Robert M. Bossarte

Hospitalizations for Poisoning by Prescription Opioids, Sedatives, and Tranquilizers

BACKGROUNDnUnintentional poisoning deaths have been increasing dramatically over the past decade, and the majority of this increase has resulted from overdoses of specific prescription drugs. Despite this trend, there are limited existing data examining hospitalizations for poisonings, both unintentional and intentional, associated with prescription drugs. A better understanding of these hospitalizations may help identify high-risk populations in need of intervention to prevent subsequent mortality.nnnPURPOSEnThis article aims to describe the incidence and characteristics of hospitalizations resulting from poisoning by prescription opioids, sedatives, and tranquilizers in the U.S. from 1999 to 2006 and make comparisons to hospitalizations for all other poisonings during this time period.nnnMETHODSnHospitalizations for poisonings were selected from the Nationwide Inpatient Sample (NIS), a stratified, representative sample of approximately 8 million hospitalizations each year, according to the principal discharge diagnosis. Intentionality of the poisoning was determined by external cause of injury codes. SAS callable SUDAAN software was used to calculate weighted estimates of poisoning hospitalizations by type and intentionality. Demographic and clinical characteristics of poisoning cohorts were compared. Data were analyzed in 2009.nnnRESULTSnFrom 1999 to 2006, U.S. hospitalizations for poisoning by prescription opioids, sedatives, and tranquilizers increased a total of 65%. This increase was double the increase observed in hospitalizations for poisoning by other drugs and substances. The largest increase in the number of hospitalized cases over the 7-year period was seen for poisonings by benzodiazepines, whereas the largest percentage increase was observed for methadone (400%). In comparison to patients hospitalized for poisoning from other substances, those hospitalized for prescription opioids, sedatives, and tranquilizers were more likely to be women, aged >34 years, and to present to a rural or urban nonteaching hospital.nnnCONCLUSIONSnPrescription opioids, sedatives, and tranquilizers are an increasing cause of hospitalization. The hospital admission provides an opportunity to better understand the contextual factors contributing to these cases, which may aid in the development of targeted prevention strategies.

Measuring Sex Differences in Violence Victimization and Perpetration Within Date and Same-Sex Peer Relationships

This study examines sex differences in the patterns of repeated perpetration and victimization of physical violence and psychological aggression within dating relationships and same-sex peer relationships. Data were obtained from the Youth Violence Survey: Linkages among Different Forms of Violence, conducted in 2004, and administered to all public school students enrolled in grades 7, 9, 11 and 12 (N = 4,131) in a high-risk school district. Analyses of adolescents who dated in the past year (n = 2,888) show that girls are significantly more likely than boys to report physical violence and psychological aggression perpetration within dating relationships. However, boys are significantly more likely than girls to report physically injuring a date. Boys are also significantly more likely than girls to report physical violence victimization and perpetration within same-sex peer relationships. Implications and directions for future research are discussed.

Disparities in Adverse Childhood Experiences Among Individuals With a History of Military Service

IMPORTANCEnAdverse childhood experiences (ACEs) are associated with several adulthood health problems, such as self-directed violence. For some individuals, enlistment in the military may be an instrumental act to escape adverse household environments; however, to our knowledge prevalence of ACEs among persons with a history of military service has not been documented in the United States using population-based data.nnnOBJECTIVEnTo compare the prevalence of ACEs among individuals with and without a history of military service.nnnDESIGN, SETTING, AND PARTICIPANTSnData are from the 2010 Behavioral Risk Factor Surveillance System. Computer-assisted telephone interviews were conducted with population-based samples of noninstitutionalized US adults from January 1 through December 31, 2010. Analyses were limited to respondents who received the ACE module (nu2009=u200960,598). Participants were categorized by history of military service and whether a respondent was 18 years of age in 1973.nnnMAIN OUTCOMES AND MEASURESnHistory of military service was defined by active duty service, veteran status, or training for the Reserves or National Guard. The ACE inventory assessed 11 negative experiences before the age of 18 years. Weighted χ2 tests and multiple logistic regression analyses were used to examine differences in ACEs by history of military service, era of service, and sex.nnnRESULTSnThose with military experience had greater odds of any difference in prevalence of ACEs. In the all-volunteer era, men with military service had a higher prevalence of ACEs in all 11 categories than men without military service. Notably, in the all-volunteer era, men with military service had twice the odds of reporting forced sex before the age of 18 years (odds ratio,u20092.19; 95% CI, 1.34-3.57) compared with men without military service. In the draft era, the only difference among men was household drug use, in which men with a history of military service had a significantly lower prevalence than men without a history of military service (2.1% vs. 3.3%; Pu2009=u2009.003). Fewer differences were observed among women in the all-volunteer and draft eras.nnnCONCLUSIONS AND RELEVANCEnDifferences in ACEs by era and sex lend preliminary support that enlistment may serve as an escape from adversity for some individuals, at least among men. Further research is needed to understand how best to support service members and veterans who may have experienced ACEs.

Intimate Partner Violence Victimization Among Women Veterans and Associated Heart Health Risks

PURPOSEnCardiovascular disease (CVD) is the leading cause of death for women in the United States. CVD risk factors, including depression, smoking, heavy drinking, being overweight, and physical inactivity, are associated with stress and may be linked to womens experiences of intimate partner violence (IPV) victimization. We know little about IPV and CVD risk factors among veteran women. The purpose of this study was to identify the association between lifetime IPV victimization and CVD risk factors among women, accounting for veteran status.nnnMETHODSnWe used data from the Centers for Disease Control and Preventions Behavioral Risk Factor Surveillance System for 2006 for the eight states that included the IPV module. We explored the associations between veteran status and lifetime IPV victimization and between IPV exposure and CVD risk factors, for veteran and non-veteran women.nnnFINDINGSnVeteran women were more likely than non-veteran women to report lifetime IPV victimization (33.0% vs. 23.8%). IPV exposure was associated with depression, smoking, and heavy drinking. We did not find evidence for an association between IPV exposure and lack of exercise or being overweight or obese, when controlling for demographic characteristics and veteran status.nnnCONCLUSIONnWomen veterans have particularly high rates of lifetime IPV victimization. In addition, IPV victimization is associated with an increased risk of heart health risk factors. The findings suggest that we should attend to IPV exposure among veteran women and further investigate the link between IPV and military service, and the associated health impacts.

Drivers of Disparity: Differences in Socially Based Risk Factors of Self-injurious and Suicidal Behaviors Among Sexual Minority College Students

Abstract Lesbian, gay, and bisexual (ie, sexual minority) populations have increased prevalence of both self-injurious and suicidal behaviors, but reasons for these disparities are poorly understood. Objective: To test the association between socially based stressors (eg, victimization, discrimination) and self-injurious behavior, suicide ideation, and suicide attempt. Participants: A national sample of college-attending 18- to 24-year-olds. Methods: Random or census samples from postsecondary educational institutions that administered the National College Health Assessment during the Fall 2008 and Spring 2009 semesters. Results: Sexual minorities reported more socially based stressors than heterosexuals. Bisexuals exhibited greatest prevalence of self-injurious and suicidal behaviors. In adjusted models, intimate partner violence was most consistently associated with self-injurious behaviors. Conclusions: Sexual minorities’ elevated risks of self-injurious and suicidal behaviors may stem from higher exposure to socially based stressors. Within-group differences among sexual minorities offer insight to specific risk factors that may contribute to elevated self-injurious and suicidal behaviors in sexual minority populations.

Low‐Level Violence in Schools: Is There an Association Between School Safety Measures and Peer Victimization?

BACKGROUNDnLow-level violent behavior, particularly school bullying, remains a critical public health issue that has been associated with negative mental and physical health outcomes. School-based prevention programs, while a valuable line of defense to stave off bullying, have shown inconsistent results in terms of decreasing bullying. This study explored whether school safety measures (eg, security guards, cameras, ID badges) were associated with student reports of different forms of peer victimization related to bullying.nnnMETHODSnData came from the 2007 School Crime Supplement of the National Crime Victimization Survey. Chi-square tests of independence were used to examine differences among categorical variables. Logistic regression models were constructed for the peer victimization outcomes. A count variable was constructed among the bullying outcomes (0-7) with which a Poisson regression model was constructed to analyze school safety measures impacts on degree of victimization.nnnRESULTSnOf the various school safety measures, only having adults in hallways resulted in a significant reduction in odds of being physically bullied, having property vandalized, or having rumors spread. In terms of degree of victimization, having adults and/or staff supervising hallways was associated with an approximate 26% decrease in students experiencing an additional form of peer victimization.nnnCONCLUSIONSnResults indicated that school safety measures overall were not associated with decreased reports of low-level violent behaviors related to bullying. More research is needed to further explore what best promotes comprehensive safety in schools.

Suicidal ideation among sexual minority veterans: results from the 2005-2010 Massachusetts Behavioral Risk Factor Surveillance Survey.

Suicide is a public health problem disproportionately associated with some demographic characteristics (e.g., sexual orientation, veteran status). Analyses of the Massachusetts Behavioral Risk Factor Surveillance Survey data revealed that more lesbian, gay, and bisexual (i.e., sexual minority) veterans reported suicidal ideation compared with heterosexual veterans. Decreased social and emotional support contributed to explaining the association between sexual minority status and suicidal ideation. More research is needed about suicide risk among sexual minority veterans; they might be a population for outreach and intervention by the Veterans Health Administration.

Psychosocial predictors and outcomes of loneliness trajectories from childhood to early adolescence.

Using latent class growth analysis, we were interested in investigating how experiences of loneliness emerge in distinct developmental patterns over the course of middle childhood and adolescence (NICHD Study of Early Child Care, N = 832). Second, we examined the role of demographic, mental health, and behavioral variables in association with these discrete patterns of loneliness. Loneliness was measured at 3 time points: age 9, age 11, and age 15. Results indicated five discrete trajectories of loneliness from middle childhood to adolescence. Most children exhibited a stable and low level of loneliness over time. The remaining children were split among moderate increasing, high increasing, decreasing, and chronic loneliness groups. Ethnicity, income, age 7 social skills, age 7 depression, and age 7 aggression were associated with trajectory membership. In addition, the loneliness trajectories predicted self-reports of social skills deficits, depression, aggression, and suicidal ideation at age 15.

Changes in Loneliness during Middle Childhood Predict Risk for Adolescent Suicidality Indirectly through Mental Health Problems

We investigated whether changes in loneliness during middle childhood as well as from middle childhood into adolescence were associated with adolescent self-harm behaviors and suicidal thoughts using a community sample of 889 participants. Multivariate logistic regressions indicate that the relationship between changes in loneliness and suicidality is no longer statistically significant once depression and externalizing behavior problems are included as controls. Follow-up analyses indicate that increases in loneliness indirectly affect self-harm behaviors and suicidal thoughts through depression and externalizing behavior problems. These findings are consistent with other studies on peer relationships and adolescent suicidality, suggesting that experiences with peers indirectly affect risk for suicidality through mental health problems. These findings highlight the importance of considering how experiences in middle childhood peer relationships affect risk for suicide in consecutive developmental periods, particularly adolescence.

Alcohol and Drug Use Among Gang Members: Experiences of Adolescents Who Attend School

BACKGROUNDnProblems related to gangs have been noted in large cities and in many schools across the United States. This study examined the patterns of alcohol, drug use, and related exposures among male and female high school students who were gang members.nnnMETHODSnAnalyses were based on the Youth Violence Survey, conducted in 2004, and administered to over 80% of eligible public school students in grades 7, 9, 11, and 12 (N = 4131) in a high-risk, urban school district. The self-administered survey, completed during a class period, included measures of alcohol and drug use and related exposures. Tests of associations were determined using chi-square tests and logistic regression analyses.nnnRESULTSnIn this study, 8.8% of students reported gang membership. Students who initiated alcohol use prior to age 13 (OR = 4.90; 95% CI: 3.65-6.58), who drank alcohol 3 or more times per week (OR = 9.57; 95% CI: 6.09-15.03) and who used drugs 3 or more times per week (OR = 6.51; 95% CI: 4.59-9.25) were more likely to report gang membership than students who did not report alcohol or drug use. Boys were more likely than girls to report alcohol-related fighting and drug selling.nnnDISCUSSIONnGang members were significantly more likely than non-gang members to have initiated alcohol early, to have reported a high prevalence of alcohol use, to have engaged in alcohol-related physical fighting, peer drinking, drug use, drug selling, peer drug selling, and having seen drug deals in their neighborhood. Schools may serve as a critically important source for intervention and prevention efforts for gang members, especially those in 7th grade, who still attend school.