This general population survey study evaluates the association between past 12-month exposure to police violence and concurrent mental health symptoms among urban residents in 2 US cities.

Background As most health professions in the United States have adopted clinical or practice doctorates, there has been an ongoing debate on whether physician assistants (PAs) should transition from a master’s to a doctorate as the terminal degree. The authors examined perceived risks, benefits and impact of transitioning to an entry-level PA doctoral degree. Methods A multi-prong, mixed-methods approach was used that included a literature review and collecting quantitative and qualitative data using a survey and interviews. Bivariate analysis and binomial logistic regression were performed to evaluate relationships between perceptions/perspectives on an entry-level PA doctoral degree and the anticipated impact of it causing more harm than good to the PA profession. Deductive content analysis was used to analyze the qualitative data. Results Of 636 PA clinicians and students (46% response rate), 457 (72%) disagreed that an entry-level PA doctoral degree should be required. More than half of the respondents (54%) agreed that it should be offered but not required and 380 respondents (60%) agreed that an entry-level doctoral degree would cause more harm than good. Race, educational attainment, occupation, and length of practice as a PA were significantly associated with having a perception of causing more harm. There was strong positive association between the perception of a doctoral degree causing more harm with expectations of having a negative impact on the availability of clinical training sites (OR = 4.39, p < .05). The most commonly cited benefits were parity with other professions and competitive advantage, whereas the perceived risks were increased cost for education, decreased diversity in the profession, and negative impact on the PA/physician relationship. Conclusions The major takeaway of our study was that perceived benefits and risks are strongly influenced by the lens of the stakeholder. While the majority of PAs and students appear to be not in favor mainly due to the potential harm, the proportion of those in favor is not insignificant and their views should not be ignored. Addressing concerns with key stakeholders could help the PA profession to transition to a doctoral degree with minimal adverse impact.

Social defeat has been proposed as the common mechanism underlying several well-replicated risk factors for sub-threshold psychotic experiences (PEs) identified in epidemiological research. Victimization by the police may likewise be socially defeating among vulnerable individuals and, therefore, may be associated with elevated risk for PEs. However, no prior studies have examined the relation between police victimization and PEs. We tested the hypothesis that exposure to police victimization (ie, physical, sexual, psychological, and neglect) would be associated with increased odds for PEs in the Survey of Police-Public Encounters data (N = 1615), a general population sample of adults from 4 US cities. Respondents who reported each type of police victimization were more likely to report PEs in logistic regression analyses (all P < .01), most of which were significant even when adjusting for demographic variables, psychological distress, and self-reported crime involvement (adjusted OR range: 1.30 to 7.16). Furthermore, the prevalence of PEs increased with greater exposure to police victimization in a linear dose-response relation, OR (95% CI) = 1.44 (1.24-1.66). These findings suggest that police victimization is a clinically important and previously unreported risk factor for PEs in the urban US population. These findings support the need for community-based outreach efforts and greater police training to reduce the prevalence of this exposure, particularly in socially disadvantaged urban communities.

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Background In adolescence, internalizing (e.g., anxious, depressive, and withdrawn) and externalizing (e.g., aggressive, oppositional, delinquent, and hyper-active) symptoms are related with alcohol use. However, the directionality among internalizing symptoms, externalizing symptoms, and alcohol use during adolescence is equivocal. Moreover, gender differences and similarities among these behaviors are not definitive in existing literature. Objectives This study examined longitudinal relationships between internalizing and externalizing symptoms and past-month alcohol use among adolescent boys and girls. Methods Using longitudinal survey data from a study of community-dwelling adolescents (n = 724), we estimated cross-lagged structural equation models to test relations between internalizing and externalizing symptoms (as measured by the Youth Self Report, YSR [Achenbach, 1991]) and self-report alcohol use in the past month among adolescents. Gender differences were tested in a multiple group structural equation model. Results Alcohol use at age 12 was a predictor of internalizing and externalizing symptoms at age 15 for both boys and girls. With regard to gender differences, girls demonstrated an association between internalizing symptoms and drinking at age 12, whereas boys showed a stronger association between externalizing symptoms and drinking at age 18. Conclusions/Importance Early alcohol use is problematic for youth, and results of this study lend support to prevention programs for youth. Preventing or curbing early drinking may offset later externalizing and internalizing symptoms, as well as ongoing alcohol use, regardless of gender.

Background: As most health professions in the United States have adopted clinical or practice doctorates, there has been an ongoing debate on whether physician assistants (PAs) should transition from a master’s to a doctorate as the terminal degree. The authors examined perceived risks, benefits and impact of transitioning to an entry-level PA doctoral degree. Methods: A multi-prong, mixed-methods approach was used that included a literature review and collecting quantitative and qualitative data. Bivariate analysis and binomial logistic regression analysis were performed to evaluate relationships between perceptions/perspectives on an entry-level PA doctoral degree and the anticipated impact of it causing more harm than good to the PA profession. For the semi-structured interviews (38 interprofessional stakeholders), deductive content analysis was used to analyze the qualitative data. Results: Six hundred and thirty six PA clinicians and PA students (46%) completed the survey. Most respondents (n = 457, 72%) disagreed that an entry-level PA doctoral degree should be required. More than half of the respondents (n = 341, 54%) agreed that it should be offered but not required and 380 respondents (60%) agreed that an entry-level doctoral degree would cause more harm than good. Race, educational attainment, occupation, and length of practice as a PA were significantly associated with having a perception of causing more harm. There was strong positive association between the perception of a doctoral degree causing more harm with expectations of having a negative impact on the availability of clinical training sites (OR = 4.39, p <.05). Based on the analysis of qualitative data, the most commonly cited perceived risks were increased cost for education, decreased diversity in the profession, and negative impact on the PA/physician relationship. Conclusions: The perceived benefits and risks of an entry-level PA doctoral degree are strongly influenced by the lens of the stakeholder. While the majority of PAs and students appear to be not in favor, the proportion of those in favor is not insignificant and their views should not be ignored in future discussions. Addressing concerns with key stakeholders could help the PA profession to transition to a doctoral degree with minimal adverse impact.

BackgroundPhysician assistant/associates (PAs) are healthcare professionals whose roles expand universal access across many nations. PAs fill medical provider supply and demand gaps. Our paper reports a forecasting project to predict the likely census of PAs in the medical workforce spanning from 2020 to 2035. Methods Microsimulation modelling of theAmerican PA workforce was performed using the number of clinically active PAs employed in 2020 as the baseline. Graduation rates and PA programme expansion were parameters used to predict annual growth; attrition estimates balanced the equation. Two models, one based on data from the US Bureau of Labor Statistics (BLS) and another based on National Commission on Certification of Physician Assistants (NCCPA) data were used to estimate future annual PA census numbers. Results Asof 2020, the BLS estimated 125,280 PAs were in the medical workforce; the NCCPA estimate was 148,560 PAs in active practice. The BLS model predicted approximately 204,243 clinically active PAs by 2035; the NCCPA-based model predicted 214,248 PAs in clinical practice. Conclusions A PA predictive model based on four data sources projects that the 2035 census of clinically active PAs to be between 204,000 and 214,000: a growth rate of approximately 35%.

Resilience has been found to attenuate the effects of negative mental health symptomology associated with interpersonal victimization; however, existing research has largely focused on resilience traits, such as individual cognitive and environmental factors that promote resilience. In addition, empirical knowledge on the extent to which resilience mitigates suicidal symptomology associated with interpersonal violence victimization is particularly limited. This study assesses whether the relationship between interpersonal violence (i.e., IPV and nonpartner sexual violence) and mental health symptomology (i.e., depression, psychological distress, and suicidal ideation) is moderated by resilience using a general population sample of women ( N = 932). A cross-sectional, observational survey was administered in four U.S. cities (Baltimore, New York City, Philadelphia, and Washington, D.C.). Bivariate results indicated that women exposed to interpersonal violence reported significantly higher rates of suicidal ideation, depression, and psychological distress compared with women without exposure to interpersonal violence. Regression models revealed significant positive associations between interpersonal violence and depression, distress, and suicidal ideation, adjusting for sociodemographics. Resilience did not significantly moderate the relationship between interpersonal violence victimization and any associated mental health outcomes. However, subgroup analyses reveal significant interaction effects between resilience and IPV within specific racial and ethnic minority subgroups, suggesting that attenuating effects of resilience on mental health symptoms (i.e., depression and psychological distress) associated with IPV likely vary across race and ethnicity. Implications for future research and clinical interventions focused on resilience among survivors of interpersonal violence are discussed.