Poised for Prevention: Advancing Promising Approaches to Primary Prevention of Intimate Partner Violence

Includes a discussion of primary prevention of partner violence, promising approaches to environmental/norms change, an examination of primary prevention within immigrant communities, and recommended actions and immediate next steps

Early-Life Air Pollution Exposure, Neighborhood Poverty, and Childhood Asthma in the United States, 1990⁻2014.

Ambient air pollution is a well-known risk factor of various asthma-related outcomes, however, past research has often focused on acute exacerbations rather than asthma development. This study draws on a population-based, multigenerational panel dataset from the United States to assess the association of childhood asthma risk with census block-level, annual-average air pollution exposure measured during the prenatal and early postnatal periods, as well as effect modification by neighborhood poverty. Findings suggest that early-life exposures to nitrogen dioxide (NO₂), a marker of traffic-related pollution, and fine particulate matter (PM2.5), a mixture of industrial and other pollutants, are positively associated with subsequent childhood asthma diagnosis (OR = 1.25, 95% CI = 1.10⁻1.41 and OR = 1.25, 95% CI = 1.06⁻1.46, respectively, per interquartile range (IQR) increase in each pollutant (NO₂ IQR = 8.51 ppb and PM2.5 IQR = 4.43 µ/m³)). These effects are modified by early-life neighborhood poverty exposure, with no or weaker effects in moderate- and low- (versus high-) poverty areas. This work underscores the importance of a holistic, developmental approach to elucidating the interplay of social and environmental contexts that may create conditions for racial-ethnic and socioeconomic disparities in childhood asthma risk

Voicing narratives of structural violence in interpersonal firearm violence research and prevention in the United States

Violence is defined as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.” Encompassed in this definition are multiple, interrelated forms of violence, including interpersonal firearm death and injury, but also the systems, policies, and practices enacted by those with power to advantage some groups while depriving others of meaningful opportunities for meeting their basic needs—known as “structural violence”. Yet dominant violence prevention narratives too often ignore or deemphasize the deeply intertwined threads of structural violence with other forms of violence, leading to policies and practices that are frequently insufficient, and often harmful, for reducing interpersonal firearm violence and building community safety, particularly in minoritized and structurally marginalized communities. We highlight ways in which limited scrutiny of structural violence, the omission of its defining characteristics—power and deprivation—from functional characterizations and frameworks of interpersonal firearm violence, and the inadequate distribution of power and resources to those most impacted by violence to self-determine narratives of and solutions to interpersonal firearm violence grossly impacts how interpersonal firearm violence is collectively conceived, discussed, and addressed. Expanding dominant narratives of interpersonal firearm violence, guided by the wisdom and determination of those most impacted, such that the goal of prevention and intervention efforts is not merely the absence of violence but rather the creation of a community safety and health ecosystem is essential to meet this critical moment in firearm violence research and prevention

Effects of Prolonged and Timing-Specific Exposure to Neighborhood Disadvantage during Childhood and Adolescence on Health and Health Inequalities in Early Adulthood

Thesis (Ph.D.)--University of Washington, 2015Mounting evidence that purely individual-based explanations fail to fully explain persistent disparities in morbidity and mortality has contributed to a surge in research investigating how residential contexts further shape the health of individual residents. Until recently, however, the majority of scholarship in this area measured neighborhood characteristics only once or over just a short window of observation, conflating persons who were recently exposed with those who have – and in the case of many communities of color, are more likely to have – experienced repeated or prolonged residential adversity. Such a conceptualization is inconsistent with most theories of neighborhood effects, which tend to specify mechanisms that imply sustained or age-specific exposures, as well as with a developmental or life course perspective in which experiences earlier in life are posited to have formative and enduring impacts on future outcomes, even when controlling for more contemporaneous determinants. Using data from the 1970 to 2011 waves of the Panel Study of Income Dynamics (PSID) merged with census data on respondents’ neighborhoods, this dissertation comprises three interrelated studies examining the effects of prolonged and timing-specific exposures to neighborhood disadvantage throughout childhood and adolescence on health and health inequalities later in life, including self-rated health status, obesity incidence, and early smoking initiation. Neighborhood disadvantage is characterized regularly throughout the child and adolescent life course using a composite index based on the spatial clustering of poverty, unemployment, female-headed households, public assistance receipt, and educational and occupational marginalization. The assumption is that such collective conditions of neighborhoods are concomitant to social and structural resources and opportunities (or the lack thereof) that can, alone or in conjunction with individual- and household-level risk and protective factors, be health promoting or health compromising. Analyses employ marginal structural models with inverse probability of treatment (and censoring) weights to adjust for selection bias without “controlling away” the effects of neighborhood exposures that operate indirectly though the same individual-level covariates that are associated with mobility into and out of different neighborhood contexts. Results indicate that prolonged exposure to neighborhood disadvantage throughout childhood and adolescence is strikingly more common among nonwhite, predominantly African American, respondents and is associated in turn with significantly greater odds of experiencing worse self-rated health as well as obesity in early adulthood. Moreover, contrary to family-level poverty in which experiences during early childhood have been shown to be particularly influential, these analyses suggest that exposure to neighborhood-level deprivation during adolescence may be more detrimental to young adult health than exposure that occurs earlier in life. Nonetheless, the findings for early smoking initiation highlight the potential for differential impacts of neighborhood poverty across different racial/ethnic groups. Overall, however, this dissertation adds support to the growing body of literature suggesting that place-based, developmentally-appropriate, and ongoing investments in the social, economic, institutional, and physical structures of under-resourced communities and communities of color can have long-term benefits for population health and health equity that extend over the life course

Family Systems and Parents’ Financial Support for Education in Early Adulthood

Young adults raised outside of two-parent families receive less financial support from their families for education compared with peers who always lived with both parents. We consider how parents' union status over time shapes contributions for young adult children's education. Our approach emphasizes the dynamic relationship between family structure and family economic resources. Marginal structural models with inverse probability weights estimate the association of parents' union status history with eventual financial transfers while not overcontrolling for the effects of union status operating indirectly through time-varying characteristics, such as coresident family composition and economic circumstances. The analytic sample includes parents of a recent cohort of young adults (Panel Study of Income Dynamics, 1983-2013, N = 2,754). Compared with parents who lived continuously with a child's other parent, unpartnered parents' transfers to children were 44 % to 90 % smaller, and repartnered parents' transfers were one- to two-thirds smaller, depending on how long the parent was unpartnered or repartnered. Through its influence on subsequent coresident family composition and family economic resources, parents' union status has indirect as well as direct associations with financial transfers to adult children for education

“What does it depend on?”: Perceptions of safety related to firearms in homes and neighborhoods

BackgroundThough research has established that firearms in the home increase risk for injury and death, a substantial number of Americans, especially gun owners, believe that guns make their homes safer. More than half of gun owners in a nationally-representative survey said "it depends" when asked whether guns make their homes safer or more dangerous, but little is known about the factors that affect perceived safety.ObjectiveTo determine whether the relationship between the presence of firearms and perceived home or neighborhood safety is fixed or depends on additional factors and to identify the additional factors on which it depends.MethodsA mixed-methods cross-sectional analysis of the 2018 state-representative California Safety and Wellbeing Survey (n = 2558, completion rate 49%), including calculation of weighted proportions and qualitative analysis of write-in responses.FindingsOne in six respondents (17.2%, 95% CI 14.9% to 19.7%) reported "it depends" when asked whether a gun in their home made the home a safer or more dangerous place to be ("the home scenario"). One in six (16.6%, 95% CI 14.3% to 19.2%) reported "it depends" when asked whether the neighborhood would be safer if all neighbors had guns in the home ("the neighborhood scenario"). For the home scenario, 28.3% (95% CI 21.9% to 35.7%) cited firearm owner characteristics (e.g., training and proficiency, temperament, and mental health), 28.4% (95% CI 22.3% to 35.5%) cited firearm storage and access, and 28.0% (95% CI 21.5% to 35.7%) cited intended use for guns as factors affecting perceived safety. For the neighborhood scenario, respondents overwhelmingly cited gun owner characteristics (72.1%, 95% CI 63.4% to 79.3%). Factors on which "it depends" varied by gun ownership status.ConclusionPerceived safety when firearms are in the home depends on numerous factors. Understanding these factors may inform tailored, targeted messaging and interventions for firearm injury prevention

Voicing narratives of structural violence in interpersonal firearm violence research and prevention in the United States.

Violence is defined as "the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation." Encompassed in this definition are multiple, interrelated forms of violence, including interpersonal firearm death and injury, but also the systems, policies, and practices enacted by those with power to advantage some groups while depriving others of meaningful opportunities for meeting their basic needs-known as "structural violence". Yet dominant violence prevention narratives too often ignore or deemphasize the deeply intertwined threads of structural violence with other forms of violence, leading to policies and practices that are frequently insufficient, and often harmful, for reducing interpersonal firearm violence and building community safety, particularly in minoritized and structurally marginalized communities. We highlight ways in which limited scrutiny of structural violence, the omission of its defining characteristics-power and deprivation-from functional characterizations and frameworks of interpersonal firearm violence, and the inadequate distribution of power and resources to those most impacted by violence to self-determine narratives of and solutions to interpersonal firearm violence grossly impacts how interpersonal firearm violence is collectively conceived, discussed, and addressed. Expanding dominant narratives of interpersonal firearm violence, guided by the wisdom and determination of those most impacted, such that the goal of prevention and intervention efforts is not merely the absence of violence but rather the creation of a community safety and health ecosystem is essential to meet this critical moment in firearm violence research and prevention

Heterogeneous effects of spatially proximate firearm homicide exposure on anxiety and depression symptoms among U.S. youth.

The burden of firearm homicide in the United States is not evenly distributed across the population; rather, it disproportionately affects youth in disadvantaged and marginalized communities. Research is limited relevant to the impacts of exposure to firearm violence that occurs near where youth live or attend school - spatially proximate firearm violence - on youths mental health and whether those impacts vary by characteristics that shape youths risk for experiencing that exposure in the first place. Using a dataset linking the Fragile Families and Child Wellbeing Study with the Gun Violence Archive (N = 3086), we employed propensity score matching and multilevel stratification to examine average and heterogeneous associations between spatially proximate firearm homicide exposure and anxiety and depression among all youth and then separately for boys and girls. We found a statistically significant average association between firearm homicide exposure and symptoms of depression among youth. Furthermore, heterogeneous effects analyses yielded evidence that the average association is driven by youth, and particularly boys, who are the most disadvantaged and have the highest risk of firearm homicide exposure. The results of this study suggest that the accumulation of stressors associated with structural disadvantage and neighborhood disorder, coupled with exposure to spatially proximate and deadly firearm violence, may make boys and young men, particularly Black boys and young men, uniquely vulnerable to the mental health impacts of such exposure. Ancillary analyses of potential effect moderators suggest possible future areas of investigation