.09, p = 0.005, beta = −0.01, p = 0.02, respectively). Neighborhood-active children living in the lowest crime-quartile neighborhoods based on police reports had 40 min more of total MVPA on average compared to neighborhood-active children living in the highest crime-quartile neighborhoods. Findings suggest that police reports of neighborhood crime may be contributing to lower children’s physical activity.     

Food insecurity among Canadian youth and young adults: insights from the Canada Food Study

ObjectiveThis study explored associations between socio-demographic characteristics, self-reported health, and household food security among young adults.MethodsNational cohort study participants from Toronto, Montreal, Vancouver, Edmonton, and Halifax, Canada, aged 16–30 years (n = 2149) completed online surveys. Multinomial logistic regression, weighted to reflect age and sex proportions from the 2016 census, was conducted to examine associations between food security status and covariates.ResultsAlmost 30% of respondents lived in food-insecure households, with 19% in “moderately” food-insecure and 10% in “severely” food-insecure households. Respondents identifying as Black or Indigenous were more likely to live in moderately (AOR = 1.96, CI: 1.10, 3.50; AOR = 3.15, CI: 1.60, 6.20) and severely (AOR = 4.25, CI: 2.07, 8.74; AOR = 6.34, CI: 2.81, 14.30) food-insecure households compared with those identifying as mixed/other ethnicity. Respondents who found it “very difficult” to make ends meet were more likely to be moderately (AOR = 20.37, CI: 11.07, 37.46) and severely (AOR = 101.33, CI: 41.11, 249.77) food insecure. Respondents classified as “normal” weight (AOR = 0.64, CI: 0.43, 0.96) or overweight (AOR = 0.53, CI: 0.34, 0.83) were less likely to be moderately food insecure compared with those affected by obesity. Compared with “very good or excellent,” “poor” health, diet quality, and mental health were each positively associated with severe food insecurity (AOR = 7.09, CI: 2.44, 20.61; AOR = 2.63, CI: 1.08, 6.41; AOR = 2.09, CI: 1.03, 4.23, respectively).ConclusionThe high prevalence of correlates of food insecurity among young adults suggests the need for policies that consider the unique challenges (e.g., precarious income) and vulnerability associated with this life stage.     

The Influence of Community Violence and Protective Factors on Asthma Morbidity and Healthcare Utilization in High-Risk Children

We examined the longitudinal effects of community risk and protective factors on asthma morbidity and healthcare utilization. Three hundred urban caregivers of children with poorly controlled asthma were enrolled in a randomized controlled trial testing the effectiveness of a behavioral/educational intervention and completed measures of exposure to community violence (ECV), social cohesion (SC), informal social control (ISC), child asthma control, child asthma symptom days/nights, and healthcare utilization. Latent growth curve modeling examined the direct and interaction effects of ECV, SC, and ISC on the asthma outcomes over 12 months. Caregivers were primarily the biological mother (92 %), single (70 %), and poor (50 % earned less than $10,000). Children were African American (96 %) and young (mean age = 5.5 years, SD = 2.2). ECV at baseline was high, with 24.7 % of caregivers reporting more than two exposures to violence in the previous 6 months (M = 1.45, SD = 1.61). Caregiver ECV-predicted asthma-related healthcare utilization at baseline (b = 0.19, SE = 0.07, p = 0.003) and 2 months (b = 0.12, s.e. = 0.05, p = 0.04). ISC and SC moderated the effect of ECV on healthcare utilization. Our findings suggest that multifaceted interventions that include strategies to curb violence and foster feelings of cohesion among low-income urban residents may be needed to reduce asthma-related emergency services.     

Witnessing a Violent Death and Smoking,Alcohol Consumption,and Marijuana Use among Adolescents

Witnessing violence has been linked to maladaptive coping behaviors such as smoking, alcohol consumption, and marijuana use. However, more research is required to identify mechanisms in which witnessing violence leads to these behaviors. The objectives of this investigation were to examine the association between witnessing a violent death and smoking, alcohol consumption, and marijuana use among adolescents, to identify whether exhibiting depressive symptoms was a mediator within this relationship, and to determine if those who had adult support in school were less likely to engage in risky health behaviors. Data were collected from a sample of 1,878 urban students, from 18 public high schools participating in the 2008 Boston Youth Survey. In 2012, we used multilevel log-binomial regression models and propensity score matching to estimate the association between witnessing a violent death and smoking, alcohol consumption, and marijuana use. Analyses indicated that girls who witnessed a violent death were more likely to use marijuana (relative risk (RR) = 1.09, 95 % confidence interval (CI) = 1.02, 1.17), and tended towards a higher likelihood to smoke (RR = 1.06, 95 % CI = 1.00, 1.13) and consume alcohol (RR = 1.07, 95 % CI = 0.97, 1.18). Among boys, those who witnessed a violent death were significantly more likely to smoke (RR = 1.20, 95 % CI = 1.11, 1.29), consume alcohol (RR = 1.30, 95 % CI = 1.17, 1.45) and use marijuana (RR = 1.33, 95 % CI = 1.21, 1.46). When exhibiting depressive symptoms was included, estimates were not attenuated. However, among girls who witnessed a violent death, having an adult at school for support was protective against alcohol consumption. When we used propensity score matching, findings were consistent with the main analyses among boys only. This study adds insight into how witnessing violence can lead to adoption of adverse health behaviors.     

Triple Comorbid Trajectories of Tobacco,Alcohol, and Marijuana Use as Predictors of Antisocial Personality Disorder and Generalized Anxiety Disorder Among Urban Adults

Objectives. We modeled triple trajectories of tobacco, alcohol, and marijuana use from adolescence to adulthood as predictors of antisocial personality disorder (ASPD) and generalized anxiety disorder (GAD).Methods. We assessed urban African American and Puerto Rican participants (n = 816) in the Harlem Longitudinal Development Study, a psychosocial investigation, at 4 time waves (mean ages = 19, 24, 29, and 32 years). We used Mplus to obtain the 3 variable trajectories of tobacco, alcohol, and marijuana use from time 2 to time 5 and then conducted logistic regression analyses.Results. A 5-trajectory group model, ranging from the use of all 3 substances (23%) to a nonuse group (9%), best fit the data. Membership in the trajectory group that used all 3 substances was associated with an increased likelihood of both ASPD (adjusted odds ratio [AOR] = 6.83; 95% CI = 1.14, 40.74; P < .05) and GAD (AOR = 4.35; 95% CI = 1.63, 11.63; P < .001) in adulthood, as compared with the nonuse group, with control for earlier proxies of these conditions.Conclusions. Adults with comorbid tobacco, alcohol, and marijuana use should be evaluated for use of other substances and for ASPD, GAD, and other psychiatric disorders. Treatment programs should address the use of all 3 substances to decrease the likelihood of comorbid psychopathology.Tobacco use, alcohol use, and marijuana use often co-occur, such that some individuals who use 1 of these substances are at risk for use of the others.1–4 Schulenberg et al.,5 for instance, showed that membership in the chronic and abstainer marijuana use groups predicted the highest and lowest rates, respectively, of both binge drinking and tobacco use among emerging adults. In one of the few studies to assess concurrent trajectories of the use of 2 or more substances, Jackson et al.6 showed that separate patterns of tobacco, alcohol, or marijuana use from late adolescence to young adulthood were related to an increased likelihood of similar patterns of other substance use (e.g., chronic marijuana use was more frequent among chronic tobacco smokers).The use of 1 or more substances, as well as substance use disorders (SUDs), have consistently been found to be comorbid with or predictive of psychopathology, including antisocial behaviors and disorders as well as anxiety.7–11 Relatively little research, however, has examined the comorbidity of SUDs and psychopathology across ethnic groups, and no study has focused on substance use as opposed to SUDs. Findings generally show that SUDs increase the likelihood of generalized anxiety disorder (GAD), among African Americans.12,13 Similar associations have been found less consistently among Latino individuals. Smith et al.,14 for instance, showed that alcohol dependence, but not abuse, was related to GAD among Latino patients. Although a strong link has been established between substance use or SUDs and antisocial behaviors or disorders,15,16 we are unaware of any studies that assessed these associations among both African American and Latino persons.Some investigations have specifically examined the relation between patterns of substance use, or patterns of comorbid substance use over time (i.e., trajectories), and externalizing or internalizing problems.17 Caldeira et al.,18 for instance, found that membership in the chronic heavy marijuana use trajectory group (from ages 18 to 24 years) was associated with greater use of alcohol and tobacco and predicted more anxiety during emerging adulthood than in any other trajectory group. In an analysis of separate trajectories of alcohol use and marijuana use from preadolescence to emerging adulthood, Flory et al.19 also found that membership in the trajectory group with the highest levels of both alcohol and marijuana use over time (early-onset users) was related to more symptoms of antisocial personality disorder (ASPD) among emerging adults than was membership in the nonusers group. Evidence also indicates that the concurrent use of 2 or more substances is associated with worse psychosocial outcomes than is the use of 1 substance alone.17,20–22 To date, however, no studies have examined triple trajectories of substance use (i.e., the comorbid use of 3 substances) or their consequences. Given the high prevalence of the comorbidity of substance use and that concurrent substance use over time may be related to more adverse psychosocial outcomes, understanding the longitudinal trajectories of comorbid substance use and their sequelae might aid the design of more effective prevention and treatment programs for long-term polysubstance use.Building on the work of Jackson et al.,6 the current study was unique in several respects. First, we examined concurrent triple comorbid trajectories of tobacco, alcohol, and marijuana use. Second, the sample consisted of racial/ethnic minority adults from varied socioeconomic backgrounds. Third, we used a life-span approach and followed up the participants from adolescence into adulthood. Our outcome variables, ASPD and GAD, were selected to represent both externalizing and internalizing behaviors. Our specific hypotheses were as follows:

• There will be approximately 5 to 7 trajectory groups, consisting of the high use of (1) tobacco, alcohol, and marijuana; (2) alcohol and marijuana; (3) alcohol and tobacco; (4) tobacco only; (5) alcohol only; and (6) marijuana only; or (7) nonuse.
• Membership in the triple comorbid trajectory group (tobacco, alcohol, and marijuana use) will be associated with a greater likelihood of having ASPD and GAD in adulthood than will membership in the alcohol and marijuana users group and the alcohol and tobacco users group.
• Membership in the triple comorbid trajectory group of tobacco, alcohol, and marijuana use will be associated with a greater likelihood of having ASPD and GAD than will membership in the alcohol use only or tobacco use only trajectory group.
• Membership in the triple comorbid trajectory group will be related to a greater likelihood of having ASPD or GAD in adulthood than will membership in the nonuse trajectory group.

     

Effects of the It’s Your Game . . . Keep It Real Program on Dating Violence in Ethnic-Minority Middle School Youths: A Group Randomized Trial

Objectives. We examined whether It’s Your Game . . . Keep It Real (IYG) reduced dating violence among ethnic-minority middle school youths, a population at high risk for dating violence.Methods. We analyzed data from 766 predominantly ethnic-minority students from 10 middle schools in southeast Texas in 2004 for a group randomized trial of IYG. We estimated logistic regression models, and the primary outcome was emotional and physical dating violence perpetration and victimization by ninth grade.Results. Control students had significantly higher odds of physical dating violence victimization (adjusted odds ratio [AOR] = 1.52; 95% confidence interval [CI] = 1.20, 1.92), emotional dating violence victimization (AOR = 1.74; 95% CI = 1.36, 2.24), and emotional dating violence perpetration (AOR = 1.58; 95% CI = 1.11, 2.26) than did intervention students. The odds of physical dating violence perpetration were not significantly different between the 2 groups. Program effects varied by gender and race/ethnicity.Conclusions. IYG significantly reduced 3 of 4 dating violence outcomes among ethnic-minority middle school youths. Although further study is warranted to determine if IYG should be widely disseminated to prevent dating violence, it is one of only a handful of school-based programs that are effective in reducing adolescent dating violence behavior.Adolescent dating violence is a serious public health concern in the United States. National estimates indicate that almost 10% of high school youths (9th–12th graders) are victims of physical dating violence,1 and more than 20% are victims of emotional dating violence.2 In addition to being associated with many negative health outcomes (i.e., substance abuse, suicide, depression, and sexual activity),3–8 adolescent dating violence may be predictive of intimate partner violence in adulthood,8–10 which has exceedingly high economic costs (particularly those related to health care).11 Thus, preventing adolescent dating violence may not only protect youths from severe health consequences, but also reduce the short- and long-term health costs associated with this type of violence.Although most research on adolescent dating violence focuses on high school youths, recent studies indicate that adolescent dating violence begins in middle school.12–14 For example, in a survey of seventh graders from diverse geographic locations, 37% reported being victims of psychological dating violence, and 15% reported being victims of physical dating violence in the last 6 months.14 Furthermore, there is mounting evidence that dating violence disproportionately affects ethnic-minority middle school youths. For instance, in a sample of multiethnic sixth graders from 4 US states, approximately one third of Hispanics and African Americans with a history of dating each reported physical dating violence perpetration, compared with only 14% of Whites.15 A similar racial/ethnic pattern emerged for physical dating violence victimization. Thus, it is becoming increasingly evident that dating violence is prevalent among middle school youths, especially among those who belong to ethnic-minority groups.Adolescent dating violence prevention programs are available, but only a few have been rigorously evaluated. Of these, only 2 school-based programs—Safe Dates and Fourth R: Skills for Youth Relationships (Fourth R)—have been shown to produce significant behavioral effects: both reduced dating violence perpetration or victimization.16–18 However, these programs may not be as effective in ethnic-minority middle school youths because they were developed for and evaluated in older, predominantly White youths. Of the relatively fewer dating violence programs developed for and evaluated in ethnic-minority youths, most have been shown to produce either no19 or inconsistent20 behavioral effects, or have been limited by a weak study design (i.e., lack of control group).21,22 Thus, there is a need for rigorously evaluated, effective dating violence prevention programs16 that specifically target younger, ethnic-minority youths.It’s Your Game…Keep It Real (IYG) is a health education program designed to delay sexual behavior and promote healthy dating relationships in ethnic-minority middle school youths. It is based on the premise that healthy relationships are foundational to healthy adolescent sexual health. In 2 previous randomized controlled trials, IYG was shown to be effective in delaying sexual initiation and reducing other sexual risk behaviors.23,24 An additional research question was whether IYG had an impact on emotional and physical dating violence perpetration and victimization. Thus, our goal was to determine if IYG reduces dating violence behavior among ethnic-minority middle school youths. We hypothesized that, by ninth grade, students who did not receive IYG would report more physical and emotional dating violence perpetration and victimization than students who did receive IYG.     

Gender-Equitable Attitudes,Bystander Behavior,and Recent Abuse Perpetration Against Heterosexual Dating Partners of Male High School Athletes

Objectives. We assessed the relationship between gender attitudes, identified as a critical component of violence prevention, and abuse toward dating partners among adolescent male athletes.Methods. Our sample comprised 1699 athletes from 16 high schools in northern California who were surveyed between December 2009 and October 2010 in the larger Coaching Boys Into Men trial. We used logistic regression to assess the association between gender-equitable attitudes, bystander behavior, and recent abuse incidents.Results. Athletes with more gender-equitable attitudes and greater intention to intervene were less likely (adjusted odds ratio [AOR] = 0.36; 95% confidence interval [CI] = 0.28, 0.46; and AOR = 0.60; 95% CI = 0.48, 0.75, respectively) and athletes who engaged in negative bystander behavior were more likely (AOR = 1.22, 95% CI = 1.10, 1.35) to perpetrate abuse against their female dating partners.Conclusions. Despite the shift among bystander intervention programs toward gender neutrality, our findings suggest a strong association between gender attitudes and dating violence. Programs designed for adolescents should include discussion of gender attitudes and target bystander behavior, because these components may operate on related but distinct pathways to reduce abuse.Adolescent relationship abuse among heterosexual youths is common, with 20% to 25% of adolescents reporting this exposure.1,2 Adolescent relationship abuse is a gendered exposure. Although adolescent boys report experiencing aggression or physical violence from their female dating partners,3 women and girls are more likely to experience such violence, particularly sexual assault, and to experience poor health as a result.4,5 This disparity has been attributed to social norms supportive of male dominance in sexual and dating relationships, normalization of the use of violence as a means of conflict resolution, and the perception that peers support aggressive and abusive behavior.6,7Gender-equitable norms (socially prescribed definitions of masculinity and equitable power in sexual relationships) have been recognized by the global health community as a critical component of violence prevention.8,9 A small body of literature has empirically tested the association of such attitudes with adolescent relationship abuse10,11 and adult intimate partner violence.12 Although attitudes that degrade women and legitimize violence have been shown to be modifiable in men,12–16 limited attention has been paid to addressing norms in the context of dating violence among adolescents.Recent work in the field has focused on the social context of violence by attempting to alter the behavior of men and boys when they witness peers perpetrating physical–sexual abuse, rather than targeting the behavior of individual perpetrators. This bystander intervention approach aims to help witnesses better recognize abusive behaviors and take responsibility to stop them.17–19 Early bystander intervention programs incorporated conversations about masculinity and power into their curricula, the most notable of which was designed for male high school and college athletes.20 The athletic context provided a unique opportunity to implement gender-transformative programming within a culture influenced by discourses of masculinity and power, and the program encouraged athletes to model respectful behavior for peers in the greater school community. Today, discussions of gender norms are largely absent from bystander intervention programs so as not to target individual perpetrators.20 Such gender-neutral programs consider the impact of power imbalances on violence, but the underlying causes of these imbalances are less clearly articulated.In light of the shift in bystander intervention programs toward gender neutrality,20 despite evidence that sexual violence and harassment are influenced by social norms regarding relationships and masculinity,21 we empirically examined the relationships between gender-equitable attitudes, bystander behavior, and abuse toward heterosexual dating partners among a sample of male high school athletes.     

Community Characteristics are Associated with Blood Pressure Levels in a Racially Integrated Community

Community problems have been associated with higher, and community resources and social cohesion with lower, blood pressure. However, prior studies have not accounted for potential confounding by residential racial segregation. This study tested associations between community characteristics and blood pressure levels and prevalent hypertension in a racially integrated community. The Exploring Health Disparities in Integrated Communities Study measured blood pressure in residents of two contiguous racially integrated and low-income US Census Tracts. Community characteristics included a standardized community problem score and binary indicators for community social cohesion, having a community leader available, and having at least one community resource observed on the participant’s block. In adjusted models, greater community problems and proximity to resources were associated with lower systolic (β = −2.020, p = 0.028; β = −4.132, p = 0.010) and diastolic (β = −1.261, p = 0.038; β = −2.290, 0.031) blood pressure, respectively, among whites (n = 548). Social cohesion was associated with higher systolic (β = 4.905, p = 0.009) and diastolic blood pressure (β = 3.379, p = 0.008) among African Americans (n = 777). In one racially integrated low-income community, community characteristics were associated with blood pressure levels, and associations differed by race. Directions of associations for two findings differed from prior studies; greater community problem was associated with lower blood pressure in whites and community social cohesion was associated with higher blood pressure in African Americans. These findings may be due to exposure to adverse environmental conditions and hypertensive risk factors in this low-income community.     

Response to the COVID-19 Outbreak in Urban Settings in China

The COVID-19 outbreak in China was devastating and spread throughout the country before being contained. Stringent physical distancing recommendations and shelter-in-place were first introduced in the hardest-hit provinces, and by March, these recommendations were uniform throughout the country. In the presence of an evolving and deadly pandemic, we sought to investigate the impact of this pandemic on individual well-being and prevention practices among Chinese urban residents. From March 2–11, 2020, 4607 individuals were recruited from 11 provinces with varying numbers of COVID-19 cases using the social networking app WeChat to complete a brief, anonymous, online survey. The analytical sample was restricted to 2551 urban residents. Standardized scales measured generalized anxiety disorder (GAD), the primary outcome. Multiple logistic regression was conducted to identify correlates of GAD alongside assessment of community practices in response to the COVID-19 pandemic. We found that during the COVID-19 pandemic, the recommended public health practices significantly (p < 0.001) increased, including wearing facial mask, practicing physical distancing, handwashing, decreased public spitting, and going outside in urban communities. Overall, 40.3% of participants met screening criteria for GAD and 49.3%, 62.6%, and 55.4% reported that their work, social life, and family life were interrupted by anxious feelings, respectively. Independent correlates of having anxiety symptoms included being a healthcare provider (aOR = 1.58, p < 0.01), living in regions with a higher density of COVID-19 cases (aOR = 2.13, p < 0.01), having completed college (aOR = 1.38, p = 0.03), meeting screening criteria for depression (aOR = 6.03, p < 0.01), and poorer perceived health status (aOR = 1.54, p < 0.01). COVID-19 had a profound impact on the health of urban dwellers throughout China. Not only did they markedly increase their self- and community-protective behaviors, but they also experienced high levels of anxiety associated with a heightened vulnerability like depression, having poor perceived health, and the potential of increased exposure to COVID-19 such as living closer to the epicenter of the pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-020-00498-8.     

Adolescent Experiences of Violence and Relation to Violence Perpetration beyond Young Adulthood among an Urban Sample of Black and African American Males

The purpose of this study is to determine if experiences of physical violence during early and late adolescence (12–21 years) places urban Black males at increased risk for interpersonal violence perpetration beyond young adulthood (30 years and older). Participants of this cross-sectional study were Black and African American men (N = 455) between the ages of 30 and 65 years, recruited from four urban clinical sites in the Northeast. Multivariate logistic regression models were used to analyze the relation of adolescent experiences of violence to: (1) past 6 month street violence involvement and (2) past year intimate partner violence perpetration. Ten percent of the sample reported that they experienced adolescent victimization. Men reporting adolescent victimization were significantly more likely to report past 6-month street violence involvement (Adjusted Odds Ratio (AOR) = 3.2, 95 % CI = 1.7–6.3) and past 6 month intimate partner violence perpetration (AOR = 2.8, 95 % CI = 1.8–5.4) compared to men who did not report such victimization. Study findings suggest that in order to prevent adulthood perpetration of violence, more work is needed to address experiences of victimization among young Black males, particularly violence experienced during adolescence.     

Experiences of Racial Discrimination &; Relation to Violence Perpetration and Gang Involvement among a sample of Urban African American Men

Objective To examine racial discrimination and its relation to violence involvement among a sample of urban African American men. Methods Participants of this cross-sectional study were African American men (N = 703) between the ages of 18 and 65 years, recruited from four urban community health centers and two hospital-based clinics within an urban center in the Northeast. Multivariate logistic regression models were used to assess the relation of reported racial discrimination to recent perpetration of intimate partner violence (IPV), street violence involvement, and gang involvement. Racial discrimination was measured via 7 items assessing everyday and lifetime experiences of racial discrimination. Results In logistic regression models adjusted for age and homelessness, men reporting high levels of discrimination (scores above the sample median) were significantly more likely to report IPV perpetration (Adjusted Odds Ratio (AOR) = 1.9; 95% Confidence Interval (CI): 1.2–2.9) and street violence involvement (AOR = 1.5; 95% CI: 1.1–2.2) as compared to men reporting lower levels of discrimination. No relation was found between experiencing discrimination and gang involvement. Conclusions Findings showcase the potential relevance of racial discrimination to efforts focused on reducing racial disparities related to violence.     

Perceived Discrimination and DSM-IV–Based Alcohol and Illicit Drug Use Disorders

Objectives. We examined the relationship between everyday and major discrimination and alcohol and drug use disorders in a nationally representative sample of African Americans and Black Caribbeans.Methods. With data from the National Survey of American Life Study, we employed multivariable logistic regression analyses—while controlling for potential confounders—to examine the relationship between everyday and major discrimination and substance use disorders on the basis of Diagnostic and Statistical Manual of Mental Disorders criteria.Results. Every 1 unit increase in the everyday discrimination scale positively predicted alcohol (odds ratio [OR] = 1.02; P < .01) and drug use (OR = 1.02; P < .05) disorders. Similarly, each additional major discrimination event positively predicted alcohol (OR = 1.10; P < .05) and drug use (OR = 1.15; P < .01) disorders.Conclusions. To our knowledge, this study is the first to examine problematic usage patterns rather than infrequent use of alcohol and drugs in a national sample of African American and Black Caribbean adults and the first to examine this particular relationship in a national sample of Black Caribbeans.Alcohol and drug abuse and dependence are risky health behaviors not only to the individuals who engage in these behaviors and their loved ones but also to society. Estimates from the 2000 National Survey on Drug Use and Health suggest that of persons aged 18 years or older, approximately 12.7 million (6.3%) were either dependent on or abused both alcohol and illicit drugs, 3.3 million (1.6%) were dependent on or abused illicit drugs but not alcohol, and 10.9 million (5.5%) were dependent on or abused alcohol but not illicit drugs.1 It is estimated that the overall economic cost of substance abuse in 1992 was $246 billion2 and in 2001 $414 billion.3 Psychoanalytically informed hypotheses, like the self-medication hypothesis, suggest that substance use and abuse are self-soothing behaviors among some individuals who are psychologically distressed. Individuals may use or abuse substances such as alcohol, cigarettes, and illicit and licit drugs to manage emotional pain and anxiety to achieve emotional stability.4–8On the basis of these stress-coping frameworks, a small number of studies suggests that perceived experiences of interpersonal discrimination, a psychosocial stressor, are associated with various risky health behaviors.9,10 Specifically, previous studies posit that in response to perceived experiences of interpersonal discrimination (“discrimination”), some individuals may engage in risky coping behaviors such as alcohol,11–13 tobacco,13–18 and prescribed19 and illicit drug use.13,19 Yen et al.,11,12 for example, showed that Whites who experienced racial/ethnic discrimination (e.g., at school, getting a job) in 5 or more domains consumed more alcoholic drinks than did peers who had not experienced discrimination. Using the CAGE questionnaire,20 Martin et al.21 showed that African American adults who experienced racial/ethnic discrimination were twice as likely to have a problematic drinking behavior as were African Americans who reported no discrimination. Similarly, using a standardized survey for mental illness diagnosis derived from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) criteria, Gee et al.19 reported that Filipino Americans who experienced chronic discrimination were more likely to be dependent on alcohol. With regard to tobacco use, similar to other studies,16,17 Landrine and Klonoff14 reported that African Americans who experienced racial/ethnic discrimination and appraised their experiences as more stressful were more likely to smoke cigarettes than were African Americans who did not report discrimination. Beyond alcohol and tobacco use, recent investigations have reported positive associations between discrimination and licit (e.g., medically prescribed medication) and illicit (e.g., marijuana) drug abuse.13,19 Specifically, Borrell et al.13 reported that racial discrimination was associated with increased lifetime use of marijuana and cocaine among African Americans but not among Whites. Gee et al.19 reported that discrimination was positively associated with the usage of illicit drugs among Filipino American adults. Although these studies are not directly comparable, taken together they suggest a relationship between experiences of discrimination and substance use.Despite a growing literature base in this area, our understanding of the relationship between discrimination and clinically diagnosed alcohol and drug use disorders is limited. Although most will agree that alcohol use and illicit drug use (regardless of frequency and quantity) are potential health risk behaviors, infrequent usage patterns, such as those currently studied in most of the published literature, may not indicate the damaging behavior patterns that are associated with a clinical diagnosis of abusing or being dependent on alcohol or drugs, such as recurrently driving an automobile when impaired or continued drinking despite knowledge of a serious physical or psychological problem.22Using the 2001 National Study of American Life (NSAL), we aimed to extend previous research in 2 important ways. The first concerns the generalizability of the current findings in this area. We are aware of only 1 study that has examined problematic usage patterns of alcohol use and none examining problematic drug usage among African Americans.19,21 In a sample of employed African Americans, Martin et al.18 showed that discrimination was positively associated with problematic drinking behavior; however, the sample was not representative of the general population of African Americans in the United States. To date, we are unaware of any studies that have examined the relationship between discrimination and substance use disorders among Black Caribbeans, the second largest subgroup of Blacks living in the United States. To fill these gaps, we examined the relationship between discrimination and alcohol and illicit drug use disorders in a nationally representative sample of African Americans and Black Caribbeans, 2 groups that traditionally report relatively high levels of discrimination.23–25 We subsequently examined whether interpersonal discrimination was related to the co-occurrence of alcohol and drug use disorders, given that alcohol and drug use disorders often co-occur.26–29     

Prevalence and factors associated with undernutrition and anaemia among school children in Durbete Town,northwest Ethiopia

Background

Information about risk factors of undernutrition and anaemia is useful to design appropriate strategies to control the health problems. In this study, the prevalence and factors associated with undernutrition and anaemia were assessed among school children in Abchikeli and Ayalew Mekonnen Elementary Schools, northwest Ethiopia, in February and March 2010.

Methods

A cross-sectional study was carried out among 384 school children. Stool samples were examined using single Kato-Katz slide and nutritional status was determined using anthropometry technique. A pre-tested standardized questionnaire was used to gather information on the socio-demographic and the socio-economic status of the school children. Multivariate logistic regression analysis was used to quantify the association of intestinal helminth infection and socio-demographic and socio-economic factors with undernutrition and anaemia.

Results

Out of 384 children examined, 32.3 % were undernourished (27.1 % underweight and 11.2 % stunted) and 10.7 % were anaemic. The odds of stunting were approximately seven times higher in children of ages 10 to 14 [Adjusted Odds Ratio (AOR) = 6.93, 95 % CI = 2.60, 18.46] and 2.5 times higher in males [AOR = 2.50, 95 % CI = 1.24, 5.07] than children of ages 5 to 9 and females, respectively. The odds of underweight was three times higher in children who did not wash their hands before eating compared to those who did wash their hands [AOR = 3.13, 95 % CI = 1.19, 8.17]. The chance of anaemia was nine times higher in children who were infected with hookworms compared to those who were not infected with any helminth species [AOR = 8.87, 95 % CI = 2.28, 34.58]. The odds of being undernourished and anemic were similar among children with different socio-economic status.

Conclusions

Undernutrition and anaemia are public health problems of school-age children in Durbete Town. Health education and provision of additional food supplements would be important to reduce the problem of undernutrition among school-age children in the town. Deworming of children in the town would also have additional impact on reducing the level of anaemia.     

Neighborhood Social Cohesion and Smoking among Legal and Unauthorized Brazilian Migrants in Metropolitan Boston

Tobacco smoking is estimated to be the largest preventable cause of mortality in the USA, but little is known about the relationship between neighborhood social environment and current smoking behavior or how this may differ by population and geography. We investigate how neighborhood social cohesion and disorder are associated with smoking behavior among legal and unauthorized Brazilian migrant adults using data from the 2007 Harvard-UMASS Boston Metropolitan Immigrant Health and Legal Status Survey (BM-IHLSS), a probabilistic household survey of adult Brazilian migrants. We employ logistic regression to estimate associations between neighborhood social cohesion, neighborhood disorder, and current smoking. We find that neighborhood-level social cohesion is associated with lower likelihood of being a current smoker (O.R. = .836; p < .05), and neighborhood disorder, measured as crime experienced in the neighborhood, is not associated with current smoking. Neighborhood population density, age, being male, and residing with someone who smokes are each positively associated with current smoking (p < .10). The health of participants’ parents at the age of 35, being married, and individual earnings are associated with a reduction in the probability of being a current smoker (p < .05). Migrant legal status and length of residence in the USA are not associated with current smoking. Our findings suggest that neighborhood social cohesion may be protective against smoking. Alternatively, neighborhood disorder does not appear to be related to current smoking among Brazilian migrants.