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Although peers are a major influence during adolescence, the relative importance of specific mechanisms of peer influence on the development of problem behavior is not well understood. This study investigated five domains of peer influence and their relationships to adolescents’ problem and prosocial behaviors. Self-report and teacher ratings were obtained for 1787 (53 % female) urban middle school students. Peer pressure for fighting and friends’ delinquent behavior were uniquely associated with aggression, drug use and delinquent behavior. Friends’ prosocial behavior was uniquely associated with prosocial behavior. Friends’ support for fighting and friends’ support for nonviolence were not as clearly related to behavior. Findings were generally consistent across gender. This study highlights the importance of studying multiple aspects of peer influences on adolescents’ behavior.

This study investigated reciprocal relations between adolescents' physical aggression and their perceptions of peers' deviant behaviors and attitudes. Analyses were conducted on four waves of data from 2,290 adolescents (ages 10–16) from three urban middle schools. Autoregression models revealed reciprocal relations between peer factors (i.e., friends' problem behavior, peer pressure for fighting, friends' support for fighting) and adolescents' reporting of their aggressive behavior. Bidirectional relations were also found between peer pressure for fighting and adolescents' frequency of physical aggression based on teacher ratings. Findings were consistent across sex, grade, and time. Findings suggest that multiple dimensions of peers' behaviors uniquely play a role in the development of adolescents' aggression and have important implications for interventions to reduce problem behaviors.

BackgroundPancreatic cancer care is complex, and multiple disparities in receipt of therapies have been documented. The authors aimed to conduct a systematic review of the literature to critically assess and summarize disparities in access to oncologic therapies for pancreatic cancer.MethodsA search of PubMed, Scopus, Web of Science, and Cochrane databases were performed for studies reporting disparities in access to oncologic care for pancreatic cancer. Primary research articles published in the United States from 2000 to 2020 were included. Data were independently extracted, and risk of bias was assessed using the modified Newcastle-Ottawa scale.ResultsThe inclusion criteria were met by 47 studies. All the studies used retrospective data, with 70 % involving national database studies, 41 assessing the impact of race/ethnicity, 22 assessing the impact of socioeconomic status, 18 assessing the impact of insurance status, 23 assessing the impact of gender, 26 assessing the impact of age, and 3 assessing the impact of location on the delivery of cancer-directed therapies. Race, socioeconomic status, insurance status, gender, and age- based disparities in receipt of surgical resection, treatment at high-volume facilities and multimodal therapy for resectable pancreatic cancer, receipt of systemic chemotherapy for metastatic cancer, and receipt of expected standard-of-care treatment are reported.ConclusionSignificant sociodemographic disparities in access to equitable oncologic care exist along the continuum of pancreatic cancer care. Multiple patient, provider, and systemic factors contribute to these disparities. The ongoing study of these disparities is important to elucidate processes that may be targeted to improve access to equitable oncologic care for patients with pancreatic cancer.

Few studies in India have conducted research on cyberbullying, and the existing studies lack information about psychometric properties of cyberbullying measures. To address this gap in the literature, the current study evaluated the psychometric properties of a behavioral assessment of cyberbullying perpetration and victimization from the Problem Behavior Frequency Scales—Adolescent Revised among Indian youth. Parallel samples were recruited from the New Delhi area (N = 178; Mage = 12.47; 57.1% male) and the U.S. (N = 307; Mage = 11.79; 51.9% male). A confirmatory factor analysis indicated that a one-factor solution for both scales had good fit with the data, similar to the original validation of the scale. We found measurement equivalence for cyberbullying perpetration across demographic subgroups in India—gender, age, religion, free- or reduced-price lunch, geographic location, and type of school. Measurement equivalence was found for cyberbullying victimization across subgroups in India, except for free- or reduced-price lunch status. Invariance testing across countries resulted in strong invariance for cyberbullying perpetration (e.g., same structure, factor loadings, and intercepts). Invariance testing across countries for cyberbullying victimization was weak (e.g., same structure and factor loadings), suggesting caution against cross-cultural comparisons when using the cyberbullying victimization measure. The results build capacity for cyberbullying research in India so that risk and protective factors can be measured with validated cyberbullying scales to identify ways to reduce cyberbullying.

Objectives. To examine social-ecological correlates of firearm-related violence involvement among adults. Methods. Cross-sectional surveys were collected in the United States between August 2023 and September 2023 through an AmeriSpeak Panel (n = 1681), weighted to be nationally representative. Measures included self-reported involvement in firearm-related violence victimization and perpetration and hypothesized social-ecological risk factors. Results. About 5.9% reported ever perpetrating firearm-related violence; 6.9% reported experiencing firearm-related victimization. In a fully adjusted model, factors associated with perpetration were greater traumatic stress symptoms, beliefs about gun use to enforce respect, positive attitudes about firearms, and firearm-related victimization. Factors associated with victimization were adverse childhood experiences, family and friends’ histories of violence and suicide, traumatic stress symptoms, witnessing community violence, firearm-related perpetration, male sex, and lower income. Conclusions. A range of factors across social-ecological domains were associated with firearm-related violence, emphasizing the need for a contextualized approach to understand firearm-related injuries and deaths. Posttraumatic stress and exposure to violence may be particularly important to understanding the cycle of firearm violence. Intervention strategies should be expanded to include individuals vicariously exposed to violence, not just those directly victimized. ( Am J Public Health. 2025;115(11):1903–1912. https://doi.org/10.2105/AJPH.2025.308213 )

Background Suicide rates among U.S. preteens (ages 8–12) have risen steadily since 2008, signaling a growing crisis in children’s mental health. Sexual and gender diverse (SGD) preteens are at especially high risk, with recent findings showing 4–6 times higher risk of suicidal thoughts and behaviors among sexual minority preteens and up to 14-fold higher risk among transgender preteens. Despite these alarming disparities, SGD preteens are often excluded from suicide research due to ethical, legal, and methodological barriers. There is a pressing need for expert-informed best practices to safely and ethically include this population in research. Methods We conducted a three-step Delphi process to develop expert-informed guidelines for ethically and effectively engaging SGD preteens at elevated risk in suicide research. The process was shaped by input from youth and adult community advisory boards and included 20 expert panelists across five overlapping roles: researchers, clinicians, legal/regulatory professionals, bioethicists, and community leaders. Experts completed a first-round survey, a structured virtual consensus meeting, and a second-round survey. Results Consensus was reached across multiple domains including developmentally appropriate criteria for SGD identity classification in research as well as criteria for classifying heightened suicide risk in preteens. Experts agreed that SGD identity alone should not be used as a proxy for risk nor should any preteens be excluded from research based on clinical severity of symptoms. Experts highlighted feasible sampling methods including convenience and purposive sampling and recruitment and retention strategies aimed at both youth and caregivers. Experts agreed on study safeguards such as provision of mental health resource lists and parental notification if structured risk thresholds were exceeded during research. There was full agreement on the importance of IRB review by individuals with child mental health and SGD expertise, although experts did not achieve consensus on the feasibility of implementing any IRB reforms. Conclusions This multi-phase Delphi study produced expert-endorsed recommendations for safely, ethnically, and effectively including SGD preteens at elevated suicide risk in research. These guidelines provide a foundation for inclusive, community-engaged suicide research with vulnerable youth. Clinical trial number Not applicable.

Rates of victimization and bullying perpetration may vary by adolescents’ health status. The purpose of this study was to examine risk for bullying and victimization while considering multiple health conditions and health-related behaviors. Self-reported data were collected from 64,670 youth (50.3% female; 48.8% White; 25.7% Black/African American) enrolled at 107 middle and high schools across the state of Maryland. Two-level logistic regressions examined the association between health conditions and other health-related behaviors (i.e., physical activity, asthma, healthy eating, sleep troubles, obesity, and being overweight) and bullying. Results indicated that obese youth had higher odds of being a victim or bully-victim. Youth with asthma were more likely to be victimized, both in-person and online, and were more likely to be cyberbully-victims. Sleep difficulties were consistently associated with involvement in bullying, having higher odds of being a victim or bully-victim in-person and online as well as higher odds of perpetration of bullying. In contrast, healthy food consumption was associated with significantly lower odds of bullying perpetration, and physical activity was associated with significantly lower odds of being a bully-victim. Taken together, the findings suggest that various conditions and health-related behaviors may be important risk factors for both bullying victimization and perpetration.

The purposes of the present study were to: (1) describe rates of peer victimization in young adolescents with attention-deficit/hyperactivity disorder, (2) evaluate the association between types of peer victimization (i.e., physical, relational, and reputational) and internalizing problems (i.e., anxiety, depression, and self-esteem), and (3) examine whether associations between victimization and internalizing problems differ for males or females. Participants were 131 middle-school students (ages 11–15 years, 73 % male, 76 % White) diagnosed with ADHD who completed ratings of victimization, anxiety, depression, and self-esteem. Over half of the participants (57 %) reported experiencing at least one victimization behavior at a rate of once per week or more, with higher rates of relational victimization (51 %) than reputational victimization (17 %) or physical victimization (14 %). Males reported experiencing more physical victimization than females, but males and females did not differ in rates of relational or reputational victimization. Whereas relational and physical victimization were both uniquely associated with greater anxiety for both males and females, relational victimization was associated with greater depressive symptoms and lower self-esteem for males but not females. These findings indicate that young adolescents with ADHD frequently experience peer victimization and that the association between victimization and internalizing problems among young adolescents with ADHD differs as a result of victimization type, internalizing domain, and sex.

BackgroundSocioeconomic- and demographic-based disparities exist in the treatment of pancreatic adenocarcinoma (PDAC). Medicaid expansion (ME) may have an impact on these disparities. Analyses of patients with PDAC from the National Cancer Database (NCDB) were performed to examine the impact of ME on access to treatment and outcomes.MethodsPatients with non-metastatic PDAC diagnosed between 2006 and 2016 were identified. Multiple logistic regression analyses were performed to evaluate factors associated with curative-intent surgical resection, multimodal therapy, treatment at a high-volume facility (HVF), and survival.ResultsThe study identified 41,876 patients who met the criteria. Medicaid expansion was independently associated with curative-intent resection (odds ratio [OR] 1.54; 95 % confidence interval [CI] 1.43–1.67; p < 0.001). In a multivariable analysis, ME was independently associated with multimodal therapy (OR 1.60; 95 % CI 1.44–1.76; p < 0.001) and treatment at an HVF (OR 1.57; 95 % CI 1.42–1.74; p < 0.001). Medicaid expansion was independently associated with improved 30-day mortality (OR 0.49; 95 % CI 0.34–0.79) and 90-day mortality (OR 0.48 95 % CI 0.35–0.59). Cox regression analysis demonstrated that after adjustment for other variables, ME status was associated with improved overall survival (hazard ratio [HR], 0.82; 95 % CI 0.73–0.90; p < 0.001).ConclusionsMedicaid expansion is associated with increased use of care processes that improve outcomes in PDAC, operative outcomes, and overall survival. The study data suggest that ME has helped to improve disparities in PDAC in ME states.

Background Pancreatic adenocarcinoma (PDAC) is an aggressive malignancy associated with poor outcomes. Surgical resection and receipt of multimodal therapy have been shown to improve outcomes in patients with potentially resectable PDAC; however treatment and outcome disparities persist on many fronts. The aim of this study was to analyze the relationship between rural residence and receipt of quality cancer care in patients diagnosed with non-metastatic PDAC. Methods Using the National Cancer Database, patients with non-metastatic pancreatic cancer were identified from 2006–2016. Patients were classified as living in metropolitan, urban, or rural areas. Multivariable logistic regression was used to identify predictors of cancer treatment and survival. Results A total of 41,786 patients were identified: 81.6% metropolitan, 16.2% urban, and 2.2% rural. Rural residing patients were less likely to receive curative-intent surgery ( p  = 0.037) and multimodal therapy ( p  < 0.001) compared to their metropolitan and urban counterparts. On logistic regression analysis, rural residence was independently associated with decreased surgical resection [OR 0.82; CI 95% 0.69–0.99; p  = 0.039] and multimodal therapy [OR 0.70; CI 95% 0.38–0.97; p  = 0.047]. Rural residence independently predicted decreased overall survival [OR 1.64; CI 95% 1.45–1.93; p  < 0.001] for all patients that were analyzed. In the cohort of patients who underwent surgical resection, rural residence did not independently predict overall survival [OR 0.97; CI 95% 0.85–1.11; p  = 0.652]. Conclusions Rural residence impacts receipt of optimal cancer care in patients with non-metastatic PDAC but does not predict overall survival in patients who receive curative-intent treatment.