Candace J. Brancato

Challenge and Opportunity in Evaluating a Diffusion-Based Active Bystanding Prevention Program: Green Dot in High Schools

Increasing attention has recently been paid to the development of prevention programs designed to actively engage bystanders in prevention efforts to reduce the risk of sexual and dating violence; yet, few evaluations have been conducted. Our proposed plan to rigorously evaluate a randomized intervention trial of the Green Dot bystander program as it is implemented in high schools across Kentucky is presented. We highlight the value of measuring violence victimization and perpetration outcomes, capturing actual and observed student bystander behaviors, and testing the diffusion of Green Dot training through students’ social networks.

QRS Duration Is Associated With Atrial Fibrillation in Patients With Left Ventricular Dysfunction

QRSduration (QRSd) is associated with higher mortality and morbidity in patients with left ventricular (LV) dysfunction. The association between QRSd and atrial fibrillation (AF) has not been studied in this patient population.

RCT testing bystander effectiveness to reduce violence

Introduction Bystander-based programs have shown promise to reduce interpersonal violence at colleges, yet limited rigorous evaluations have addressed bystander intervention effectiveness in high schools. This study evaluated the Green Dot bystander intervention to reduce sexual violence and related forms of interpersonal violence in 26 high schools over 5 years. Design A cluster RCT was conducted. Setting/participants Kentucky high schools were randomized to intervention or control (wait list) conditions. Intervention Green Dot–trained educators conducted schoolwide presentations and recruited student popular opinion leaders to receive bystander training in intervention schools beginning in Year 1. Main outcome measures The primary outcome was sexual violence perpetration, and related forms of interpersonal violence victimization and perpetration were also measured using anonymous student surveys collected at baseline and annually from 2010 to 2014. Because the school was the unit of analysis, violence measures were aggregated by school and year and school-level counts were provided. Results A total of 89,707 students completed surveys. The primary, as randomized, analyses conducted in 2014–2016 included linear mixed models and generalized estimating equations to examine the condition–time interaction on violence outcomes. Slopes of school-level totals of sexual violence perpetration (condition–time, p<0.001) and victimization (condition time, p<0.001) were different over time. During Years 3–4, when Green Dot was fully implemented, the mean number of sexual violent events prevented by the intervention was 120 in Intervention Year 3 and 88 in Year 4. For Year 3, prevalence rate ratios for sexual violence perpetration in the intervention relative to control schools were 0.83 (95% CI=0.70, 0.99) in Year 3 and 0.79 (95% CI=0.67, 0.94) in Year 4. Similar patterns were observed for sexual violence victimization, sexual harassment, stalking, and dating violence perpetration and victimization. Conclusions Implementation of Green Dot in Kentucky high schools significantly decreased not only sexual violence perpetration but also other forms of interpersonal violence perpetration and victimization.

Dating Violence Victimization and Perpetration Rates Among High School Students

This school-based sample provides the largest estimate of physical and psychological dating violence (DV) victimization and the only report of DV perpetration among high school students. Among 14,190 students in relationships, 33.4% disclosed DV by a partner (victimization) and 20.2% used these same behaviors against a partner (perpetration) in the past 12 months. Physical DV victimization (13%) was less frequently disclosed than psychological DV (23%). Rates of DV victimization and perpetration were highest among females, those receiving free or reduced-price meals, those not exclusively attracted to the opposite sex, students reporting parental or guardian partner violence, binge drinking, and bullying.

Do Guns in the Home Predict Gender and Relationship Attitudes? An Exploratory Study

ABSTRACT This study explores the potential relationship of guns in students’ homes with attitudes indicative of tolerance of violence, negative attitudes toward women and their roles, and attitudes suggestive of myths regarding sexual assault. Seniors in Kentucky high schools whose families possessed guns (n = 1,749) produced higher scores on scales measuring these variables as well as on scales of relationship dependency and religious involvement than seniors whose families did not own guns (n = 912). Students whose families owned more than 10 guns tended to score highest on these measures compared with students whose families owned no guns or a few guns. Because of lower effect sizes, these significant associations require further investigation.

Utilization of community health workers in Canada's Children's Oral Health Initiative for indigenous communities

OBJECTIVE The Childrens Oral Health Initiative (COHI) is a federally funded community-based preventive dental programme implemented in geographically remote Canadian Indigenous communities. The study investigated the effect of the availability of local community health workers (COHI Aides) on access to the programmes preventive dental services for children. METHODS Twenty-five communities were continuously enrolled in the COHI during the 7-year study period. Communities were categorized as having uninterrupted (all 7 years), intermittent (≥4 years) or sporadic (<4 years) service from a community health worker. Four outcome variables measured longitudinal changes in access to preventive dental services: (i) the number of enrolments; (ii) the number of enrolled children with multiple fluoride varnishes delivered; (iii) the number of enrolled children with sealants placed; and (iv) the number of enrolled children receiving ART. RESULTS The general longitudinal trend for programme enrolment and each of the preventive dental service delivery outcomes was similar. Children in communities with uninterrupted service tended to have the highest rates of enrolment and service delivery, which remained constant over time. Children in communities with sporadic service tended to have persistently low rates of enrolment and service delivery over the study period. CONCLUSIONS Community health workers were beneficial in promoting programme enrolment, as well as facilitating and augmenting the delivery of preventive dental services.

Frequency of Guns in the Households of High School Seniors.

BACKGROUND In 2013, President Obama lifted the federal ban on gun violence research. The current study provides one of the first reports to estimate household gun ownership as reported by youth. METHODS In this cohort study of 3006 high school seniors from 24 schools, we examined the frequency of household guns ownership. RESULTS About 65% reported having at least 1 gun in their household. White males were more likely to have a gun and to have more guns than other demographically characterized groups. After adjustment for race and sex, those of higher income, who lived in suburban or rural areas, identified as being exclusively attracted to the opposite sex, and in a romantic relationship, were more likely to have a gun in their household. Having a gun was not associated with increasing symptoms of depression or current poor physical or mental health. CONCLUSIONS Whereas we cannot determine gun types or reasons for having a gun, this research indicates that high school seniors are aware of and may have access to guns for use other than their intended purpose. Household gun ownership among students at higher risk for violence may pose safety challenges for communities and schools.

Direct Effects of the Home, School, and Consumer Food Environments on the Association between Food Purchasing Patterns and Dietary Intake among Rural Adolescents in Kentucky and North Carolina, 2017

Background: Obesity rates are higher among rural versus urban adolescents. To examine possible mechanisms for the rural-urban adolescent obesity disparity, we examined the direct and indirect effects of food purchasing patterns, and the home, school, and consumer food environments on dietary intake among rural adolescents. Methods: A baseline survey was conducted among adolescents in eight rural high schools (four in Eastern Kentucky, and four in Eastern North Carolina). Participants answered questions about food purchasing patterns, dietary intake, home food availability, and demographics. The school and consumer food environments were assessed using validated measures from the School Meals Cost Study (United States Department of Agriculture-Mathematica) and the Nutrition Environment Measurement Survey for Stores, Restaurants, and Corner Stores. Results: Of 432 adolescents, 55% were normal weight, 24% were overweight, and 21% were obese. There was a direct association between unhealthy food purchasing patterns (shopping frequently at gas stations, fast food, and dollar stores) and consuming more added sugars, when compared to those with a healthy shopping pattern (shopping less frequently at gas stations, fast food, and dollar stores) [Odds Ratio = 2.41 (95% CI (confidence interval) 0.99, 3.82)]. Those who reported always having fruits and vegetables in the home consumed more servings of fruits and vegetables [OR = 0.31 cups (95% CI 0.22, 0.44)] compared to those who reported never having fruits and vegetables in the home. Adolescents attending a school with a low healthy food availability score consumed fewer servings of fruits and vegetables [−0.001 (95% CI −0.001, 0.0001)] compared to those attending a school with a high healthy food availability score. Conclusions: There are direct associations between food purchasing patterns, the home and school food environments, and dietary intake among rural adolescents. These cross-sectional results informed the development of the “Go Big and Bring it Home” program, a text messaging intervention to improve adolescents’ fruit, vegetable, and healthy beverage intake.

Bystander Program Effectiveness to Reduce Violence Acceptance: RCT in High Schools

Bystander-based violence prevention interventions have shown efficacy to reduce dating violence and sexual violence acceptance at the individual level yet no large randomized controlled trial (RCT) has evaluated this effect at the high-school level and over time. This rigorous cluster-randomized controlled trial addresses this gap by evaluating intervention effectiveness at both school and individual levels. Kentucky high schools were randomized to intervention or control conditions. In intervention schools educators provided school-wide ‘Green Dot’ presentations and bystander training with student popular opinion leaders. Each spring from 2010 to 2014; 73,044 students completed anonymous surveys with no missing data on relevant outcomes. Dating violence and sexual violence acceptance were the primary outcomes for this analysis. At the school level, slopes from linear mixed models using averaged school-level dating violence acceptance (condition–time, p < 0.001) and sexual violence acceptance (condition–time interaction, p < 0.001) differed indicating a significant reduction in the violence acceptance in the intervention relative to control schools over time and specifically in years 3 and 4 when ‘Green Dot’ was fully implemented. Analyses based on student’s self-reported receipt of ‘Green Dot’ training by condition confirmed the school level finding of significant reductions in both dating violence and sexual violence acceptance in years 3 and 4 for both males and females. In this RCT we find evidence that the bystander-based violence prevention intervention ‘Green Dot’ works, as hypothesized and as implemented, to reduce acceptance of dating violence and sexual violence at the school and individual levels.

Types of Trauma and Self-Reported Pain That Limits Functioning in Different-Aged Cohorts:

There is a growing body of literature that childhood or adult trauma exposure can have lifelong mental and physical health impacts. In this large cross-sectional analysis, authors investigated combinations of trauma types and pain resulting in functional limitations among women recruited into a statewide health registry. Combinations of traumas such as child physical abuse (CPA), child sexual abuse (CSA), and adult violence were hypothesized to be associated with greater likelihood of limiting pain and earlier symptom onset, relative to women with no or singular trauma exposures. Pain prevalence rates (PRs) and adjusted prevalence rate ratios (aPRRs) were highest among women experiencing multiple forms of violence (43.3% among women disclosing CPA, CSA, and adult violence; aPRR = 2.06, p < .001), intermediate for women experiencing CPA or CSA yet no adult violence (37.0%; aPRR = 1.76, p < .001), and lower among women experiencing adult violence only (27.1%; aPRR = 1.29, p < .001), relative to women never experiencing violence (20.7%). As hypothesized, the effect of combinations of trauma on chronic pain was consistently greatest for those reporting limiting pain at younger ages. Implications include the need to identify combinations of traumatic events across the life span, and to intervene early to reduce the impact of trauma on health and functioning.