Risk factors for community violence exposure in adolescence

Exploring bereavement processes among BLACK adolescent male CO-VICTIMS of homicide

Black adolescent males are disproportionally impacted by violence exposure and violent loss. The primary aim of this study was to explore the bereavement experiences of Black adolescent males who have lost a friend or family member to murder. Participants were Black adolescent males between the ages of 14-19 years. This was a purposive sample recruited from a community-based study that took place in urban neighborhoods in Pittsburgh, Pennsylvania. Participants who completed their final survey for the parent study were recruited from January to June 2017. Participants completed a brief computerized survey and those who responded affirmatively to a screening question about losing a friend or family member to murder were invited to a qualitative interview. Interviews were audio recorded, transcribed, and coded to identify key themes. Among the 31 youth interviewed, 30 had lost more than one person to murder. Four primary themes emerged from their narratives: (1) self-preservation through isolation, (2) finding sanctuary through shared narratives of loss, (3) freedom from the mind, and (4) post-traumatic growth (i.e., motivation, healing, resilience). Findings suggest that interventions that provide sanctuary for youth that are culturally relevant and create opportunities for youth to process violent loss may aid in promoting opportunities for youth to grieve and heal from violent loss.

Exposure to Recurring Community Violence Scale: A validity and reliability study in Turkey

Recent years have witnessed a substantial increase in the interest in violence occurring at home or school, as well as in neighborhoods. Yet, there is no standardized instrument to measure community violence in Turkey. Thus, the present study aimed to adapt the Exposure to Recurring Community Violence Scale into Turkish and explore its psychometric properties. The sample consisted of 210 participants (57% were females) between 18 and 64 years (Mage = 38.33, SD = 10.67). For criterion-related validity, we evaluated the participants' scores on the Brief Symptom Inventory (BSI), the Traumatic Life Events Form, the Relationship Quality Scale, and a Demographic Information Form. We performed all statistical analyses using the FACTOR and SPSS v.20 programs. Exploratory factor analysis revealed a 2-factor structure for the scale (victimization and witnessing), explaining 52% of the total variance. As expected, the witnessing and victimization scores were correlated with the subscales of the BSI, the number of traumatic life events, and the subscales of The Relationship Quality Scale. For reliability concerns, we calculated Cronbach's α coefficients to be 0.79 for the victimization and 0.90 for the witnessing. Besides, the findings revealed acceptable psychometric properties for the Turkish version of the Exposure to Recurring Community Violence Scale. Thereby, we concluded that the scale can be used as a reliable and valid measure in the Turkish context. Overall, the scale will likely allow further research to scrutinize the risk factors and consequences of community violence.

Profiles of Community Violence Exposure, Moral Disengagement, and Bullying Perpetration: Evidence from a Sample of Italian Adolescents

According to the Pathologic Adaptation Model of community violence exposure, repeated experiences of violence within the community lead youth to accept violence as a normative and legitimate strategy to cope with conflict, thus increasing their involvement in aggressive behaviors. This hypothesis has been under-investigated with reference to bullying at school. Using a person-centered analytical approach (latent profile analysis), this study examines the mediating role of moral disengagement as a type of normalizing cognition about violence, in the relationship between profiles of community violence exposure and perpetration of bullying. Eight hundred and two adolescents (11-18 years; 43.4% girls) from two different urban and societal contexts in Italy (Milan vs. Naples) participated in the study. Four profiles of exposure to community violence emerged. Context site and age influenced belonging to the four profiles. Being moderately exposed to violence, both as a victim and as a witness, was significantly associated with higher levels of moral disengagement and bullying perpetration. Being exposed as a witness and as a victim, and being exposed only as a witness were associated with bullying perpetration via the increase of moral disengagement. These findings support the Pathologic Adaptation Model and indicate that adolescents who experience higher levels of community violence, as a witness or both as a witness and a victim, are more likely to develop morally disengaged beliefs about violence, which in turn would increase the likelihood to perpetrate bullying. Results are also discussed in the context of social diversity.

Individual Differences in Patterns of Community Violence Exposure and Internalizing and Externalizing Behaviors

Youth community violence has been linked with depressive and anxious symptoms, and aggressive behavior; however, little research has examined different combinations of emotional and behavioral adjustment among community-violence-exposed youth, or individual characteristics that may account for different patterns of emotional and behavioral adjustment in community-violence-exposed youth. This research used person-centered methods to examine how gender, temperament characteristics, and prior exposure to community violence were linked with classes of community violence exposure and internalizing and externalizing adjustment among a sample of urban African American youth. Participants were 464 African American adolescents (46.7% female; mean age = 14.83, SD = .43) who reported their community violence exposure in Grade 9 and for whom reports of depressive and anxious symptoms, and aggressive behavior were available. Latent class analysis identified four classes of adolescents distinguished by their exposure to community violence exposure and internalizing and externalizing behavior. The two classes with high community violence exposure were characterized by internalizing symptoms or aggressive behavior; the two classes with low community violence exposure had low internalizing symptoms with moderate aggression or had all moderate symptoms. These community violence adjustment classes were distinguished by gender, history of community violence exposure, behavioral inhibition, and fight-flight-freeze systems. Findings highlight heterogeneity in internalizing and externalizing responses of community-violence-exposed youth and suggest factors that explain community violence exposure, repeat exposure, and responses to community violence exposure.

Community Violence Exposure and Externalizing Problem Behavior Among Chinese High School Students: The Moderating Role of Parental Knowledge

Adolescents' community violence exposure (CVE) has been demonstrated with a range of behavioral and psychological problems, but the processes that explain these correlations are not clear. In our 2017 study, the mediating role of deviant peer affiliation in the relationship between CVE and externalizing problem behaviors has been confirmed. However, the moderating effect of parental factors is still unclear. Therefore, a new group (high school group) was adopted in this study to further explore the moderating effect of parental knowledge based on also confirming the mediating effect of deviant peer affiliation. Stratified-cluster sampling was used to recruit 1,797 volunteers who completed questionnaires on CVE, deviant peer affiliation, parental knowledge, and externalizing problem behaviors. The results of the structural equation modeling were: on the basis of our previous research, we further analyzed the mediating role of deviant peer affiliation, and the mediated association was moderated by parental knowledge. Especially when the school climate is added as a covariate, the moderating effect of parental knowledge has changed, that is, the positive association between CVE and externalizing problem behaviors was much stronger for adolescents who reported lower levels of parental knowledge than for those who reported higher levels of parental knowledge. The results support the assumptions of social learning theory and have implications for interventions of community violence.

The Role of Depressive Symptoms in Substance Use Among African American Boys Exposed to Community Violence

Adolescents exposed to community violence (CV) are at increased risk for alcohol, marijuana, and tobacco use. The disproportionate exposure to CV among African American boys heightens their susceptibility to substance use and related problems. Depressive symptoms are linked to both CV exposure and adolescent substance use; however, their role in the link between CV exposure and substance use in African American male adolescents has received little attention. The current study examined whether depressive symptoms mediate or moderate the associations between CV exposure and substance use among African American male adolescents. Participants were 225 African American adolescent boys in Baltimore, Maryland who completed measures of CV exposure and depressive symptoms in 10th grade and measures of substance use in 10th and 11th grades. Hierarchal linear regression analyses indicated that depressive symptoms moderated associations between violent victimization and alcohol and tobacco use, R² = .21-.30, ps < .001. There was a positive association between CV victimization and alcohol and tobacco use among those who reported high levels of depressive symptoms but not low levels. Depressive symptoms also moderated the link between witnessing CV and alcohol use such that witnessing CV was negatively related to alcohol use among those who reported high levels of depressive symptoms only. The findings suggest that depressive symptoms may play an important role in differentiating alcohol and tobacco use outcomes in CV-exposed African American boys. Prevention efforts should assess for depressive symptoms to identify adolescent boys with the highest risk of substance use.

Caregiver and family factors promoting child resilience in at-risk families living in Lima, Peru

BACKGROUND

Child victimization is one of the most serious, preventable threats to child health and wellbeing around the world. Contemporary research has demonstrated that polyvictimization, or children's experience of multiple types of victimization, is particularly detrimental.

OBJECTIVE

The current study aims to evaluate relationships between child victimization and child resilience with a particular focus on caregiver and family promotive factors.

PARTICIPANTS AND SETTING

Participants included N = 385 caregiver-child dyads from a high-risk neighborhood in San Juan de Lurigancho district in Lima, Peru.

METHODS

Data were collected in the context of a representative survey of houses in the neighborhood; an index child (ages 4-17) was randomly selected for each household and caregivers provided reports on core study constructs.

RESULTS

Child victimization (β = .35, p < .001) and harsh punishment (β = .17, p < .001) were associated with higher levels of child adjustment problems. Caregiver depression was associated with both higher adjustment problems (β = .22, p < .001) and higher prosocial skills (β = .14, p = .003). Caregiver resilience was associated with lower adjustment problems (β = -.15, p = .01) and higher prosocial skills (β = .14, p = .04). Positive parenting was associated with lower adjustment problems (β = -.15, p < .001) and higher prosocial skills (β = .20, p < .001). Family cohesion (β = .23, p = .001) was positively associated only with children's prosocial skills.

CONCLUSIONS

Findings suggest that caregiver resilience and positive parenting are consistent promotive factors for child resilience across indicators, including both adjustment problems and prosocial skills. These promotive factors may therefore be promising potential targets address in the context of interventions aimed at promoting child resilience.

Polyvictimization and Recurrent Falling in Older Ecuadorian Adults: The Mediation Role of Depressive Symptoms

Objective: To assess depressive symptoms as a mediator in the association between polyvictimization and recurrent falling. Methods: Using data from the Salud, Bienestar y Envejecimiento (Health, Well-being, and Aging) Ecuador Study, we analyzed community-dwelling adults 60 years and older (n = 5227). Recurrent falling was determined as ≥2 falls during the prior 12 months. Polyvictimization was determined as a history of ≥2 types of abuse. The mediator was depressive symptoms. Mediation analyses were based on the VanderWeele method. Results: Polyvictimization was significantly associated with higher odds of recurrent falling, and odds ratio (OR) = 1.45 (95% confidence intervals [CI] 1.20-1.76). Higher depressive symptoms increase the odds for recurrent falling (OR = 1.09 and 95% CI 1.07-1.11). Moreover, depressive symptoms were a significant mediator between polyvictimization and recurrent falling. The mediating effect was 28.4%. Discussion: Polyvictimization was associated with higher odds of recurrent falling, and this association was mediated by depressive symptoms.

Hopelessness and Delinquent Behavior as Predictors of Community Violence Exposure in Ethnic Minority Male Adolescent Offenders

Justice-involved boys from urban communities are disproportionately impacted by community violence exposure (ECV) and despite decades of research, rates of ECV in youth continue to increase particularly for youth involved in the juvenile justice system. Despite the increased risk of exposure, the majority of research focuses on what may protect youth from the deleterious outcomes associated with violence exposure, rather than strategies that may prevent the violence exposure from occurring. The current study seeks to shift the focus of research in this area to examining factors that may predict future violence exposure. Specifically, the purpose of the current study is to examine the role of hopelessness as a predictor of the risk for violence exposure in a sample of 831 justice-involved, urban boys ages 14-18 (52.2% African American, 42.1% Hispanic, 5.7% other). Results revealed that baseline levels of low aspirations and hopelessness towards the future indirectly predicted violence exposure 1 year later through engagement in delinquent behavior. Clinical implications for targeting youth with elevated risk and preventing future violence exposure are discussed.

The Association Between Social Support, Violence, and Social Service Needs Among a Select Sample of Urban Adults in Baltimore City

Experiencing violence has been associated with negative health outcomes. The objectives of this study were to determine whether experiencing violence is associated increased support service needs and suboptimal general health indicators. In addition, we explore the relationship between these and perceived social support among a select sample of urban predominantly male adults in Baltimore City. A cross-sectional survey was conducted among 187 adults being seen in one of seven urban partner agencies participating in a parent HIV prevention and treatment demonstration project. Associations were examined using a multivariable logistic regression model, adjusting for the clinic site at which the client was being seen as well as age and gender identity. There was a significant amount of violence experienced by this population; 131 (72%) reported having seen someone be physically assaulted, and 89 (49%) had been physically assaulted without a weapon. Direct victimization from violence was associated with a threefold increased odds of needing housing and mental health/substance use services. Exposure to violence was associated with a threefold increase in needing housing and mental health/substance use services, and with sub-optimal health status. Perceived social support was associated with 30% decreased reports of experiencing violence. In conclusion, our select sample of urban adults report having experienced high rates of violence, and this is associated with increased support service needs as well as suboptimal perceived health status. Incorporating care for the effects of experiencing violence as well as social service needs are important in optimizing the health of urban populations.

Psychometric properties of the Community Violence-Prevention Activation Measure (CV-PAM): Evaluating provider activation toward community violence prevention

This study reports on the conceptualization of activation, and the development and psychometrics of the Community Violence-Prevention Activation Measure (CV-PAM). The CV-PAM was adapted from the Patient Activation Measure (PAM; Hibbard et al., 2004, Health Serv Res, 39, 1005-1026; Hibbard et al., 2005, Health Serv Res, 40, 1918-1930) for use among a workforce servicing youth exposed to community violence. Activation toward community violence prevention is defined as a process in which community members are activated to prevent violence, believe they have important roles to play in violence prevention and supporting the well-being of community members. Activated community members have a good understanding of the factors that contribute to violence and they apply skills and strategies that are consistent with prevention efforts. Six hundred and ninety-four youth providers completed the 18-item CV-PAM to describe their level of activation toward community violence. Exploratory and confirmatory factor analyses were performed and demonstrated that a three factor versus a four factor structure of activation (modeled after PAM) held together. The three factors included (a) belief that an active role is important to address community violence; (b) having the confidence and knowledge to take action around community violence prevention; (c) taking action: frequency of participation and responsiveness to community needs. The proposed fourth factor, staying the course under stress, did not have any qualifying loadings, and thus, could not be interpreted. CV-PAM performed well in tests of reliability and validity. The CV-PAM appears to be a precise, valid, reliable, and useful measure. Implications suggest that using this tool is potentially the first step toward understanding activation among engaged providers and a stepping stone toward increased involvement in community violence prevention through implementation and dissemination efforts.

The Influence of Internalizing Symptoms and Emotion Dysregulation on the Association Between Witnessed Community Violence and Aggression Among Urban Adolescents

The current cross-sectional study examined whether internalizing (i.e. anxiety and depressive) symptoms and/or emotion dysregulation moderated the association between witnessed community violence and aggressive behavior. Participants were 180 predominantly African American adolescents (62% girls; M age = 15.87 years, SD = 1.19 years) from a high school located in an urban community in the United States. Approximately 95% of adolescents reported having witnessed at least one violent act during their lifetimes, with many endorsing repeated exposure to severe acts of community violence. Results indicated that emotion dysregulation exacerbated the association between witnessed community violence and aggression. A quadratic effect of anxiety symptoms also moderated this association, such that witnessed community violence was linked to aggression at low and high, but not moderate, levels of anxiety symptoms. In contrast, a quadratic effect of depressive symptoms was uniquely related to aggression, regardless of witnessed community violence. Directions for future research and implications for practice are reviewed.

Exposure to Community Violence, Affiliations With Risk-Taking Peer Groups, and Internet Gaming Disorder Among Chinese Adolescents: The Moderating Role of Parental Monitoring

Among adolescents, exposure to community violence (ECV) has been consistently linked to problem behaviors such as Internet gaming disorder (IGD). However, the associated risk and protective factors have not been adequately explored in past studies. Therefore, in accordance with the risk-buffering model and social development model, this study aimed to test whether parental monitoring moderated the relationship between ECV and IGD among adolescents, and whether this moderating effect was mediated by affiliations with risk-taking peer groups. A sample of 2,423 Chinese middle-school students anonymously responded to questionnaires that assessed ECV, IGD, affiliations with risk-taking peer groups, and parental monitoring. The results of structural equation modeling revealed that the interaction between ECV and parental monitoring negatively related to IGD among adolescents. Specifically, the positive relationship between ECV and IGD was stronger for adolescents, who reported low levels of parental monitoring than for those who reported high levels of parental monitoring. Moreover, this moderating effect was mediated by affiliations with risk-taking peer groups. These results suggest that parental monitoring is an important protective factor that can mitigate the risk of IGD among adolescents who have been exposed to community violence. Accordingly, these findings serve as an empirical base upon which prevention and intervention strategies that are aimed at mitigating the risk of IGD among adolescents can be developed.

HIV risk and the association with accessibility coverage to medical facilities and socioeconomic status among heroin users in Kaohsiung, Taiwan (2011-2015): A GIS approach

Illegal drug use has caused considerable health and social costs. Access to medical treatment has been one of the most cost-effective interventions to reduce problematic drug use. Accessibility to treatment, which can be analyzed by the spatial approach such as geographic information system (GIS), has thus been utilized as a measure of the proportion of population that reaches appropriate health services. In this study, the association of accessibility coverage to medical facilities and socioeconomic status with human immunodeficiency virus (HIV) risk for heroin users was evaluated by GIS analysis in Kaohsiung, Taiwan. Data of 7890 heroin users were collected from 2011 to 2015 and categorized into five risk groups according to their income and distance to treatment settings. The results of this GIS-based analysis show that the areas with over 50% accessibility coverage rate had less amounts of HIV cases with statistical significance. Inconvenient access to medical facilities could result in poor treatment outcomes such as higher HIV incidences. Therefore, in order to effectively reduce HIV incidences among the heroin users, the accessibility coverage and locations of medical treatment facilities should meet the needs of drug users. It is also advised that the formulation of policies associated with illegal drug use problems should be evidence-based and geographical indicators could serve for this purpose from either prevention or intervention perspective.

Polyvictimization, Related Symptoms, and Familial and Neighborhood Contexts as Longitudinal Mediators of Racial/Ethnic Disparities in Violence Exposure Across Adolescence

African American and Hispanic adolescent experience more violence exposure relative to White youth. The present study examined the mediating role of posttraumatic stress symptoms (PTSS), delinquency, earlier victimization, and familial and neighborhood factors in disparities in future victimization. The study utilized data from the National Survey of Adolescents-Replication (N = 3,312), which consists of three waves of data collected approximately 1 year apart. A series of path models, tested polyvictimization, PTSS, delinquency, familial socioeconomic factors, and neighborhood safety as mediators of disparities in new polyvictimization. All cross-lagged and autoregressive paths positively predicted past-year polyvictimization and mediated longitudinal disparities. Familial socioeconomic variables and neighborhood safety mediated initial violence exposure disparities. Overall, results indicate that prior violence exposure, related mental health symptoms, and familial and neighborhood factors account for significant portions of disparities in new violence exposure across adolescence.

Violence exposure in an urban city: A GxE interaction with aggressive and impulsive behaviors

BACKGROUND

Previous research has demonstrated a reciprocal relationship between community violence exposure and disruptive behavior problems among youth. No study to date, however, has explored the potential interaction between violence exposure in early adolescence and genetics.

METHODS

We explore the gene x environment interaction's impact on teacher-rated aggressive and impulsive behaviors. Violence exposure during the middle school years was assessed using self-report. Genetic data collection occurred in emerging adulthood. A polygenic score was created using findings from a conduct disorder symptomatology genome-wide association study.

RESULTS

Three longitudinal classes of teacher reported aggressive and impulsive behavior were identified. We found a significant relationship between violence exposure and class membership. There was a significant GxE interaction, such that those with below average levels of the polygenic score and who were exposed to violence were more likely to be in the moderately high aggressive and impulsive class as compared to the no to low class.

CONCLUSIONS

These findings highlight the influence of genetic risk together with violence exposure on adolescent problem behavior. Although youth may have little control over the environments in which they live, interventions can and should focus on helping all youth.

Walking Away Hurt, Walking Around Scared

Using a person-centered approach, we examine phenomenological variations in exposure to violence for Black males and describe risk and protective factors associated with patterns of violence exposure. We ran K-means iterative cluster analysis to determine patterns of violence exposure and conducted analysis of variance to test whether clusters differed. Data are from 287 Black males ( M = 18.9) who participated in the Black Youth Project–Youth Culture Survey. Participants in the current study self-identified as Black or African American and male, and completed the political participation, health, and demographic portions of the survey questionnaire. We found four clusters of violence exposure that were related to demographic characteristics, maternal closeness, neighborhood condition, and sociopolitical inequity. Our findings highlight the heterogeneity of exposure to violence among young Black males and the individual and environmental risk and protective factors that are related to types and levels of exposure. This examination of quality of violence exposure in the context of available risks and protective factors may help clinicians and researchers improve their intervention efforts.

Exposure to Community Violence and the Trajectory of Internalizing and Externalizing Symptoms in a Sample of Low-Income Urban Youth

This study examined trajectories of psychopathology in a sample of low-income urban youth and tested exposure to community violence as a predictor of these trajectories. Self-report and parent-report survey measures of psychological problems and exposure to community violence were collected annually over 3 years from a sample of 364 fifth- to ninth-grade low-income urban youth (64% female; 95% youth of color). Linear growth models showed that youth experienced declines in both internalizing and externalizing symptoms across adolescence. Exposure to community violence was more strongly associated with externalizing symptoms than with internalizing symptoms but predicted declines in both types of symptoms. Results also indicated that youth reported more internalizing and externalizing symptoms than their parents reported for them. Exposure to community violence may explain unique trajectories of mental health problems among low-income urban youth. In addition, youth efforts to adopt a tough façade in the face of community violence could lead to higher rates of externalizing problems relative to internalizing problems, whereas desensitization processes may better explain reductions in both types of symptoms over time. Finally, youth report may be more valid than parent report in the context of urban poverty.

Exposure to Violence in the Community Predicts Friendships with Academically Disengaged Peers During Middle Adolescence

Adolescents who have been exposed to violence in the community often experience subsequent difficulties with academic achievement. Because competence in the classroom is a salient developmental task during the adolescent years, outcomes in this critical context can then have broader implications for social and psychological functioning. In the current study, we tested a hypothesized progression in which the association between violence exposure and deficient achievement is presumed to potentiate friendships with academically disengaged peers. We followed 415 urban adolescents (53 % girls; average age of 14.6 years) for a one-year period, with two annual assessment of psychosocial functioning. Exposure to violence in the community and academic engagement were assessed with a self-report inventory; reciprocated friendships were assessed with a peer interview; and achievement was indexed based on a review of school records. Consistent with our hypotheses, neighborhood violence was associated with deficient classroom achievement. Poor achievement, in turn, mediated associations between community violence exposure and low academic engagement among friends. Our findings highlight pathways though which exposure to community violence potentially predicts later dysfunction.

You Do What You See

African American boys are more likely than same-aged counterparts to live in disadvantaged neighborhoods characterized by exposure to physical violence, lower socioeconomic status, poor parent education, and acts of violence. The current study used structural equation modeling to test the associations between witnessing violence, peer and parent expectations, peer behaviors, self-efficacy to avoid violence, and violent behavior as the outcome. Results suggest that African American boys who witnessed physical violence are more likely to engage in violence themselves. Peer and parent violence expectations, peer violence, and adolescent’s self-efficacy to avoid violence mediate this. These findings suggest potential for prevention of violent behaviors through modification of norms of male African American adolescents at risk for witnessing violence in their daily life.

Correlates of Polyvictimization Among African American Youth: An Exploratory Study

African American adolescents are exposed to high rates of community violence, and recent evidence indicates that these youth may also be at high risk of polyvictimization. Guided by an ecological approach, this study explored individual, familial, and extra-familial correlates of single and multiple forms of violence exposures (i.e., witnessing verbal parental aggression, witnessing or being a victim of community violence exposures) among a sample of 563 urban African American adolescents. Findings indicated that boys reported higher levels of polyvictimization than girls. In addition, the correlates of violence exposures varied by typology and gender. These findings support the development and use of gender-oriented approaches for identifying youth at risk of various types of violence exposures.

Exposure to violence predicting cortisol response during adolescence and early adulthood: understanding moderating factors

Previous research on the association between violence and biological stress regulation has been largely cross-sectional, and has also focused on childhood. Using longitudinal data from a low-income, high-risk, predominantly African-American sample (n = 266; 57 % female), we tested hypotheses about the influence of cumulative exposure to violence during adolescence and early adulthood on cortisol responses in early adulthood. We found that cumulative exposure to violence predicted an attenuated cortisol response. Further, we tested whether sex, mothers' support, or fathers' support moderated the effect of exposure to violence on cortisol responses. We found that the effect of cumulative exposure to violence on cortisol was modified by sex; specifically, males exposed to violence exhibited a more attenuated response pattern. In addition, the effect of cumulative exposure to violence on cortisol was moderated by the presence of fathers' support during adolescence. The findings contribute to a better understanding of how cumulative exposure to violence influences biological outcomes, emphasizing the need to understand sex and parental support as moderators of risk.

Gender patterns in the contribution of different types of violence to posttraumatic stress symptoms among South African urban youth

OBJECTIVE

Identifying the comparative contributions of different forms of violence exposure to trauma sequelae can help to prioritize interventions for polyvictimized youth living in contexts of limited mental health resources. This study aimed to establish gender patterns in the independent and comparative contributions of five types of violence exposure to the severity of posttraumatic stress symptoms among Xhosa-speaking South African adolescents.

METHOD

Xhosa-speaking adolescents (n=230) attending a high school in a low-income urban community in South Africa completed measures of violence exposure and posttraumatic stress symptoms.

RESULTS

While witnessing of community violence was by far the most common form of violence exposure, for the sample as a whole only sexual victimization and being a direct victim of community violence, together with gender, contributed independently to the severity of posttraumatic stress symptoms. When the contribution of different forms of violence was examined separately for each gender, only increased exposure to community and sexual victimization were associated with symptom severity among girls, while increased exposure to direct victimization in both the community and domestic settings were associated with greater symptom severity in boys.

CONCLUSIONS

The findings provide some preliminary motivation for focusing trauma intervention initiatives in this community on girls who have experienced sexual abuse compounded by victimization in the community, and boys who have been direct victims of either domestic or community violence. Further research is required to establish whether the risk factors for posttraumatic stress symptoms identified among adolescents in this study are consistent across different communities in South Africa, as well as across other resource-constrained contexts.

Stressors in multiple life-domains and the risk for externalizing and internalizing behaviors among African Americans during emerging adulthood

Behavioral and mental health outcomes have been associated with experiencing high levels of stress. Yet, little is known about the link between the nature of stressors, their accumulation over time, and the risk for externalizing and internalizing outcomes. Compared to the general population, African Americans are exposed to a disproportionate number of stressors beginning earlier in life. Incorporating Agnew's General Strain Theory into the study of stress, this study examined whether different kinds of stressors are equally salient in the risk for violent behaviors and depressive symptoms among African Americans transitioning into young adulthood. It further examined the effects of the accumulation of stressors in different life domains and their effect on risks. This study utilized data from an African American subsample of an ongoing longitudinal study that followed 604 adolescents (53 % females) from 9th grade into adulthood. Multilevel growth curve models were used to examine how changes in stressors across multiple life domains related to violent behaviors and depressive symptoms. We found that continued exposure to perceived daily stress and racial discrimination stress increased the risk for violent behaviors during young adulthood, and exhibited a nonlinear relationship between the accumulation of stressors and risk for violence. Moreover, we found that exposure to perceived daily stress, financial stress, neighborhood stress, and racial discrimination stress increased the risk of depressive symptoms and led to a linear relationship between the accumulation of stressors and risk for depressive symptoms. Findings suggest identifiable stressors that can persist over time to influence risks at young adulthood.

Contextual factors and anxiety in minority and European American youth presenting for treatment across two urban university clinics

The current study compared ethnic minority and European American clinically-referred anxious youth (N=686; 2-19 years) on internalizing symptoms (i.e., primary anxiety and comorbid depression) and neighborhood context. Data were provided from multiple informants including youth, parents, and teachers. Internalizing symptoms were measured by the Multidimensional Anxiety Scale for Children, Child Depression Inventory, Child Behavior Checklist and Teacher Report Form. Diagnoses were based on the Anxiety Disorders Interview Schedule for Children. Neighborhood context was measured using Census tract data (i.e., owner-occupied housing, education level, poverty level, and median home value). Ethnic minority and European American youth showed differential patterns of diagnosis and severity of anxiety disorders. Further, ethnic minority youth lived in more disadvantaged neighborhoods. Ethnicity and neighborhood context appear to have an additive influence on internalizing symptoms in clinically-referred anxious youth. Implications for evidence-based treatments are discussed.

Relationship proximity to victims of witnessed community violence: associations with adolescent internalizing and externalizing behaviors

Witnessing community violence has been linked with several adverse outcomes for adolescents, including emotional and behavioral problems. Among youth who have witnessed community violence, proximity to the victim of community violence is one factor that may determine, in part, the nature of adolescents' responses to community violence exposure. The present study examines whether relationship proximity to the victim of community violence is associated with internalizing and externalizing behaviors among a sample of urban and predominantly African American adolescents (N = 501) who have witnessed community violence. In 10th grade, participants reported whether they had witnessed 10 community violence events during the past year, and, if so, whether the victim of the violence was a family member, close friend, acquaintance, or stranger. Witnessed community violence against a family member or close friend was associated with depressive symptoms, and witnessed community violence against known individuals was associated with anxiety symptoms. Witnessing community violence against familiar persons and strangers was linked with aggressive behavior. Gender differences in these associations and implications for assessment and intervention with community violence-exposed youth are discussed.

Role of Parent and Peer Relationships and Individual Characteristics in Middle School Children's Behavioral Outcomes in the Face of Community Violence

This study examines processes linking inner-city community violence exposure to subsequent internalizing and externalizing problems. Hypothesized risk and protective factors from three ecological domains -- children's parent and peer relationships and individual characteristics -- were examined for mediating, moderating or independent roles in predicting problem behavior among 667 children over three years of middle school. Mediation was not found. However, parent and peer variables moderated the association between exposure and internalizing problems. Under high exposure, normally protective factors (e.g., attachment to parents) were less effective in mitigating exposure's effects than under low exposure; attachment to friends was more effective. Individual competence was independently associated with decreased internalizing problems. Variables from all domains, and exposure, were independently associated with externalizing problems. Protective factors (e.g., parent attachment) predicted decreased problems; risk factors (e.g., friends' delinquency) predicted increased problems. Results indicate community violence reduction as essential in averting inner-city adolescents' poor behavioral outcomes.

Urban African American youth exposed to community violence: a school-based anxiety preventive intervention efficacy study

This study evaluated the efficacy of a school-based anxiety prevention program among urban children exposed to community violence. Students who attended Title 1 public elementary schools were screened. Ninety-eight 3rd-5th-grade students (ages 8-12; 48% female; 92% African American) were randomized into preventive intervention versus wait list comparison groups. Students attended 13 biweekly one-hour group sessions of a modified version of FRIENDS, a cognitive-behavioral anxiety intervention program. Results indicated that both intervention and control groups manifested significant reductions in anxiety symptomatology and total exposure to community violence, along with improved standardized reading achievement scores. Additional gains observed only in the intervention group were increased standardized mathematics achievement scores, decreased life stressors, and reduced victimization by community violence. The intervention was equally efficacious for both genders and for children exposed to higher, compared to lower, levels of community violence. Implications for comprehensive, culturally and contextually relevant prevention programs and research are discussed.

Examining the developmental process of risk for exposure to community violence among urban youth

Considerable research has documented the effects of community violence exposure on adolescents' behavior and mental health functioning, yet there has been less research on the process by which early risks increase the likelihood that youth will be exposed to community violence. The current study used data from a community epidemiologically defined sample of 623 urban youth followed from 1st grade through adolescence to examine the process by which early-onset aggressive behavior and poor academic readiness influenced risk for community violence exposure. Consistent with transactional developmental theories, early-onset aggressive and disruptive behavior was associated with poor academic readiness; these early risks contributed to later peer rejection, and subsequent conduct problems and greater affiliation with deviant peers, which in turn increased youths' exposure to community violence. Having an enhanced understanding of the risk process directs attention to potential targets for preventive interventions for youth at risk for subsequent exposure to violence.

DISCREPANCIES BETWEEN COMMUNITY VIOLENCE EXPOSURE AND PERCEIVED NEIGHBORHOOD VIOLENCE

Community violence exposure (CVE) has been identified as a significant public health concern given its association with numerous mental health problems. Perceptions of neighborhood violence (PNV) also may adversely affect youth adjustment. In recognition that PNV may differ from individuals own experience of CVE, the current study utilized latent class analysis to examine the degree and consequences of consistency and discrepancy in adolescents community violence exposure and PNV. Participants included an epidemiologically-defined community sample of 456 African American adolescents (52% male; mean age=11.77). Results revealed three groups of youth: high CVE/high PNV, low CVE/low PNV, and low CVE/high PNV. Longitudinal analyses suggest that a discrepancy between CVE and PNV is important for understanding depressive and anxious symptoms among urban African American youth. Implications for intervention are discussed.

Patterns of community violence exposure during adolescence

This study examined cross-sectional and longitudinal patterns of community violence exposure and malleable predictors of these exposure patterns among a community sample of 543 urban African American early adolescents (45.3% female; mean age: 11.76). In each of grades 6, 7, and 8, latent class analyses revealed two patterns of community violence exposure: high exposure and low exposure. For the majority of participants, experiences with community violence were similar at each grade. Impulsive behavior and depressive symptoms distinguished adolescents in the high and low exposure classes in grade 6. Implications for interventions to prevent community violence exposure are discussed.

Community violence, protective factors, and adolescent mental health: a profile analysis

This study examined interrelationships among community violence exposure, protective factors, and mental health in a sample of urban, predominantly African American adolescents (N = 504). Latent Profile Analysis was conducted to identify profiles of adolescents based on a combination of community violence exposure, self-worth, parental monitoring, and parental involvement and to examine whether these profiles differentially predict adolescents' depressive symptoms and aggressive behavior. Three classes were identified-a vulnerable class, a moderate risk/medium protection class, and a moderate risk/high protection class. The classes differentially predicted depressive symptoms but not aggressive behavior for boys and girls. The class with the highest community violence exposure also had the lowest self-worth.

Attributing activity space as risky and safe: The social dimension to the meaning of place for urban adolescents

The social dimension of urban adolescents' interpretation of their activity space was investigated by examining reasons for attributing place as risky and safe, and analyzing these reasons by social network quality. Activity space and social network data were collected on 301 teens presenting for routine medical check-ups. SPSS Text Analysis for Surveys performed linguistic analyses on open-ended survey responses, applying concept derivation, concept inclusion, semantic networks, and co-occurrence rules. Results produced 13 categories of reasons for locations attributed as risky and safe. Categories were then transformed into dichotomous variables and analyzed with chi-square tests by social network quality. Results indicated two categories of reasons for locations attributed as risky: alcohol and drugs and Illegal activity, which were dependent upon social network quality. Two categories of reasons for locations attributed as safe, namely protective place and Neighborhood, were also dependent upon social network quality. These findings assert that adolescents' social networks influence their interpretations of risk and safety, highlighting a social dimension to the meaning of place.

Contextual stress and health risk behaviors among African American adolescents

This study examined the longitudinal association between contextual stress and health risk behaviors and the role of protective factors in a community epidemiologically-defined sample of urban African American adolescents (N = 500; 46.4% female). Structural equation modeling was used to create a latent variable measuring contextual stress (community violence, neighborhood disorder, and experiences with racial discrimination). Contextual stress in 8th grade was associated with aggressive behavior and substance use 2 years later for boys. For girls, contextual stress predicted later substance use, but not aggressive behavior. High academic competence and self-worth reduced the impact of contextual stress on substance use for boys. Implications for intervention and directions for future research on health risk behaviors among African American adolescents are discussed.

Contextual stress and health risk behaviors among African American adolescents

This study examined the longitudinal association between contextual stress and health risk behaviors and the role of protective factors in a community epidemiologically-defined sample of urban African American adolescents (N = 500; 46.4% female). Structural equation modeling was used to create a latent variable measuring contextual stress (community violence, neighborhood disorder, and experiences with racial discrimination). Contextual stress in 8th grade was associated with aggressive behavior and substance use 2 years later for boys. For girls, contextual stress predicted later substance use, but not aggressive behavior. High academic competence and self-worth reduced the impact of contextual stress on substance use for boys. Implications for intervention and directions for future research on health risk behaviors among African American adolescents are discussed.

Toward a stress process model of children's exposure to physical family and community violence

Theoretically informed models are required to further the comprehensive understanding of children's ETV. We draw on the stress process paradigm to forward an overall conceptual model of ETV (ETV) in childhood and adolescence. Around this conceptual model, we synthesize research in four dominant areas of the literature which are detailed but often disconnected including: (1) exposure to three forms of physical violence (e.g., child physical maltreatment, interparental violence, and community ETV); (2) the multilevel correlates and causes of ETV (e.g., neighborhood characteristics including concentrated disadvantage; family characteristics including socio-economic status and family stressors); (3) a range of consequences of ETV (e.g., internalizing and externalizing mental health problems, role transitions, and academic outcomes); and (4) multilevel and cross domain mediators and moderators of ETV influences (e.g., school and community factors, family social support, and individual coping resources). We highlight the range of interconnected processes through which violence exposures may influence children and suggest opportunities for prevention and intervention. We further identify needed future research on children's ETV including coping resources as well as research on cumulative contributions of violence exposure, violence exposure modifications, curvilinearity, and timing of exposure.

Relational aggression and adverse psychosocial and physical health symptoms among urban adolescents

OBJECTIVES

The purpose of this study was to examine relational aggression and its relationship with adverse psychosocial and physical health symptoms among urban, African American youth.

DESIGN AND SAMPLE

Quantitative, cross-sectional survey design. The sample consisted of 185 predominantly African American (95.1%) seventh-grade students (mean age: 13.0; female: 58%) attending 4 urban middle schools.

MEASURES

The Children's Social Behavior Scale and Social Experience Questionnaire were used to measure relational aggression and relational victimization. The Pediatric Symptom Checklist was used to assess psychosocial difficulties, including internalizing behaviors, externalizing behaviors, and attention problems. Physical health symptoms were measured with questions about colds/flu, headaches, and stomach aches.

RESULTS

2-way multivariate analysis of variance revealed significant differences in externalizing behavior, with perpetrators reporting higher levels than nonperpetrators. Victims reported more internalizing behavior than nonvictims; however, this was only significant for males. For females, significant negative effects on health outcomes were found, resulting from the interaction of perpetration and victimization.

CONCLUSIONS

Findings suggest that relational aggression is a common occurrence among urban, minority adolescents and may result in adverse health outcomes. These results provide several avenues for future research and implications for healthcare practice. Intervention strategies are needed to prevent relational aggression and continual or subsequent adverse health symptoms.

Concept analysis of community violence: using adolescent exposure to community violence as an exemplar

The adverse impact of directly experiencing violence has been documented; however outcomes associated with more distal violence exposure have only recently received attention. This concept analysis uses adolescent exposure to community violence to exemplify the concept of community violence. For adolescents, community is a fluid and ever-changing concept. Research has shown that adolescents exposed to community violence may suffer from symptoms of posttraumatic stress, depression, aggression, decreased scholastic ability, and lower levels of success. Nursing interventions that address adolescent exposure to violence have the potential to decrease the detrimental effects of exposure to community violence.

Understanding Random Effects in Group-Based Trajectory Modeling: An Application of Moffitt's Developmental Taxonomy

The group-based trajectory modeling approach is a systematic way of categorizing subjects into different groups based on their developmental trajectories using formal and objective statistical criteria. With the recent advancement in methods and statistical software, modeling possibilities are almost limitless; however, parallel advances in theory development have not kept pace. This paper examines some of the modeling options that are becoming more widespread and how they impact both empirical and theoretical findings. The key issue that is explored is the impact of adding random effects to the latent growth factors and how this alters the meaning of a group. The paper argues that technical specification should be guided by theory, and Moffitt's developmental taxonomy is used as an illustration of how modeling decisions can be matched to theory.

Measuring anxiety in adolescents exposed to community violence: a review, comparison, and analysis of three measures

Exposure to community violence can influence adolescents' anxiety. Researchers have examined the relationship between exposure to community violence and anxiety. In their pursuit to explore that relationship, researchers have used a variety of instruments. This review of literature provides an overview of the instruments used to measure anxiety in adolescents exposed to community violence and evaluates three of these measures. The Trauma Symptom Checklist for Children, the Child Behavior Checklist, and the State Trait Anxiety Inventory for Children were frequently used to measure anxiety in adolescents exposed to community violence. These instruments have good reliability and construct validity.

Interventions for Childhood Aggression in a Cross-Cultural Context

Negative outcomes associated with childhood aggression, including its relation to adult criminality and domestic violence, have led researchers in the developed world to create effective interventions aimed at reducing childhood aggression and minimising its long-term negative outcomes. This article addresses the implications of adapting these interventions in a developing world context by examining issues central to the discussion of these adaptations. These include (a) comparing correlates associated with childhood aggression in the developed world and developing world, (b) addressing some of the challenges in adapting interventions for childhood aggression in a cross-cultural context and (c) presenting general guidelines on designing interventions for childhood aggression that may be helpful to clinicians and community groups within the developing world. The adaptation of interventions for the reduction of childhood aggression may prove useful in areas in which exposure to violence and instability threaten the child’s development.

Place-based social network quality and correlates of substance use among urban adolescents

A sample of 301 Philadelphia adolescents were assessed for substance use and place-based social network quality, a weighted variable based upon risky and protective behaviors of alters. The network measure was anchored in routine locations identified as safe, risky, important, or favorite. Results show young females' (13-16) substance use was strongly associated with their place-based social networks compared to older females (17-20) and compared to young and older males. Younger females' protective networks reduced their likelihood of substance use compared to females with risky networks (OR=.94, CI=.89-.99, p<.05), while young males experienced no protective network effects. Older females' protective networks reduced the likelihood of substance use compared to those with risky networks (OR=.96, CI=.93-.99, p<.005). Older males' protective networks also reduced their likelihood of substance use (OR=.86, CI=.74-.99, p<.05). Results highlight the varying affects of place, gender, and age on adolescent social network protection and associated risk for substance use.

Exposure to community violence and adolescents' internalizing behaviors among African American and asian American adolescents

Exposure to community violence can seriously threaten healthy adolescent development. This longitudinal study examines the relationship between exposure to violence in the community and the internalizing behaviors of Asian American and African American adolescents. Data analyzed was from 901 adolescents (57.9% female and 42.1% male, and 84.7% African American and 15.3% Asian American) who had participated in both Wave I and II interviews of the National Longitudinal Survey of Adolescent Health conducted between 1994 and 1996. Being female, having prior internalizing behaviors at baseline, and being exposed to violence significantly predicted African American adolescents' subsequent report of internalizing behaviors and their symptoms. Being female and having prior internalizing behaviors also predicted Asian American adolescents' subsequent internalizing behaviors and their symptoms. However, exposure to violence was not associated with Asian American adolescents' internalizing behaviors. Findings suggested a need to conceptualize mental health risk in a more nuanced context of cultural diversity.