Violence Exposure Research Articles

Predictors of early adulthood insomnia following exposure to a single mass violence attack during adolescence: 7–13 year follow-up from the Utøya and HUNT studies

ABSTRACT Background: The long-term impact of mass violence attacks is practically unknown, especially in children and adolescents. In a previous study, we found that 8.5 years after a terror attack targeting mainly adolescents, nearly half of the survivors met diagnostic criteria for insomnia. Objectives: The aims of this study were to investigate: (1) whether exposure to a single mass violence event during adolescence increases the risk of insomnia almost a decade later above that expected for a non-exposed population; and (2) whether prior interpersonal violence exposure and early post-traumatic reactions predict later insomnia. Method: Participants were survivors of the 2011 Utøya Island terrorist attack (n = 279) and controls from the HUNT Norwegian general population study (n = 35,664). Early adulthood insomnia was assessed using four items from the Karolinska Sleep Questionnaire 8.5 years after the attack. Participants who had also completed earlier data collection waves for both studies (n = 116 and 2382, respectively) were included in logistic regression models testing the associations between predictors during adolescence and later insomnia. Results: Nearly a decade after the Utøya attack, 38.4% (n = 56) of the survivors reported symptoms of insomnia indicative of probable insomnia compared to 20.5% (n = 5771) of controls. Terror exposure during adolescence was a significant predictor of later insomnia [odds ratio (OR) = 3.18, 95% confidence interval (CI) = 2.05–4.87, p < .001]. Early post-trauma symptoms of anxiety and depression (OR = 1.34, 95% CI = 1.02–1.76, p = .033) and weekly headaches (OR = 1.64, 95% CI = 1.08–2.47, p = .018) were also significant predictors while controlling for background factors and other predictors. Conclusion: Long-term assessment and treatment are needed for survivors of mass violence to improve resilience and recovery.

Responding to Childhood Trauma: Developing and Learning from Collaborations Beyond the Consulting Room

ABSTRACT Whether within or outside of the psychoanalytic consulting room, when individuals or professional groups can recognize their limitations in addressing familiar challenges and have the opportunity to find partners to explore and understand the underlying sources of their distress, opportunities for new adaptive solutions emerge as well. Shared concerns about the challenges of violence exposure and childhood trauma formed the basis of what at first seemed an unlikely collaboration between psychoanalysts and other clinicians at the Yale Child Study Center and members of the New Haven Police Department. This paper will describe the development of the Child Development-Community Policing partnership and later, our engagement with policymakers. The story of how these collaborations emerged illustrates ways in which the application of the most basic psychoanalytic principles of listening, close observation, and collaborative learning led to the development of early intervention and clinical treatment that have helped to advance the field of childhood trauma. Mobilizing these collaborative efforts outside of the consultation room has, most importantly, led to a far greater number of traumatized children who no longer need to remain alone in the immediate aftermath of the traumatic realization of their worst nightmares.

Contributions of Violence Exposure and Traumatic Stress Symptoms to Physical Health Outcomes in Incarcerated Adolescents

Violence and traumatic stress negatively affect physical health in youth. Incarcerated adolescents have high rates of violence exposure and health problems, however, few studies have examined medical records and violence exposure in this high-risk population. Self-reported violence exposure and symptoms of stress were collected in 115 incarcerated male adolescents. Medical charts were reviewed for the presence of somatic complaints and chronic health conditions. Regression modeling and odds ratios demonstrated that exposure to intimate partner violence (IPV), child abuse, and sexual abuse predicted specific health conditions. The hierarchical regression model established that traumatic stress and a history of sexual abuse predict cumulative health problems. The study demonstrates that early exposure to violence combined with the presence of traumatic stress symptoms increases the risk for later health problems and can be used by healthcare providers to identify youth at increased risk of long-term health outcomes in high-risk populations.

JAMA study: Exposure to gun violence increases suicide risk in Black adults

Gun violence exposure (GVE) is associated with a risk for suicide among Black adults, according to a new study published Feb. 5 in JAMANetwork Open. Researchers said their primary aim was to extend existing research by examining the association between GVE and suicidal thoughts and behaviors within a nationally representative sample of Black adults.

The being safe, health and positively empowered pilot randomized controlled trial: A digital multicomponent intervention for immigrant women with cumulative exposures to violence.

Pre- and postmigration exposures to violence are significant social determinants of immigrant women's health, safety, and well-being, with Black immigrant women being at high risk because of many coming from conflict-zone countries. The existing literature does not report the development and testing of a multicomponent digital intervention to address safety and health issues among immigrant women with cumulative exposures to violence. This pilot randomized controlled trial evaluated preliminary efficacy of a multicomponent digital intervention (BSHAPE) to improve health and safety outcomes for immigrant women with cumulative violence exposures, posttraumatic stress disorder and/or depression symptoms, and human immune deficiency virus (HIV) risk behaviors. The intervention was developed based on formative qualitative work and input from women. In the randomized controlled trial, 144 Black immigrant women, average age being 33.6 years, were randomly assigned to either the BSHAPE arm (n = 72) or a control arm (n = 72). Data were collected at four time points over 12 months. A generalized estimating equation analysis was performed to examine group differences in change in outcomes over time. Compared to the control arm, participants in BSHAPE showed significant improvement in multiple outcome measures (e.g., HIV/STI risk). This pilot trial of BSHAPE showed promising results for immigrant women with lifetime exposures to violence, poor mental health, and HIV risk. The study also provided useful information to further improve BSHAPE for a full-scale efficacy trial. The digital BSHAPE can be especially advantageous for violence-affected immigrant women who face numerous barriers to accessing in-person care for their safety and health needs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Correlation of violence with anxiety and sleep disturbance among Talibs (mosque students) in Afghanistan: A cross-sectional study

BackgroundDespite ample research on violence's impact on mental health, a literature gap persists regarding its specific influence on anxiety and sleep quality among mosque students, particularly Talibs, in Afghanistan. This study examines the influence of violence on anxiety levels and sleep quality among mosque students, specifically Talibs, in Afghanistan. MethodsThis cross-sectional study administered between March 10, 2023 to June 25 2023, among Talibs (mosque students) across Herat province of Afghanistan. Data were collected using a pretested structured questionnaire. The Pittsburgh Sleep Quality Index (PSQI), and anxiety subscale of the Depression, Anxiety, Stress – Youth (DASS-Y) questionnaire was used to assess sleep quality and anxiety among Talibs. Logistic regression models were used to examine the association of violence, anxiety, and sleep disturbance, and socio-demographic characteristics among Talibs (N = 378). ResultsPrevalence rates for anxiety symptoms, sleep disturbances, and experiences of violence were 47.9 %, 29.1 %, and 79.6 %, respectively. Notably, anxiety symptoms in Talibs exhibited correlations with advanced age and exposure to violence. Multiple regression analysis revealed significant associations between father's education, violence exposure, and anxiety, while age, economic status, and parental employment correlated with sleep disturbances. ConclusionGiven the impact of violence on anxiety and sleep quality, this study recommends routine screening for anxiety and sleep disturbances by authorities and health organizations. Psychological counseling services should be available for vulnerable Talibs. Enforcing a prohibition against violence within mosque settings could alleviate anxiety symptoms and sleep disturbances among this population.

Gun Violence Exposure and Suicide Among Black Adults.

Black individuals are disproportionately exposed to gun violence in the US. Suicide rates among Black US individuals have increased in recent years. To evaluate whether gun violence exposures (GVEs) are associated with suicidal ideation and behaviors among Black adults. This cross-sectional study used survey data collected from a nationally representative sample of self-identified Black or African American (hereafter, Black) adults in the US from April 12, 2023, through May 4, 2023. Ever being shot, being threatened with a gun, knowing someone who has been shot, and witnessing or hearing about a shooting. Outcome variables were derived from the Self-Injurious Thoughts and Behaviors Interview, including suicidal ideation, suicide attempt preparation, and suicide attempt. A subsample of those exhibiting suicidal ideation was used to assess for suicidal behaviors. The study sample included 3015 Black adults (1646 [55%] female; mean [SD] age, 46.34 [0.44] years [range, 18-94 years]). Most respondents were exposed to at least 1 type of gun violence (1693 [56%]), and 300 (12%) were exposed to at least 3 types of gun violence. Being threatened with a gun (odds ratio [OR], 1.44; 95% CI, 1.01-2.05) or knowing someone who has been shot (OR, 1.44; 95% CI, 1.05-1.97) was associated with reporting lifetime suicidal ideation. Being shot was associated with reporting ever planning a suicide (OR, 3.73; 95% CI, 1.10-12.64). Being threatened (OR, 2.41; 95% CI, 2.41-5.09) or knowing someone who has been shot (OR, 2.86; 95% CI, 1.42-5.74) was associated with reporting lifetime suicide attempts. Cumulative GVE was associated with reporting lifetime suicidal ideation (1 type: OR, 1.69 [95% CI, 1.19-2.39]; 2 types: OR, 1.69 [95% CI, 1.17-2.44]; ≥3 types: OR, 2.27 [95% CI, 1.48-3.48]), suicide attempt preparation (≥3 types; OR, 2.37; 95% CI, 2.37-5.63), and attempting suicide (2 types: OR, 4.78 [95% CI, 1.80-12.71]; ≥3 types: OR, 4.01 [95% CI, 1.41-11.44]). In this cross-sectional study, GVE among Black adults in the US was significantly associated with lifetime suicidal ideation and behavior. Public health efforts to substantially reduce interpersonal gun violence may yield additional benefits by decreasing suicide among Black individuals in the US.

Assessing the Relationship Between Exposure to Violence and Perceptions of School Safety and Emergency Preparedness in the Context of Lockdown Drills

ABSTRACT Although lockdown drills are a practice widely used in K-12 public schools across the United States to prepare students and staff to respond to acts of violence, research has only just begun to consider the impacts of these practices on those who participate in them. This study adds to the growing body of literature by examining the potential impact of students’ exposure to violence (ETV) in their school on perceptions of safety and emergency preparedness in the context of lockdown drills. The findings indicate that ETV decreases both safety and preparedness perceptions. The association between perceived school safety and ETV, however, weakens over time and may be lessened by participation in drills and associated training. Implications for policy and practice are also discussed.

Early Results of an Initiative to Assess Exposure to Firearm Violence in Ambulatory Care: Descriptive Analysis of Electronic Health Record Data.

Current research on firearm violence is largely limited to patients who received care in emergency departments or inpatient acute care settings or who died. This is because standardized disease classification codes for firearm injury only represent bodily trauma. As a result, research on pathways and health impacts of firearm violence is largely limited to people who experienced acute bodily trauma and does not include the estimated millions of individuals who were exposed to firearm violence but did not sustain acute injury. Assessing and collecting data on exposure to firearm violence in ambulatory care settings can expand research and more fully frame the public health issue. The aim of the study is to evaluate the demographic and clinical characteristics of patients who self-reported exposure to firearm violence during a behavioral health visit. This study assessed early data from an initiative implemented in 2022 across a national network of ambulatory behavioral health centers to support trauma-informed care by integrating structured data fields on trauma exposure into an electronic health record behavioral health patient assessment form (SmartForm), as such variables are generally not included in standard outpatient medical records. We calculated descriptive statistics on clinic characteristics, patient demographics, and select clinical conditions among clinics that chose to implement the SmartForm and among patients who reported an exposure to firearm violence. Data on patient counts are limited to positive reports of exposure to firearm violence, and the representativeness of firearm exposure among all patients could not be calculated due to unknown variability in the implementation of the SmartForm. There were 323 of 629 (51%) clinics that implemented the SmartForm and reported at least 1 patient exposed to firearm violence. In the first 11 months of implementation, 3165 patients reported a recent or past exposure to firearm violence across the 323 clinics. Among patients reporting exposure, 52.7% (n=1669) were male, 38.8% (n=1229) were Black, 45.7% (n=1445) had posttraumatic stress disorder, 37.5% (n=1186) had a substance abuse disorder (other than nicotine), and 11.7% (n=371) had hypertension. Current research on firearm violence using standardized data is limited to acute care settings and death data. Early results from an initiative across a large network of behavioral health clinics demonstrate that a high number of clinics chose to implement the SmartForm, resulting in thousands of patients reporting exposure to firearm violence. This study demonstrates that collecting standardized data on firearm violence exposure in ambulatory care settings is feasible. This study further demonstrates that resultant data from ambulatory settings can be used for meaningful analysis in describing populations affected by firearm violence. The results of this study hold promise for further collection of structured data on exposure to firearm violence in ambulatory settings.

Contrasting ecological contexts among treatment-seeking military sexual assault survivors: Consideration of relationships with sexual and gender minority identification.

Survivors of military sexual trauma (MST) seeking mental health services may present with concerns extending beyond symptom relief. Attention to social, economic, and coping resource contexts is salient for care consideration. Although those identifying as sexual and gender minorities (SGM) are overrepresented among service members exposed to assaultive MST, research contrasting ecological resource variability among treatment seekers is limited. The present study delineates modifiable risk and protective factors that might be used to inform MST-related health care for Veterans, broadly, and SGM-identifying Veterans, specifically. Veterans (N = 493, 12.8% identifying as SGM) presenting for treatment secondary to military sexual assault completed a semistructured clinical interview and intake survey including demographic characteristics, diversity-related factors, and access to psychosocial resources. SGM/non-SGM-identifying groups were contrasted on individual-, interpersonal-, and community-level ecological characteristics. SGM-identifying Veterans were less likely to report access to sufficient financial resources and had double the prevalence rate of housing instability in contrast to non-SGM-identifying Veterans. No significant differences emerged in terms of past-year interpersonal violence exposure, endorsement of helpful spiritual beliefs, or availability of social support based on SGM identification. Findings underscore the importance of attending to the intersection of SGM identity and ecological factors that can influence Veterans' clinical presentation and treatment engagement. Recommendations for provision of MST services are made. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A latent profile analysis of resilience and the associations with flourishing in emergency nurses exposed to workplace violence in China.

Workplace violence (WPV) exposure has been particularly prevalent in emergency nurses, coupled with negative mental health outcomes. Few explored resilience after WPV exposure using the perspective of positive mental health. We aimed to identify latent profiles of resilience and examine associations with flourishing in emergency nurses with WPV exposure. A total of 1241 Chinese emergency nurses were surveyed on the frequency of WPV exposure, resilience, and flourishing. Eight hundred and twenty five participants (90.1% female, 86.6% aged 20-39) reported WPV exposure at least once in the past 3 months. Latent profile analysis identified profiles of resilience as low resilience (15.0%), moderate decision respond and interpersonal link with low rational thought and flexible adaption (18.0%), moderate resilience (31.0%), high decision respond, interpersonal link, and rational thought with moderate flexible adaption (16.0%), and high resilience (20.0%). Higher flourishing was observed in profiles of moderate resilience, high decision respond, interpersonal link, and rational thought with moderate flexible adaption, and high resilience. We differentiated profiles of resilience and the associations with flourishing in emergency nurses with WPV exposure, which informed targeted interventions for promoting positive mental health.

The Prevalence of Sexually Transmitted Infections and Subsequent Association with Exposure to Childhood Violence and Mental Health Outcomes for Adolescents and Young Adults in Zimbabwe

Sexually transmitted infections (STIs) represent a major public health concern for young people in developing nations, impacting approximately two-thirds of individuals below the age of 25. This study examined the prevalence and the association between self-reported STIs, childhood violence exposure, and mental health outcomes among adolescents and young adults (13-24 years old) in Zimbabwe. Secondary data from the 2017 Zimbabwe Violence Against Children and Youth Survey (n=8,715) was utilized. Data analysis was performed using chisquare to determine the prevalence estimates for bivariate. Seven logistic regression models were used to examine the significant association between independent variables and outcomes for multivariate. About 45.5% of adolescents and young adults with self-reported STIs were exposed to multiple forms of childhood violence, 49.8% reported lifetime suicide risk, and 44.9% reported moderate-to-severe mental distress in the past 30 days. Furthermore, logistic regression results indicated that adolescents and young adults with self-reported STI diagnoses were more likely to be exposed to multiple forms of childhood violence, including physical, emotional, and sexual violence, as well as mental distress in the past 30 days and lifetime suicide risk compared to those without STIs. Therefore, this study underscores the importance of implementing comprehensive public health strategies to protect the wellbeing of adolescents and young adults with STIs. Interventions should also prioritize raising awareness, destigmatizing STIs, implementing and strengthening violence prevention policies, and addressing mental health problems through community mental health treatment programs in Zimbabwe. Keywords: Childhood violence, Emotional violence, Exposure, Mental distress, Physical violence, Sexual violence, Sexually transmitted infections (STIs), Suicide risk, Zimbabwe.

The Impact of Early Violence Exposure on Adolescent Flourishing : Is There Light at the End of the Tunnel?

Child maltreatment (CM) and intimate partner violence (IPV) are prevalent in the United States and associated with negative mental and physical health outcomes. Thus far, research and clinical care have focused on reducing symptoms of illness, but little is known about whether or how CM and IPV exposure can lead to flourishing in adolescence. To examine the impact of CM and IPV exposure on adolescent mental and physical flourishing as well as moderators and mediators affecting this pathway. A secondary data analysis of 2,232 children in the Future of Families Child Wellbeing Study (FFCWS) was conducted to examine waves 1-6 including variables on CM/IPV, general flourishing, mental flourishing, BMI, and healthy eating. Race, socioeconomic status (SES), and gender were included as moderators; depression and anxiety were included as mediating variables. Adolescent boys experienced significantly more general flourishing (β = 4.00, p < .001). There were significant direct effects of CM (p = .025) and anxiety (p = .019) on well-being, and anxiety mediated the pathway from CM to mental flourishing (CI [0.001, 0.017]). Depression (CI [0.001, 0.026]) and anxiety (CI [-0.023, - 0.005]) mediated the pathway from CM to BMI. Our findings indicated that exposure to CM and IPV impacted the likelihood of adolescent flourishing. Future research should evaluate whether and how these flourishing outcomes could be modified.

Drivers of men's use of intimate partner violence in conflict-affected settings: learnings from the Democratic Republic of Congo.

Intimate partner violence against women (IPVAW) is prevalent in conflict-affected settings. Yet, there is limited knowledge about the risk factors that influence men's use of IPVAW in conflict-affected settings. This paper adopts a transdisciplinary perspective to understand how experiences hypothesized to increase men's use of IPVAW relate to each other and to men's use of IPVAW. The findings may help researchers and interventionists to better select and target interventions for IPVAW in conflict-affected settings. We used baseline data from the Tushinde Ujeuri project in the Democratic Republic of Congo. Men with at least partial data for the variables of interest were included in the analysis (n = 2080). We estimated a structural equation model that explored how five constructs - interpersonal violence, mental health, socioeconomic adversity, gender inequitable attitudes, and conflict violence - influenced men's self-reported past-year use of physical and/or sexual IPVAW. The model had acceptable fit (χ2 = 1576.574, p = 0.000; RMSEA = 0.041; CLI = 0.882; SRMR = 0.055). There was a statistically significant path from interpersonal violence to IPVAW (β = 0.875; OR = 2.40). Interpersonal violence also was linked to gender inequitable attitudes (β = 0.364), which were linked to increased use of IPVAW (β = 0.180; OR = 1.20). Moreover, interpersonal violence was linked to trauma symptoms (β = 0.331), which were linked to increased use of IPVAW (β = 0.238; OR = 1.27). Use of IPVAW decreased as conflict exposures increased (β=-0.036; OR = 0.96), and there was no path from socioeconomic adversity to IPVAW. Our findings suggest interpersonal violence exposures, trauma symptoms, and gender inequitable attitudes are all risk factors for the use of IPVAW in a conflict-affected setting. While continuing to focus on gender inequitable attitudes and norms, interventionists should also consider addressing men's experiences of victimization and mental wellbeing. Doing so can help to improve trauma symptoms and may hold promise to reduce IPVAW in conflict-affected settings.

Compensatory prosocial behavior in high-risk adolescents observing social exclusion: The effects of emotion feedback

Although exposure to violence has been consistently associated with deficits in prosocial behavior among adolescents, effective methods of mitigating these deficits have yet to be identified. The current investigation tested whether prosocial behavior could be promoted by providing adolescents with feedback about the emotional states of others and whether the effects of feedback varied between adolescents who had versus had not experienced violence in the home or in the community. Adolescents aged 8 to 17 years with (n = 87) and without (n = 61) histories of violence exposure completed a virtual social exclusion ball-tossing paradigm in which information about an excluded peer’s emotions (sad, angry, or neutral) was experimentally manipulated. Among adolescents with histories of violence exposure, those who received feedback that the peer was sad due to being excluded compensated by throwing the ball more often to that peer. In contrast, adolescents without histories of violence exposure did not engage in compensatory prosocial behavior, instead maintaining a relatively even number of tosses to all players. Findings offer new insight into simple potential methods of eliciting prosocial behavior in adolescents for whom such responding may be compromised and may provide a potential starting point for interventions.

Compassion Fatigue and Compassion Satisfaction: The Underlying Mechanisms Between Work-Related Violence Exposure and Turnover Intention in the Social Work Setting

ABSTRACT Work-related violence exposure has been identified as one of the risk factors for social workers’ turnover intention, but little is known about its underlying mechanisms. This study aims to distinguish compassion satisfaction and compassion fatigue from a dual perspective and investigate the mediating effects of these two co-existing constructs in the relationship between work-related violence exposure and turnover intention. A sample of 1023 Chinese social workers in H city, China (mean age = 36.24 years, SD = 7.11) is obtained by multistage cluster random sampling. Findings demonstrate that the relationship between work-related violence exposure and turnover intention is partially mediated by compassion satisfaction (b = 0.023, 95% CI [0.007, 0.045]) and compassion fatigue (b = 0.139, 95% CI [0.093, 0.187]). The present study clarifies two influencing paths between work-related violence exposure and turnover intention, adding knowledge to the social work profession. Practical implications for reducing turnover intention are suggested in the social work setting.

Individual and cumulative firearm violence exposure: Implications for sleep among Black and American Indian/Alaska Native adults

PurposeWe investigated the relationship between various forms of firearm violence exposure and sleep problems among nationally representative samples of Black (N = 3015) and American Indian and Alaska Native (AI/AN) (N = 527) adults, focusing on difficulties falling asleep, staying asleep, and waking too early. Survey data were collected in April and May 2023. MethodsWe employed negative binomial regression models to analyze the associations between the different types of firearm violence exposure and sleep problems. We further examined associations between cumulative firearm violence exposure and sleep outcomes. ResultsA substantial proportion of Black (59%) and AI/AN (56%) adults reported experiencing some form of firearm violence exposure. Being threatened with a firearm emerged as a consistent factor associated with sleep problems for both racial groups. Witnessing or hearing about shootings was linked to sleep problems in the Black sample, while cumulative firearm violence exposure was associated with all sleep problems in both groups. ConclusionsIndividual and cumulative firearm violence exposure is associated with increased sleep problems among Black and AI/AN adults.

Longitudinal associations between community violence exposure, posttraumatic stress symptoms, and eating disorder symptoms

BackgroundEating disorder (ED) symptoms have been associated with different types of traumatic events, such as exposure to sexual and physical violence, and emotional abuse. However, the relation between ED symptoms and community violence exposure (CVE) is underexplored, despite the latter’s adverse effects on many aspects of adolescent functioning. The primary aim of this study was to evaluate the relation between CVE and ED symptoms in adolescents, while also investigating the potential mediating and moderating roles of posttraumatic stress (PTS) symptoms, gender, and ethnicity.MethodsData were collected longitudinally over two consecutive years in the city of New Haven, CT, in the United States. Participants were 2612 adolescent students from the public school system (1397 girls and 1215 boys) with an average age of 12.8 years (SD = 1.29). The students were comprised of several different ethnic groups, including Caucasians, African Americans and Hispanic Americans. Associations between CVE (no exposure, witnessing, and victimization) and PTS symptoms at year one, and ED symptoms (thoughts and compensatory behaviors) at year two, were assessed with self-rating instruments. Moderation and mediation analyses were conducted using a variant of linear regression (Hayes PROCESS macro).ResultsED symptoms at year two were significantly associated with both witnessing and being a victim of community violence at year one, with most or all of the relations being explained by PTS symptoms. Overall, neither gender nor ethnicity had a meaningful moderating effect in the observed relations.ConclusionsThe findings support the notion that assessing and addressing PTS symptoms might be beneficial when treating individuals with ED symptoms who have experienced community violence, irrespective of gender or ethnicity.

Cumulative Stress Across the Life Course and Biological Aging in Adulthood.

Psychosocial stressors have been linked with accelerated biological aging in adults; however, few studies have examined stressors across the life course in relation to biological aging. In 359 individuals (57% White, 34% Black) from the Child Health and Development Studies Disparities study, economic (income, education, financial strain), social (parent-child relations, caretaker responsibilities) and traumatic (death of a sibling or child, violence exposure) stressors were assessed at multiple time points (birth and ages 9, 15, and 50 years). Experiences of major discrimination were assessed at age 50. Life period stress scores were then assessed as childhood (birth-age 15 years) and adulthood (age 50 years). At age 50 years, participants provided blood samples, and DNA methylation was assessed with the EPIC BeadChip. Epigenetic age was estimated using six epigenetic clocks (Horvath, Hannum, Skin and Blood age, PhenoAge, GrimAge, Dunedin Pace of Aging). Age acceleration was determined using residuals from regressing chronologic age on each of the epigenetic age metrics. Telomere length was assessed using the quantitative polymerase chain reaction-based methods. In linear regression models adjusted for race and gender, total life stress, and childhood and adult stress independently predicted accelerated aging based on GrimAge and faster pace of aging based on the DunedinPace. Associations were attenuated after adjusting for smoking status. In sex-stratified analyses, greater childhood stress was associated with accelerated epigenetic aging among women but not men. No associations were noted with telomere length. We found that cumulative stressors across the life course were associated with accelerated epigenetic age, with differences by sex (e.g., accelerated among women). Further research of this association in large and diverse samples is needed.

Associations between violent crime inside and outside, air temperature, urban heat island magnitude and urban green space

There are more incidents of violence in summer and on hot days, a trend likely to be exacerbated by climate change. Urban areas experience additional temperature modulation due to the urban form, however, to date, no studies have considered the effect of the urban heat island (UHI) or green space with respect to the temperature–violence relationship. This study modelled the relationship between the number of daily violent crime incidents that occurred inside or outside between July 2013 and June 2018, and the average surface UHI or percentage greencover (including grasses, shrubs and trees) within each local government area in Greater Sydney, Australia. Panelised negative binomial time series regression models indicated that the violent crime rate was associated with higher surface UHI for crimes committed outside (p = 0.006) but not inside (p = 0.072). Greater percentage of all vegetation was associated with significantly lower rates of violent crime committed outside (p = 0.011) but was not associated with violent crimes committed inside (p = 0.430). More socio-economic disadvantage was associated with higher rates of violent crime committed inside (p = 0.002) but not outside (p = 0.145). Greater temperature was non-linearly associated with higher rates of violent crime committed both inside and outside (p < 0.001). The findings of this study are important because both violence and heat exposure are critical health issues and will be stressed by urbanisation and climate change. The expansion of green space and/or reduction in UHI may mitigate these effects.