Epidemiological measurement of children's and adolescents' exposure to community violence: working with the current state of the science

Patterns of Violence Exposure and Substance Use among Child Welfare Involved Youth

Emerging research suggests an association between exposure to violence, specifically indirect forms, and substance use among youth involved in the child welfare (CW) system. However, this has only been recently and tentatively explored. This study examined the associations among various forms of indirect violence exposure and substance use among subgroups of youth involved in the CW system. The analytic sample consisted of participants (aged 11 years or older) in the baseline year of the second National Survey of Child and Adolescent Well-Being (2008-2012), including youth and their caregivers. Latent class analysis was used to examine associations among distinct forms of indirect violence exposure and substance use and the potential identification of unique at-risk groups. Models for the overall sample suggested two classes of at-risk youth, with the higher-risk class having higher probabilities of alcohol, marijuana, and hard drug use, which coincided with higher probabilities of exposure to arrests, stealing, drug deals, and weapon use. However, stratified models suggested unique results for youth aged 13-14 and 15-17, suggesting that the confluence of these risks appears to differ developmentally. Prevention and intervention services for CW-involved youth should assess and address violence exposure types among youth as a potential opportunity to mitigate substance use and subsequent high-risk behavior.

Psychological Distress and Well-Being in Trauma-Exposed Adolescents: A Residualized, Person-Centered Approach to Resilience

Positive adaptation manifests differently in the aftermath of traumatic events. Methodological limitations, however, impede the ability to test conceptualizations of resilience that emphasize the multifaceted nature of these responses. In response, an approach that synthesized a residualized and person-centered conceptualization of resilience examined associations between aspects of resilience in an adolescent sample. In total, 584 racially/ethnically diverse adolescents (age range: 12-17 years; M = 14.98 years; SD = 1.05; 50.9% female; 30.1% White, 29.6% African American, 19.5% Hispanic) self-reported lifetime emotional maltreatment and community violence exposure as well as current levels of depression, posttraumatic stress symptoms (PTSS), violent behavior, and psychological well-being (PWB). Each mental health outcome was regressed on lifetime trauma exposure to create residuals used as indices of resilience. Correlations between the residuals suggested that PWB was more closely related to resilience to depression and PTS, rs = .17-.30, than violent behavior, r = .00. Residuals were subsequently entered into person-centered analyses to identify representative well-being profiles. Cluster analysis identified four groups, including two adaptive profiles defined by (a) lower distress and higher PWB and (b) lower psychopathology and lower PWB, based on adolescents' levels of trauma exposure. These two profiles did not vary regarding impairment, p > .999, suggesting both profiles represent positive adaption to lifetime trauma exposure. Theoretical and clinical implications of distinguishing between these two profiles by assessing PWB in adolescents are discussed, as well as how PWB may manifest within the context of different patterns of psychological distress.

Neighborhood Violent Crime and Academic Performance: A Geospatial Analysis

Decades of empirical work have confirmed that experiences with violence are associated with a variety of adverse behavioral and mental health as well as academic outcomes for children and adolescents. Yet this research largely has relied on indirect measures of exposure. In this study, we apply geospatial analysis to examine the relation between neighborhood violent crime (via police reports) and academic performance (via school-level standardized test proficiency rates). Findings suggest that greater numbers of crimes proximal to school buildings relate to lower levels of academic performance. These results persisted even when controlling economic disadvantage in the student body. Implications for research and policy are discussed.

Neighborhood violent crime and adolescent relationship aggression

Research has shown that neighborhoods play a role in the etiology of violence. However, few adolescent relationship aggression (ARA) studies have objective measures of violent neighborhoods. Drawing on a nationally representative sample of youth, this study examines the association between ARA and local levels of violent crime (measured using geocoded Uniform Crime Report data from each of the youths' residential neighborhoods). Study analyses are based on survey data from 723 youth (ages 10-18) in current or recent dating relationships (351 males and 372 females) in the Survey on Teen Relationships and Intimate Violence (STRiV), a national representative household panel survey exploring interpersonal violence and related aggression among adolescents. About 19% of the sample reported ARA victimization in their most recent dating relationship (ARA perpetration was 17%). Neighborhood violent crime in the study (males living in 86.9 and females 99.8) was slightly lower than the national average of 100. With a broad national sample, 40% non-Whites, hypotheses guided by theories of neighborhood influence were tested. The study did not find an association between neighborhood violent crime and ARA victimization and perpetration, controlling for key demographic factors. The results, for a broad range of high- and low-crime neighborhoods, suggest that neighborhood violence does not seem to affect individual rates of ARA. The results suggest the ARA victimization and perpetration are perhaps ubiquitous and found both in low and high violent crime neighborhoods, suggesting that addressing local violent crime rates alone does not seem to be a path to also reducing ARA.

Neighborhood context and transitions in marijuana use among urban young adults

BACKGROUND

In emerging adulthood when many youth are maturing out of marijuana use, Blacks continue to have high rates of use and disorder. Theory suggests that factors tied to neighborhood disadvantage may partially explain this phenomenon but research is limited.

OBJECTIVES

This study examines the influence of neighborhood physical and social disorder on transitions in marijuana use during emerging adulthood in a low-income urban sample.

METHODS

379 primarily Black young adults residing in low-income neighborhoods in Baltimore City were followed-up annually from ages 18 to 21. Neighborhood environment was evaluated using a valid and reliable field-rater assessment of the residential block. Longitudinal latent class and latent transition analyses were performed.

RESULTS

Fit indices supported three-classes of marijuana use: no use, infrequent use and frequent use. Between ages 18 and 21, young adults tended to transition toward lower levels of use. However, neighborhood physical disorder was associated with transitioning to increased marijuana use (no use to frequent use; AOR = 2.712; p = .023) while positive neighborhood social activity was associated with a decreased risk (AOR = 0.002; p = .013). Neighborhood social activity was also associated with decreases in use (frequent to infrequent use; AOR = 2.342; p = .020). Conclusions/Importance: These findings demonstrate that physical disorder within the context of a low-income urban neighborhood adversely impacts marijuana use. However, even in the presence of physical disorder, interventions that foster collective efficacy among residents through positive social activity may prevent initiation and progression of marijuana use.

We Are Family: Specifying the Unique Contribution of Abuse and Neglect of Siblings on the Prevalence, Severity, and Chronicity of Maltreatment in the Household

Prior research typically focuses on a single child ("index" victim) when measuring child abuse and neglect (CAN) using Child Protective Services (CPS) records. However, excluding siblings has the potential to underestimate estimates of the prevalence, severity, and chronicity of CAN in the household, which includes all children in the family. CPS maltreatment records were searched in 2005 for 366 "index" victims who were surveyed for 5 consecutive years (from 1998 to 2002) for the Mobile Youth Survey (MYS) as well as other siblings in the household. The estimate of prevalence of CAN in the household increased by 10% when sibling(s) in the household were included in the CPS search. In addition, prevalence of sexual abuse in the household increased by 38% when siblings were included in the broader search of CPS records. More importantly, including sibling victims of CAN uncovered incidents of maltreatment that occurred before the birth of the targeted MYS "index" victim. In short, the inclusion of abuse and neglect of siblings is a straightforward and intuitive way to improve estimates of abuse and neglect in the household. More importantly, the age of onset of CAN of sibling victims provides a wider window of opportunity to identify at-risk families for targeted interventions and may represent a critical stepping stone toward the primary prevention of CAN in the household.

Violence and child mental health in Brazil: The Itaboraí Youth Study methods and findings

OBJECTIVES

To demonstrate a study design that could be useful in low-resource and violent urban settings and to estimate the prevalence of child violence exposure (at home, community, and school) and child mental health problems in a low-income medium-size city.

METHODS

The Itaboraí Youth Study is a Norway-Brazil collaborative longitudinal study conducted in Itaboraí city (n = 1409, 6-15 year olds). A 3-stage probabilistic sampling plan (random selection of census units, eligible households, and target child) generated sampling weights that were used to obtain estimates of population prevalence rates.

RESULTS

Study strengths include previous pilot study and focus groups (testing procedures and comprehension of questionnaire items), longitudinal design (2 assessment periods with a mean interval of 12.9 months), high response rate (>80%), use of standardized instruments, different informants (mother and adolescent), face-to-face interviews to avoid errors due to the high frequency of low-educated respondents, and information gathered on a variety of potential predictors and protective factors. Children and adolescents presented relevant levels of violence exposure and clinical mental health problems.

CONCLUSIONS

Prevalence estimates are probably valid to other Brazilian low-income medium-size cities due to similarities in terms of precarious living conditions. Described study methods could be useful in other poor and violent world regions.

Intrauterine exposure to tobacco and executive functioning in high school

BACKGROUND

Executive functioning (EF), an umbrella construct encompassing gradual maturation of cognitive organization/management processes, is important to success in multiple settings including high school. Intrauterine tobacco exposure (IUTE) correlates with negative cognitive/behavioral outcomes, but little is known about its association with adolescent EF and information from real-life contexts is sparse. We evaluated the impact of IUTE on teacher-reported observations of EF in urban high school students controlling for covariates including other intrauterine and adolescent substance exposures.

METHODS

A prospective low-income birth cohort (51% male; 89% African American/Caribbean) was followed through late adolescence (16-18 years old). At birth, intrauterine exposures to cocaine and other substances (52% cocaine, 52% tobacco, 26% marijuana, 26% alcohol) were identified by meconium and/or urine assays, and/or maternal self-report. High school teachers knowledgeable about the student and unaware of study aims were asked to complete the Behavior Rating Inventory of Executive Functioning-Teacher Form (BRIEF-TF) annually.

RESULTS

Teachers completed at least one BRIEF-TF for 131 adolescents. Multivariable analyses included controls for: demographics; intrauterine cocaine, marijuana, and alcohol exposures; early childhood exposures to lead; and violence exposure from school-age to adolescence. IUTE was associated with less optimal BRIEF-TF Behavioral Regulation scores (p <0.05). Other intrauterine substance exposures did not predict less optimal BRIEF-TF scores, nor did exposures to violence, lead, nor adolescents' own substance use.

CONCLUSIONS

IUTE is associated with offspring's less optimal EF. Prenatal counseling should emphasize abstinence from tobacco, as well as alcohol and illegal substances.

Role Differentiation in an Adolescent Victim-Offender Typology: Results From Medellin, Colombia

The present study evaluates adolescent victimization and offending using cross-sectional survey data from 1,475 adolescents living in a disadvantaged Comuna in Medellin, Colombia, while paying particular attention to the ways in which both victimization and violent offending are operationalized. We find that 37% of respondents experienced no lifetime victimization, while 60% experienced vicarious, and 4% personal victimization. When restricting violent offending to behavior involving a weapon, the majority of offenders (81%) also experienced victimization while only 33% of victims were also weapons offenders. Our final analysis seeks to identify theoretical conditions which differentiate roles in a victim-offender typology, a result we determine varies significantly depending on how "violent offending" is measured.

Evaluating Nighttime Observational Measures of Neighborhood Disorder: Validity of the Nighttime NIfETy Assessment

While there are a growing number of observational instruments to assess the built and social dimensions of the neighborhood environment, there are few reliable and validated instruments; there are no instruments that assess the neighborhood environment during nighttime hours, a potential peak period of health and safety risk. The purpose of this investigation is to establish the metric properties of Neighborhood Inventory for Environmental Typology (NIfETy) Instrument nighttime ratings. Reliability of the scale was measured by internal consistency reliability and test re-test correlation. Validity was evaluated through correlation with the daytime NIfETy rating and regression models with local violent crime data. The nighttime items had good internal consistency (α = .81-82) for the total scale and acceptable internal consistency for a seven-item nighttime disorder scale (α = .66-.71). Future investigations will examine the nighttime NIfETy and its association with specific risk behaviors to evaluate changes in neighborhood environment.

Family Resources as Protective Factors for Low-Income Youth Exposed to Community Violence

Exposure to community violence is a risk factor for internalizing and externalizing problems; however, resources within the family can decrease the likelihood that adolescents will experience internalizing and externalizing problems as a result of such exposure. This study investigates the potential moderating effects of kinship support (i.e., emotional and tangible support from extended family) and parental involvement on the relation between exposure to community violence (i.e., witnessing violence and violent victimization) and socioemotional adjustment (i.e., internalizing and externalizing problems) in low-income adolescents. The sample included 312 (50 % female; 71 % African American and 29 % White) low-income youth who participated in a longitudinal investigation when adolescents were age 14 (M age = 14.49 years) and again when they were 16 (M age = 16.49 years). Exposure to community violence at age 14 was related to more internalizing and externalizing problems at age 16. High levels of kinship support and parental involvement appeared to function as protective factors, weakening the association between exposure to violence and externalizing problems. Contrary to prediction, none of the hypothesized protective factors moderated the association between exposure to violence and internalizing problems. The results from this study suggest that both kinship support and parental involvement help buffer adolescents from externalizing problems that are associated with exposure to community violence.

Neighborhood Factors and Dating Violence Among Youth: A Systematic Review

CONTEXT

The purpose of this review is to summarize the empirical research on neighborhood-level factors and dating violence among adolescents and emerging adults to guide future research and practice.

EVIDENCE ACQUISITION

In 2015, a total of 20 articles were identified through a search of the literature using PubMed. Eligible articles included those that (1) had been published in a peer-reviewed journal since 2005; (2) reported a measure of association between at least one neighborhood-level factor and dating violence; and (3) had a study population of youth aged <26 years. We abstracted information about the studies, including measurement of dating violence and neighborhood factors, and measures of effect.

EVIDENCE SYNTHESIS

Results were summarized into three categories based on the aspect of neighborhood that was the focus of the work: demographic and structural characteristics (n=11); neighborhood disorder (n=12); and social disorganization (n=8). There was some evidence to suggest that neighborhood disadvantage is associated with dating violence, but very little evidence to suggest that residence characteristics (e.g., racial heterogeneity) are associated with dating violence. Results do suggest that perceived neighborhood disorder is associated with physical dating violence perpetration, but do not suggest that it is associated with physical dating violence victimization. Social control and community connectedness are both associated with dating violence, but findings on collective efficacy are mixed.

CONCLUSIONS

Existing research suggests that neighborhood factors may be associated with dating violence. However, there is a limited body of research on the neighborhood context of dating violence, and more rigorous research is needed.

Attachment as a mediator between community violence and posttraumatic stress symptoms among adolescents with a history of maltreatment

Experiences that are detrimental to the attachment relationship, such as childhood maltreatment, may reduce feelings of safety among survivors and exacerbate the effects of exposure to subsequent violence, such as witnessing community violence. Though attachment style has been examined in regard to posttraumatic stress in adults who have a history of exposure to violence in childhood, less is known about the influence of attachment on the relationship between exposure to violence and posttraumatic stress symptoms in children and adolescents. The current study aimed to explore the role of attachment in the link between exposure to community violence and posttraumatic stress symptoms in adolescents with a history of childhood abuse. Participants included adolescents (aged 15-18 years) who had a history of maltreatment (N=75) and a matched sample without a childhood abuse history (N=78) from the National Data Archive on Child Abuse and Neglect (Salzinger, Feldman, & Ng-Mak, 2008). A conditional process model using bootstrapping to estimate indirect effects showed a significant indirect effect of insecure attachment on the relationship between exposure to community violence and posttraumatic stress symptoms for adolescents with a history of childhood physical abuse, but not for adolescents without this history. Implications for a cumulative risk model for post-trauma pathology starting in adolescence are discussed.

Using police data to measure children's exposure to neighborhood violence: a new method for evaluating relations between exposure and mental health

Studies have identified a robust association between children's exposure to violence and their mental health. Yet, most of this research has been based on self-reported exposure and self-reported mental health. In this study, we used a new, map-based method via police data for measuring children's exposure to violent crime and compared it to child self-reports and parent reports of exposure. Results suggest that child self-reports of violence exposure may not be valid except for exposure to murder, but police and parent reports of violent crime can reveal interesting relations between violence and mental health. Children showed higher levels of internalizing problems in the absence of police-reported murder and parent-reported robbery. Discussion emphasizes implications for measurement as well as theory building.

Coping with violence: a comprehensive framework and implications for understanding resilience

Interpersonal violence is present at all levels of influence in the social ecology and can have comprehensive and devastating effects on child and adolescent development through multiple simultaneous channels of exposure. Children's experiences with violence have been linked with a range of behavioral and mental health difficulties including posttraumatic stress disorder and aggressive behavior. In this article, we offer a conceptual framework delineating the ways in which children and adolescents might encounter violence, and a theoretical integration describing how violence might impact mental and behavioral health outcomes through short- and long-term processes. We propose that coping reactions are fundamental to the enduring effects of violence exposure on their psychosocial development and functioning. Finally, we discuss the manner in which coping efforts can support resilience among children exposed to violence and suggest new directions for research and preventive intervention aimed at optimizing outcomes for children at risk of exposure.

Heavy alcohol use and dating violence perpetration during adolescence: family, peer and neighborhood violence as moderators

We examined the hypothesis that family, peer and neighborhood violence would moderate relations between heavy alcohol use and adolescent dating violence perpetration such that relations would be stronger for teens in violent contexts. Random coefficients growth models were used to examine the main and interaction effects of heavy alcohol use and four measures of violence (family violence, friend dating violence, friend peer violence and neighborhood violence) on levels of physical dating violence perpetration across grades 8 through 12. The effects of heavy alcohol use on dating violence tended to diminish over time and were stronger in the spring than in the fall semesters. Consistent with hypotheses, across all grades, relations between heavy alcohol use and dating violence were stronger for teens exposed to higher levels of family violence and friend dating violence. However, neither friend peer violence nor neighborhood violence moderated relations between alcohol use and dating violence. Taken together, findings suggest that as adolescents grow older, individual and contextual moderators may play an increasingly important role in explaining individual differences in relations between alcohol use and dating violence. Implications for the design and evaluation of dating abuse prevention programs are discussed.

Understanding and using informants' reporting discrepancies of youth victimization: a conceptual model and recommendations for research

Discrepancies often occur among informants' reports of various domains of child and family functioning and are particularly common between parent and child reports of youth violence exposure. However, recent work suggests that discrepancies between parent and child reports predict subsequent poorer child outcomes. We propose a preliminary conceptual model (Discrepancies in Victimization Implicate Developmental Effects [DiVIDE]) that considers how and why discrepancies between parents' and youths' ratings of child victimization may be related to poor adjustment outcomes. The model addresses how dyadic processes, such as the parent-youth relationship and youths' information management, might contribute to discrepancies. We also consider coping processes that explain why discrepancies may predict increases in youth maladjustment. Based on this preliminary conceptual framework, we offer suggestions and future directions for researchers who encounter conflicting reports of community violence exposure and discuss why the proposed model is relevant to interventions for victimized youths.

Adolescent initiation of licit and illicit substance use: Impact of intrauterine exposures and post-natal exposure to violence

Whether intrauterine exposures to alcohol, tobacco, marijuana, or cocaine predispose offspring to substance use in adolescence has not been established. We followed a sample of 149 primarily African American/African Caribbean, urban adolescents, recruited at term birth, until age 16 to investigate intrauterine cocaine exposure (IUCE). We found that in Kaplan-Meier analyses higher levels of IUCE were associated with a greater likelihood of initiation of any substance (licit or illicit), as well as marijuana and alcohol specifically. Adolescent initiation of other illicit drugs and cigarettes were analyzed only in the "any" summary variable since they were used too infrequently to analyze as individual outcomes. In Cox proportional hazard models controlling for intrauterine exposure to alcohol, tobacco, and marijuana and demographic and post-natal covariates, those who experienced heavier IUCE had a greater likelihood of initiation of any substance, and those with lighter intrauterine marijuana exposure had a greater likelihood of initiation of any substance as well as of marijuana specifically. Time-dependent higher levels of exposure to violence between ages of 8 and 16 were also robustly associated with initiation of any licit or illicit substance, and of marijuana, and alcohol particularly.

Sierra Leone's former child soldiers: a follow-up study of psychosocial adjustment and community reintegration

This is the first prospective study to investigate psychosocial adjustment in male and female former child soldiers (ages 10-18; n = 156, 12% female). The study began in Sierra Leone in 2002 and was designed to examine both risk and protective factors in psychosocial adjustment. Over the 2-year period of follow-up, youth who had wounded or killed others during the war demonstrated increases in hostility. Youth who survived rape not only had higher levels of anxiety and hostility but also demonstrated greater confidence and prosocial attitudes at follow-up. Of the potential protective resources examined, improved community acceptance was associated with reduced depression at follow-up and improved confidence and prosocial attitudes regardless of levels of violence exposure. Retention in school was also associated with greater prosocial attitudes.

Creation of a community violence exposure scale: accounting for what, who, where, and how often

Previous research has used the Rasch model, a method for obtaining a continuous scale from dichotomous survey items measuring a single latent construct, to create a scale of community violence exposure. The authors build upon previous work and describe the application of a Rasch model using the continuation ratio model to create an exposure to community violence (ETV) scale including event circumstance information previously shown to modify the impact of experienced events. They compare the Rasch ETV scale to a simpler sum ETV score, and estimate the effect of ETV on child posttraumatic stress symptoms. Incorporating detailed event circumstance information that is grounded in traumatic stress theory may reduce measurement error in the assessment of children's community violence exposure.

Violent victimization in the community and children's subsequent peer rejection: the mediating role of emotion dysregulation

This paper describes a short-term longitudinal study of the relation between violent victimization in the community and peer rejection among 199 children (mean age = 9.02 years) attending two urban Los Angeles area elementary schools. We used a multi-informant approach to assess victimization by community violence, peer group victimization, peer rejection, and impairments in emotion regulation. These data were collected annually for two consecutive school years. Violent victimization in the community predicted later peer rejection after accounting for the effects of initial levels of peer rejection. Analyses indicated that this relation was mediated by deficient emotion regulation skills. In addition, we found evidence that victimization by community violence and peer rejection are reciprocally related over time. The developmental implications of these findings are discussed.