Fighting as a marker for multiple problem behaviors in adolescents

Suicidal behaviours among adolescents from 90 countries: a pooled analysis of the global school-based student health survey

BACKGROUND

Understanding the burden and determinants of suicide during adolescence is key to achieving global health goals. We examined the prevalence and determinants of self-reported suicidal ideation and attempts among younger (13-15 years) and older adolescents (16-17 years).

METHODS

Pooled prevalence estimates with 95% confidence interval, were calculated for suicide ideation and attempts for 118 surveys from 90 countries that administered the Global School-based Student Health Survey (GSHS) to adolescents (13-17 years of age) from 2003 to 2017. Indicators (including individual and social factors) associated with suicidal ideation and attempts were determined from multivariable linear regressions on key outcomes.

RESULTS

The prevalence of suicidal ideation representing 397,299 adolescents (51.3% female) was significantly higher among girls than boys whereas attempts did not differ by age or sex. Being bullied, or having no close friends was associated with suicidal ideation among girls 13-15 years and 16-17 years, respectively. Among all boys, being in a fight and having no close friends was associated with suicidal ideation with the addition of serious injury for boys 13-15 years. Common to all younger adolescents was an association of suicide attempt with being bullied and having had a serious injury. Among young boys, having no close friends was an additional indicator for suicide attempt. Having no close friends was associated with suicide attempt in older adolescents with the addition to being bullied in older girls and serious injury in older boys.

CONCLUSIONS

Building positive social relationships with peers and avoiding serious injury appear key to suicide prevention strategies for vulnerable adolescents. Targeted programs by age group and sex for such indicators could improve mental health during adolescence in low and middle-income countries, given the diverse risk profiles for suicidal ideation and attempts.

The relationships between sexual risk behaviors and general health risk behaviors among unmarried youth in Thailand

Objectives:

The prevalence and correlates of sexual risk behaviors among unmarried youth in Thailand are poorly documented. The objectives of this study were to compare the differences in sexual behaviors across age groups and gender and to identify the relationships between sexual risk behaviors and general health risk behaviors among unmarried Thai youth.

Methods:

A population-based, nationally representative, cross-sectional survey was conducted between January and March 2013. The Thai version of the Youth Risk Behavior Survey questionnaire was used to collect data from 800 unmarried Thai youth.

Results:

Majority of the respondents (65.9%) had not engaged in any sexual risk behavior, 18.7% had engaged in 2–3 sexual risk behaviors, and only 5.5% had engaged in a single sexual risk behavior. Current sexually active youth had higher risk of participating in physical fights (odds ratio = 3.41, 95% confidence interval = 1.53–7.57), smoking cigarette (odds ratio = 4.05, 95% confidence interval = 1.89–8.67), and drinking alcohol (odds ratio = 2.17, 95% confidence interval = 1.08–4.36).

Conclusion:

Thai youth were more likely to be involved in multiple sexual risk behaviors than a single sexual risk behavior. Physical fighting was the strongest general health risk behavior associated with the sexual risk behaviors, followed by substance abuse.

Physical Fighting and Associated Factors among Adolescents Aged 13-15 Years in Six Western Pacific Countries

Youth violence is an important public health challenge around the world, yet the literature on this problem in low- and middle-income countries (LMICs) has been limited. The present study aims to examine the prevalence of adolescent physical fighting (defined as having been involved in at least one physical fight during the past 12 months) in selected LMICs, and its relations with potential risk factors. We included 6377 school-going adolescents aged 13–15 years from six Western Pacific (WP) countries that had recently conducted a Global School-based Student Health Survey. Information was gathered through a self-administered anonymous closed-ended questionnaire. The prevalence of adolescent physical fighting varied across countries, ranging from 34.5% in Kiribati to 63.3% in Samoa. The prevalence was higher in boys than in girls, and lower at age 15 than 13–14 years. Physical fighting was significantly associated (pooled odds ratios (ORs), 95% confidence intervals (CIs)) with smoking (1.78, 1.53–2.06), drinking (1.57, 1.33–1.85), drug use (1.72, 1.33–2.23), and missing school (1.72, 1.51–1.95). The association with physical fighting increased with increasing number of joint adverse behaviors (increased from 1.99 (1.73–2.29) for one risk behavior to 4.95 (4.03–6.07) for at least 3 risk behaviors, versus having none of the 4 risk behaviors). The high prevalence of physical fighting and the associations with risk behaviors emphasize the need for comprehensive prevention programs to reduce youth violence and associated risk behaviors.

Violence-Related Behaviors of Adolescents

Examined in this study were the relations between two dimensions of parenting behavior and violence-related behaviors in a sample of 1,221 9th-and 10th-grade adolescents. The results indicated that the higher the perceived responsiveness and demandingness offathers and of mothers, the lower the likelihood that adolescents had hit peers, beat up peers, carried a weapon to school, or threatened a peer with a weapon. When compared with adolescents who perceived high levels of parental responsiveness or demandingness, adolescents who perceived relatively low levels of these dimensions were two to three times more likely to report violence-related behaviors. The results also indicated that parental responsiveness and demandingness were associated more strongly with the violence-related behaviors offemales than with those of males. Studies are needed that evaluate the effects of parenting skills training on adolescent violence and that identify gender differences in how family socialization processes influence adolescents' risks of violence-related behaviors.

Patterns of clustering of six health-compromising behaviours in Saudi adolescents

Background

Clustering of multiple health-compromising behaviours is associated with an increased risk of various chronic diseases. There are few studies on patterns of clustering of multiple health-compromising behaviours in adolescents. Therefore, the aim of this study is to assess how six health-compromising behaviours, namely, low fruit consumption, high sweet consumption, less frequent tooth brushing, low physical activity, physical fighting and smoking, cluster among Saudi male adolescents.

Methods

A representative stratified cluster random sample of 1,335 Saudi Arabian male adolescents living in Riyadh city answered a questionnaire on health-related behaviours. Hierarchical Agglomerative Cluster Analysis (HACA) was used to identify cluster solutions of the six health-compromising behaviours.

Results

HACA suggested two broad and stable clusters for the six health-compromising behaviours. The first cluster included low fruit consumption, less frequent tooth brushing and low physical activity. The second cluster included high sweets consumption, smoking and physical fighting.

Conclusions

The six health-compromising behaviours clustered into two conceptually distinct clusters among Saudi Arabian male adolescents, one reflecting non-adherence to preventive behaviours and the second undertaking of risk behaviours. Clustering of health behaviours has important implications for health promotion.

Prevalence and factors associated with physical fighting among Malaysian adolescents

Physical fighting among adolescents is one manifestation of interpersonal violence that is an important issue globally, but attention to this problem in Malaysia has been limited. We analyzed data available from the Malaysia Global School-Based Health Survey conducted in 2012. Of the 25 507 respondents, 27.4% reported having been in a physical fight in the past 12 months. Being bullied (adjusted odds ratio [aOR] = 3.01; 95% confidence interval [CI] = 2.67-3.39) was significantly and highly associated with involvement in physical fighting. Smoking (aOR = 2.56; 95% CI = 2.20-2.97), males (aOR = 1.77; 95% CI = 1.62-1.93), using drugs (aOR = 1.73; 95% CI = 1.09-2.15), and drinking alcohol (aOR = 1.42; 95% CI = 1.24-1.63) were other factors associated with physical fighting. Parental supervision showed no significant association with physical fighting. These findings indicate that more attention needs to be given to bullying at school by school authorities and parents.

Longitudinal associations between violence and suicidality from adolescence into adulthood

The link between violence and suicide is well documented. Previous studies, however, largely rely on cross-sectional designs or only consider violence as an antecedent of suicide. The purpose of the current study was to investigate the longitudinal relationship between violence and suicide from adolescence into young adulthood. Data were derived from Wave II (1995-1996), Wave III (2001-2002), and Wave IV (2007-2008) of the National Longitudinal Study of Adolescent Health (N = 8,966). We tested (2011-2013) a series of path analysis models in Mplus to determine the longitudinal associations between violence and suicidality. Results from the path analyses indicated that violence and suicidality mutually affect each other from adolescence into young adulthood. We found some evidence that the association between suicidality and violence was stronger for males compared to females, particularly in early and young adulthood. The current study confirms previous findings by demonstrating that violence is a risk factor for future suicide. We also extended the previous literature by demonstrating that a history of suicidality is associated with future risk for violence. Our findings highlight the importance of further integrating prevention efforts to reduce violence and suicidality during adolescence and early/young adulthood.

Physical and emotional health problems experienced by youth engaged in physical fighting and weapon carrying

Then aims of the current study were 1) to provide cross-national estimates of the prevalence of physical fighting and weapon carrying among adolescents aged 11–15 years; (2) To examine the possible effects of physical fighting and weapon carrying on the occurrence of physical (medically treated injuries) and emotional health outcomes (multiple health complaints) among adolescents within the theoretical framework of Problem Behaviour Theory. 20,125 adolescents aged 11–15 in five countries (Belgium, Israel, USA, Canada, FYR Macedonia) were surveyed via the 2006 Health Behaviour in School Aged Children survey. Prevalence was calculated for physical fighting and weapon carrying along with physical and emotional measures that potentially result from violence. Regression analyses were used to quantify associations between violence/weapon carrying and the potential health consequences within each country. Large variations in fighting and weapon carrying were observed across countries. Boys reported more frequent episodes of fighting/weapon carrying and medically attended injuries in every country, while girls reported more emotional symptoms. Although there were some notable variations in findings between different participating countries, increased weapon carrying and physical fighting were both independently and consistently associated with more frequent reports of the potential health outcomes. Adolescents engaging in fighting and weapon carrying are also at risk for physical and emotional health outcomes. Involvement in fighting and weapon carrying can be seen as part of a constellation of risk behaviours with obvious health implications. Our findings also highlight the importance of the cultural context when examining the nature of violent behaviour for adolescents.

Trends and socioeconomic correlates of adolescent physical fighting in 30 countries

BACKGROUND AND OBJECTIVES

No recent international studies provide evidence about its prevalence, trends, or social determinants of physical fighting in adolescents. We studied cross-national epidemiologic trends over time in the occurrence of frequent physical fighting, demographic variations in reported trends, and national wealth and income inequality as correlates.

METHODS

Cross-sectional surveys were administered in school settings in 2002, 2006, and 2010. Participants (N = 493874) included eligible and consenting students aged 11, 13, and 15 years in sampled schools from 30 mainly European and North American countries. Individual measures included engagement in frequent physical fighting, age, gender, participation in multiple risk behaviors, victimization by bullying, and family affluence. Contextual measures included national income inequality, absolute wealth and homicide rates. Temporal measure was survey cycle (year).

RESULTS

Frequent physical fighting declined over time in 19 (63%) of 30 countries (from descriptive then multiple Poisson regression analyses). Contextual measures of absolute wealth (relative risk 0.96, 95% confidence interval 0.93-0.99 per 1 SD increase in gross domestic product per capita) but not income inequality (relative risk 1.01, 95% confidence interval 0.98-1.05 per 1 SD increase) related to lower levels of engagement in fighting. Other risk factors identified were male gender, younger age (11 years), multiple risk behaviors, victimization by bullying, and national homicide rates.

CONCLUSIONS

Between 2002 and 2010, adolescent physical fighting declined in most countries. Specific groups of adolescents require targeted violence reduction programs. Possible determinants responsible for the observed declines are discussed.

The relationship between dating violence and suicidal behaviors in a national sample of adolescents

Relationship violence is a common problem faced by adolescents in the United States. In general, adolescents are at higher risk for relationship victimization than adults (Silverman, Raj, Mucci, & Hathaway, 2001), and females between the ages of 16 and 24 years are at the highest risk of relationship victimization (Rennison, 2001). This study uses data from the 2007 Youth Risk Behavior Surveillance (YRBSS) System (or referred to as Youth Risk Behavior Survey [YRBS]; N = 11,781) of adolescents between the ages of 14 and 17 years to estimate two logistic regression models on the association between relationship violence and suicidal behaviors controlling for variables such as sexual assault and drug use. The findings indicated that victimized adolescents are at higher risk for planning and/or attempting suicide compared to nonvictimized adolescents. Implications for research and practice are explored.

Injuries and risk-taking behaviours in Portuguese adolescents: Highlights from the health behaviour in school-aged children survey

AIM

Injuries in adolescence are an important public health problem and a major cause of morbidity and mortality in this age group. This study aimed to determine the behaviour profile associated to risk of injury and the differences between genders, region and ethnic origin.

METHODS

A cross-sectional study design of a nationally representative sample of 1581 adolescents of the Portuguese Health Behaviour in School-Aged Children study.

RESULTS

An occurrence of one injury-related event in the previous year was reported by 21.4% of the respondents and 5.9% referred having more than one injury-related event. Boys reported higher frequency of those events when compared to girls, and non-Portuguese subjects referred higher frequency of events. Scoring higher in violence-related behaviour and psychosomatic complaints was associated to higher chances of referring more than one injury-related event.

CONCLUSION

Gender, social background and behaviour profile are factors that seem to influence the risk of injuries. This information should guide those involved in the planning of injuries prevention programs in youth.

Psychiatric risk factors in pediatric hand fractures

BACKGROUND

Various psychopathologies are becoming more commonly recognized as a cause of violence in the pediatric population. In this study, we aimed to investigate (1) the link between the pediatric hand fractures and psychopathology and (2) the prevalence of repeated hand injuries in the same population.

METHOD

We retrospectively reviewed 208 patients treated at a level 1 trauma center and recorded age, sex, past medical and psychiatric history as well as type, etiology, and treatment of hand fractures for analysis. A mental health professional has confirmed psychiatric diagnosis. Fisher exact tests and independent samples t tests were performed for analysis.

RESULTS

Metacarpal fractures were the most common hand fracture seen in patients with a psychiatric history (P=0.05). More than half (52.9%, n=18) of the patients with a positive psychiatric history had a subsequent injury whereas only 14.6% (n=29) of patients negative for psychiatric issues had a subsequent injury (P<0.001). The most common psychiatric disorders were attention-deficit hyperactivity disorder, depression, and substance abuse. Psychiatric diagnosis was significantly more frequent in those sustaining an injury due to punching compared with other mechanisms (38% vs. 8%, P<0.001). Twenty one (38%) of the 55 children whose injuries were due to punching had a documented psychiatric diagnosis. Of the 55 injuries due to a punching mechanism, 39 (68.4%) sustained metacarpal fractures and 18 (31.6%) sustained another type of hand fracture (P<0.001).

CONCLUSIONS

The high rate of repeated hand injuries in children with punching may require in depth psychiatric assessment due to its high association with mental illness.

LEVEL OF EVIDENCE

IV.

Racial, ethnic, and sex differences in the associations between violence and self-reported health among US high school students

BACKGROUND

Involvement in interpersonal violence or suicidal behaviors can have a significant impact on an adolescent's physical health. Similarly, previous research has suggested that lived experiences, more than the presence or absence of physical ailments, can significantly influence self-assessed health status among adolescents. The purpose of this study was to examine the cross-sectional associations between involvement in violence and poor or fair self-reported health among US high school students.

METHODS

Data were obtained from the 2005 national Youth Risk Behavior Survey (n = 13,953). Logistic regression analyses were conducted to determine the associations between violence-related measures and self-reported health while controlling for demographic characteristics and potential confounders. Analyses are presented for students overall and stratified by sex and race/ethnicity.

RESULTS

Overall, 7.2% of students reported fair or poor self-rated health. Having been in a physical fight, having been injured in a physical fight, having attempted suicide, and having not gone to school because of safety concerns were significantly associated with fair or poor self-rated health after controlling for demographic characteristics and other potential confounders. Differences associated with race/ethnicity and sex are identified.

CONCLUSIONS

Four of the 5 violence-related measures included in these analyses were significantly associated with fair or poor self-rated health. Future studies should consider the impact of involvement in violent behaviors and perceptions of both physical and mental well-being.

Violent adolescents and their educational environment: a multilevel analysis

OBJECTIVE

This study examined the respective roles of personal and environmental factors in youth violence in a nationally representative sample of 7548 postmandatory school students and apprentices ages 16-20 years in Switzerland.

METHODS

Youth violence was defined as having committed at least one of the following in the previous 12 months: attacking an adult, snatching something, carrying a weapon, or using a weapon in a fight. Different ecological levels were tested, resulting in a three-level model only in males (individual, classroom, and school) as the low prevalence of female violence did not allow for a multilevel analysis. Dependent variables were attributed to each level. For males, the classroom level (10%) and the school level (24%) accounted for more than one third in interindividual variance.

RESULTS

Factors associated with violence perpetration in females were being a victim of physical violence and sensation seeking at the individual level. In males, practicing unsafe sex, sensation seeking, being a victim of physical violence, having a poor relationship with parents, being depressed, and living in a single-parent household at the individual level; violence and antisocial acts at the classroom level; and being in a vocational school at the school level showed a correlation with violence perpetration.

CONCLUSION

Interventions at the classroom level as well as an explicit school policy on violence and other risk behaviors should be considered a priority when dealing with the problem of youth violence. Furthermore, prevention should take into account gender differences.

The relation between self-concept and social functioning in adolescence

A model of the relation between self-concept and internalizing and externalizing problem behaviours in adolescence, with the self-concept influencing problem behaviours (S-->IE), was assessed using a sample of 277 Swedish adolescents. The model was tested in a path analysis with data from Youth Self Report (YSR) and Structural Analysis of Social Behaviour (SASB) questionnaires. Consistent with the model, a positive self-concept was found to be the most important factor for adjustment and for protection against common problem behaviour. A negative self-concept combined with female gender were risk factors for internalized problems. Self-control had only a direct effect on externalizing behaviour for boys. Adolescents of 15, 16 years of age had a stronger relationship between a negative self-concept and externalizing problem behaviour than younger and older adolescents. Internalizing problem behaviours such as anxiety and depression predicted aggressive and delinquent behaviour. These findings highlight the importance of promoting of a positive self-concept in every adolescent in various psychosocial contexts.

Suicidal behavior amongst adolescent students in south Delhi

OBJECTIVE

To study the prevalence of suicidal behavior and its epidemiological correlates amongst adolescent students in south Delhi.

SETTINGS AND DESIGN

A cross-sectional study in three schools and two colleges in south Delhi.

PARTICIPANTS

A total of 550 adolescent students aged 14 to 19 years selected by cluster sampling.

STATISTICAL ANALYSIS

Proportions, chi square test, bivariate logistic regression.

RESULTS

About 15.8% reported having thought of attempting suicide, while 28 (5.1%) had actually attempted suicide, both being more in females than in males. Statistically significant associations were observed with the age of the student, living status of parents, working status of mother, and whether the student was working part-time. The two variables found significant on multivariate analysis were female gender and the number of role models the student had ever seen smoking or drinking.

CONCLUSION

The prevalence of suicide-risk behavior was found to be quite high and is a matter that should evoke public health concern.

The associations between health risk behaviours and suicidal ideation and attempts in a nationally representative sample of young adolescents

OBJECTIVE

To examine associations between health risk behaviours and suicidal ideation and attempts in Canadian adolescents aged 12 to 13 years. Young adolescents think about and attempt suicide. However, most existing research on suicide has been conducted on individuals aged 15 years and older.

METHOD

The present study examined a nationally representative Canadian sample of adolescents aged 12 to 13 years (n=2090). Health risk behaviours included disruptive (shoplifting, physical fighting, damaging property, fighting with a weapon, carrying a knife, and gambling), sexual (petting below the waist and sexual intercourse), and substance use behaviours (smoking cigarettes, consuming alcohol, marijuana or hash, and glue or solvents). Unadjusted and adjusted (for all significant health risk behaviour and psychiatric symptoms) models were tested.

RESULTS

All health risk behaviours were common among male and female adolescents. In unadjusted models, almost all health risk behaviours were associated with suicidal ideation and attempts among adolescent boys. In adjusted models, only damaging property, sexual intercourse, and smoking cigarettes remained statistically associated with suicidal ideation, while smoking cigarettes and using marijuana or hash remained statistically associated with suicide attempts among adolescent boys. All health risk behaviours were statistically associated with suicidal ideation and attempts among female adolescents in unadjusted models. In adjusted models, only carrying a knife remained statistically associated with suicidal ideation, while shoplifting and gambling remained statistically associated with suicide attempts among adolescent girls.

CONCLUSIONS

Health risk behaviours among young adolescents are associated with suicidal ideation and attempts among young adolescents. Recognizing health risk behaviours among young adolescents may be one means of understanding who among them is at increased risk of suicidality.

Environmental stressors and violence: lead and polychlorinated biphenyls

Many environmental risk factors for antisocial and violent behavior have been described. In recent years, this topic has become widely researched in the fields of environmental health, psychology, sociology, and many other disciplines. The results from a myriad of studies have shown that the etiologies of violent and aggressive behavior range from definitive biological environmental stressors like lead or polychlorinated biphenyls to various socio-cultural environmental stressors, such as social, economic, and racial factors. The aim of this paper is (a) to provide an overview of the specific effects of the environmental stressors that have been associated with violent behavior, and (b) to discuss current policies and regulations implemented by the United States government for minimizing exposure to environmental toxins contributing to violence in our society.

Prevalence and associated factors of physical fighting among school-going adolescents in Namibia

BACKGROUND

Interpersonal physical violence is an important global public health concern that has received limited attention in the developing world. There is in particular a paucity of data regarding physical violence and its socio-demographic correlates among in-school adolescents in Namibia.

METHODS

We analysed cross-sectional data from the Namibia Global School-Based Health Survey (GSHS) conducted in 2004. We aimed to estimate the prevalence and socio-demographic correlates of physical fighting within the last 12 months. We obtained frequencies of socio-demographic attributes. We also assessed the association between self-reported history of having engaging in a physical fight and a selected list of independent variables using logistic regression analysis.

RESULTS

Of the 6283 respondents, 50.6% (55.2% males and 46.2% females) reported having been in a physical fight in the past 12 months. Males were more likely to have been in a physical fight than females (OR = 1.71, 95% CI (1.44, 2.05)). Smoking, drinking alcohol, using drugs and bullying victimization were positively associated with fighting (OR = 1.91, 95% CI (1.49, 2.45); OR = 1.48, 95% CI (1.21, 1.81); OR = 1.55, 95% CI (1.22, 1.81); and OR = 3.12, 95% CI (2.62, 3.72), respectively). Parental supervision was negatively associated with physical fighting (OR = 0.82, 95% CI (0.69, 0.98)). Both male and female substance users (cigarette smoking, alcohol and drug use) were more likely to engage in physical fighting than non-substance users (OR = 3.53, 95% CI (2.60, 4.81) for males and OR = 11.01, 95% CI (7.25, 16.73) for females). Parental supervision was negatively associated with physical fighting (OR = 0.85, 95% CI (0.72, 0.99)).

CONCLUSION

Prevalence of physical fighting within the last 12 months was comparable to estimates obtained in European countries. We also found clustering of problem behaviours or experiences among adolescents who reported having engaged in physical violence in the past 12 months. There is a need to bring adolescent violent behaviour to the fore of the public health agenda in Namibia.

Aggressive behaviors in the adolescent children of HIV-positive and HIV-negative drug-abusing fathers

This study examined aggressive behaviors in the adolescent children of HIV-positive and HIV-negative drug-abusing fathers. Data were collected via individual structured interviews of low-income, predominantly African American and Hispanic, father-child dyads (N = 415). Structural Equation Modeling was used to assess the interrelationship of several latent constructs with respect to adolescent aggression. Results showed a mediational model linking paternal attributes (including HIV status) and ecological factors with the father-child relationship, which impacted peer influences and the adolescent's vulnerable personality, which was the most proximal construct to aggressive behaviors. Ecological factors were also mediated by peer influences and directly linked with adolescent aggression.

Cross-national study of fighting and weapon carrying as determinants of adolescent injury

OBJECTIVES

We sought to (1) compare estimates of the prevalence of fighting and weapon carrying among adolescent boys and girls in North American and European countries and (2) assess in adolescents from a subgroup of these countries comparative rates of weapon carrying and characteristics of fighting and injury outcomes, with a determination of the association between these indicators of violence and the occurrence of medically treated injury.

DESIGN AND SETTING

Cross-sectional self-report surveys using 120 questions were obtained from nationally representative samples of 161082 students in 35 countries. In addition, optional factors were assessed within individual countries: characteristics of fighting (9 countries); characteristics of weapon carrying (7 countries); and medically treated injury (8 countries).

PARTICIPANTS

Participants included all consenting students in sampled classrooms (average age: 11-15 years).

MEASURES

The primary measures assessed included involvement in physical fights and the types of people involved; frequency and types of weapon carrying; and frequency and types of medically treated injury.

RESULTS

Involvement in fighting varied across countries, ranging from 37% to 69% of the boys and 13% to 32% of the girls. Adolescents most often reported fighting with friends or relatives. Among adolescents reporting fights, fighting with total strangers varied from 16% to 53% of the boys and 5% to 16% of the girls. Involvement in weapon carrying ranged from 10% to 21% of the boys and 2% to 5% of the girls. Among youth reporting weapon carrying, those carrying handguns or other firearms ranged from 7% to 22% of the boys and 3% to 11% of the girls. In nearly all reporting countries, both physical fighting and weapon carrying were significantly associated with elevated risks for medically treated, multiple, and hospitalized injury events.

CONCLUSIONS

Fighting and weapon carrying are 2 common indicators of physical violence that are experienced by young people. Associations of fighting and weapon carrying with injury-related health outcomes are remarkably similar across countries. Violence is an important issue affecting the health of adolescents internationally.

The intention of adolescents to carry a knife or a gun: a study of low-income African-American adolescents

PURPOSE

To examine whether African-American inner-city adolescents are independently motivated by a fear of victimization or by delinquency to carry a knife or gun.

METHODS

A household sample of 130 female and 93 male African-American adolescents, aged 13-19 years old, were queried about their fear of victimization, history of delinquency, and intention to carry a knife or a gun in the next 3 months.

RESULTS

A high intention to carry a knife was reported by 27% of the males and 35% of the females. A high intention to carry a gun was reported by 25% of the males and 9% of the females. The intention to carry a knife was independently associated with a history of delinquency in females (odds ratio [OR] = 3.0; 95% confidence interval [CI] = 1.4-6.2) and males (OR = 4.7; 95% CI = 1.7-13.3). It was not associated with a fear of victimization. The intention to carry a gun was independently associated with fear of victimization in females (OR = 4.5; 95% CI = 1.1-17.7) and males (OR = 3.3; 95% CI = 1.1-9.9). It was also independently associated with a history of delinquency in females (OR = 4.1; 95% CI = 1.1-16.3) and males (OR = 11.7; 95% CI = 3.1-44.7).

CONCLUSIONS

Delinquency may play a role in motivating inner-city African-American adolescents to carry a knife, whereas both delinquency and fear of victimization may influence adolescents' motivation to carry a gun.

Suicidal ideation and aggressiveness in school-aged youths

This study set out to explore the frequency and correlates of suicidal ideation in a community sample of school-aged adolescents living in a northeastern area of Italy. The study involved a mixed male-female sample of 1,000 adolescents, corresponding to 10% of the young population aged 15-19 in the district. We investigated psychological distress through the revised Symptom Checklist (SCL-90-R), from which we also derived our indicators on suicidality (items concerning hopelessness and suicidal ideation). Propensity to aggression was measured with an Italian version of the Aggression Questionnaire. Females scored significantly higher than males on all SCL-90-R subscales, with the exception of the hostility subscale. In our sample, 30.8% of females and 25.3% of males reported having thought about suicide; one adolescent out of 20 reported suicidal ideation of high intensity (5% out of the total sample in both genders). Males scored significantly higher than females on the Aggression Questionnaire. Both males and females who reported suicidal feelings had significantly higher scores on the Aggression Questionnaire than did those who denied suicidal ideation. Suicidal ideation is a rather widespread occurrence among adolescents and correlates with other indicators of psychological distress. Psychological distress in adolescence might also be expressed through turbulent behaviors and conduct disorders. Identification of the mental disorders underlying a higher propensity to aggression might help to prevent other negative outcomes such as suicide.

Some theoretical models and constructs generic to substance abuse prevention programs for adolescents: possible relevance and limitations for problem gambling

For the past several years the author and his colleagues have explored the area of how social psychological constructs and theoretical models can be applied to the prevention of health threatening behaviors in adolescents. In examining the need for the development of gambling prevention programs for adolescents, it might be of value to consider the application of such constructs and theoretical models as a foundation to the development of prevention programs in this emerging problem behavior among adolescents. In order to provide perspective to the reader, the present paper reviews the history of various psychosocial models and constructs generic to programs directed at prevention of substance abuse in adolescents. A brief history of some of these models, possibly most applicable to gambling prevention programs, are presented. Social inoculation, reasoned action, planned behavior, and problem behavior theory, are among those discussed. Some deficits of these models, are also articulated. How such models may have relevance to developing programs for prevention of problem gambling in adolescents is also discussed. However, the inherent differences between gambling and more directly health threatening behaviors such as substance abuse must, of course, be seriously considered in utilizing such models. Most current gambling prevention programs have seldom been guided by theoretical models. Developers of gambling prevention programs should consider theoretical foundations, particularly since such foundations not only provide a guide for programs, but may become critical tools in evaluating their effectiveness.

Psychopathology and delinquency in adolescents: a descriptive and developmental perspective

The current article presents a review on psychiatric pathology in delinquent adolescents. The putative developmental significance of this co-occurrence is discussed within Moffitt's [Psychol. Rev. 100 (1993) 674] developmental framework on antisocial behavior. Articles on psychopathology in delinquent adolescents were retrieved through search engines (MEDLINE, Psychlit) and by exploration of references in those articles. Substantial evidence is at hand that delinquent adolescents have higher rates of externalizing and internalizing disorders when compared to adolescents in the general population. Although substantial limitations hamper interpretation of the findings, the marked similarities across a diversity of samples from different countries suggest that the findings are fairly generalizable. Evidence was found for differences in prevalence and developmental significance of psychiatric pathology between adolescent limited (AL) offenders and life-course persistent (LCP) offenders. Although psychopathology was more severe in LCP offenders, AL offenders still had significant and potential harmful levels of psychopathology. These findings emphasize the necessity of developing mental health services to delinquent adolescents and the necessity of adequate diagnostic and therapeutic interventions in these adolescents.

Suicidal behavior and violence in male adolescents: a school-based study

OBJECTIVE

To investigate characteristics of suicidal and violent behavior in a community school sample of adolescents.

METHOD

Self-report questionnaires were administered to 794 male students (aged 12-18 years) from Antwerp, Belgium. Subjects were classified into four groups: a suicidal-only (n = 40; suicidal ideation and/or self-harming behavior), a violent-only (n = 142), a suicidal-violent (n = 21), and a control group (n = 591).

RESULTS

Compared with controls, higher levels of internalizing problems, risk-taking behavior (substance use, diminished perception of risk, sensation seeking), and aggression were found in the comparison groups. The suicidal-violent group had the highest levels of depression, somatization, overt and covert aggression, and risk-taking behavior. Compared with the suicidal-only group, the violent-only group had less depression, anxiety, and covert aggression, but higher levels of overt aggression, sensation seeking, diminished perception of risk, and marijuana use.

CONCLUSIONS

Although adolescent suicidal and violent behavior are both related to internalizing problems, aggression, and risk-taking behavior, marked differences in severity and nature exist in these relationships. Differentiation of suicidal youths based on the presence or absence of violent behavior may add to our understanding of suicidal phenomena and may thus have important clinical consequences.

Adolescent cocaine exposure and offensive aggression: involvement of serotonin neural signaling and innervation in male Syrian hamsters

Repeated low-dose cocaine treatment (0.5 mg/kg/day) during adolescence facilitates offensive aggression in male Syrian hamsters (Mesocricetus auratus). The current study assessed whether adolescent cocaine-facilitated offensive aggression was inhibited by increased serotonin activity and if cocaine exposure during this developmental period influenced serotonin development in the primary aggression areas of hamster brain. In a first experiment, hamsters were treated with low doses of cocaine throughout adolescence and then scored for offensive aggression following the systemic administration of vehicle or fluoxetine, a selective serotonin reuptake inhibitor. Vehicle-treated hamsters showed high levels of offensive aggression, while treatment with fluoxetine inhibited the cocaine-facilitated aggressive response. Only one out of ten fluoxetine-treated animals both attacked and bit intruders, compared to nine out of ten saline-treated animals. In a second experiment, hamsters were administered low doses of cocaine or saline throughout adolescence, tested for offensive aggression, and then examined for differences in serotonin afferent innervation to regions of the hamster brain implicated in aggressive responding. Aggressive cocaine-treated hamsters showed significant reductions (35-50%) in the number of serotonin immunoreactive varicosities and fibers in several aggression areas, including the anterior hypothalamus, lateral septum, medial amygdala, and bed nucleus of the stria terminalis. Together, these results support a role for serotonin innervation and function in adolescent cocaine-facilitated offensive aggression.

Urban elementary school students' perceptions of fighting behavior and concerns for personal safety

This study assessed urban elementary school students' experience with weapon carrying and violence, concerns for personal safety, and perceptions of passive and direct interventions in resolving fights. The survey was completed by 1,912 urban students in the fourth and fifth grades. This cross-sectional study found that one in 12 students reported weapon carrying one or more times during the past month. One-third indicated that they would hit peers back if struck by them. One-quarter of students did not feel safe going to or from school, and 23%-43% worried about being physically attacked in or around school. Adjusted odds ratios and 95% confidence intervals were calculated using logistic regression. Significant associations were found between the independent variables of age, race, gender, and academic success (grades) and the dependent variables of weapon carrying, hitting a peer back, concerns of safety, and passive solutions or direct interventions for peer fighting.

Violent behaviors in early adolescent minority youth: results from a "middle school youth risk behavior survey"

OBJECTIVES

To describe the prevalence and characteristics of violence and violence-related behaviors among six populations of U.S. minority adolescents in grades 6-8.

METHODS

Six thousand four hundred non-White adolescents were recruited from six sites that were part of a collaborative project. Surveys were administered either during the school day or at community facilities. All students at each site were asked 10 questions about recent violence-related behaviors (including use of threats, fighting, weapon carrying, and weapon use). Prevalence of each violence-related behavior was reported within and across sites, and stratified by race/ethnicity, gender, age, and other characteristics expected to influence the behaviors.

RESULTS

Sixty-six percent (66%) of the middle school students sampled reported being involved in some type of recent fighting and/or weapon-related behaviors. Sixty-one percent (61%) indicated some form of fighting behavior in the past 3 months (threatening to beat someone up, physical fighting, and/or being hurt in a fight). Thirty percent (30%) of participating youth reported one or more weapon-related behaviors (threatening to use a weapon, carrying a weapon, using a weapon, and/or being cut, stabbed or shot at). Reported gun carrying among males varied depending upon site, but was as high as 20%. Grade in school was positively associated with reported violent behaviors. Adolescents who reported living full-time with a parent or parent figure, and those who reported religious observance or beliefs, were less likely to report violence involvement. All violence-related behaviors were more common among male than female adolescents.

CONCLUSIONS

Violence prevention efforts should begin in elementary school and continue throughout adolescence. Programs should be prepared to provide services or referrals to victims of violence, implement programs tailored toward females as well as males, and build partnerships with churches and other community organizations in which youth are involved.

Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation

OBJECTIVE

To identify the independent psychosocial and risk behavior correlates of suicidal ideation and attempts.

METHOD

The relationships between suicidal ideation or attempts and family environment, subject characteristics, and various risk behaviors were examined among 1,285 randomly selected children and adolescents, aged 9 through 17 years, of whom 42 (3.3%) had attempted suicide and 67 (5.2%) had expressed suicidal ideation only. The youths and their parents were enumerated and interviewed between December 1991 and July 1992 as part of the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study.

RESULTS

Compared with subjects with suicidal ideation only, attempters were significantly more likely to have experienced stressful life events, to have become sexually active, to have smoked more than one cigarette daily, and to have a history of ever having smoked marijuana. After adjusting for sociodemographic characteristics, a statistically significant association was found between suicidal ideation or attempt and stressful life events, poor family environment, parental psychiatric history, low parental monitoring, low instrumental and social competence, sexual activity, marijuana use, recent drunkenness, current smoking, and physical fighting. Even after further adjusting for the presence of a mood, anxiety, or disruptive disorder, a significant association persisted between suicidal ideation or attempts and poor family environment, low parental monitoring, low youth instrumental competence, sexual activity, recent drunkenness, current smoking, and physical fighting.

CONCLUSION

Low parental monitoring and risk behaviors (such as smoking, physical fighting, alcohol intoxication, and sexual activity) are independently associated with increased risk of suicidal ideation and attempts, even after adjusting for the presence of psychiatric disorder and sociodemographic variables.

Adolescent suicide attempts: risks and protectors

OBJECTIVE

In 1997, suicide was the third leading cause of death among 10- to 19-year-olds in the United States, with the greatest increases in suicide rates in the previous decade experienced by black and other minority youth. The purpose of this study was to identify risk and protective factors for suicide attempts among black, Hispanic, and white male and female adolescents.

METHODS

We used data from the National Longitudinal Study of Adolescent Health, conducted in 1995 and 1996. A nationally representative sample of 13 110 students in grades 7 through 12 completed 2 in-home interviews, an average of 11 months apart. We examined Time 1 factors at the individual, family, and community level that predicted or protected against Time 2 suicide attempts.

RESULTS

Perceived parent and family connectedness was protective against suicide attempts for black, Hispanic, and white girls and boys, with odds ratios ranging from 0.06 to 0.32. For girls, emotional well-being was also protective for all of the racial/ethnic groups studied, while a high grade point average was an additional protective factor for all of the boys. Cross-cutting risk factors included previous suicide attempt, violence victimization, violence perpetration, alcohol use, marijuana use, and school problems. Additionally, somatic symptoms, friend suicide attempt or completion, other illicit drug use, and a history of mental health treatment predicted suicide attempts among black, Hispanic, and white females. Weapon-carrying at school and same-sex romantic attraction were predictive for all groups of boys. Calculating the estimated probabilities of attempting suicide for adolescents with increasing numbers of risk and protective factors revealed that the presence of 3 protective factors reduced the risk of a suicide attempt by 70% to 85% for each of the gender and racial/ethnic groups, including those with and without identified risk factors.

CONCLUSIONS

In these national samples of black, Hispanic, and white youth, unique and cross-cutting factors derived from a resiliency framework predicted or protected against attempting suicide. In addition to risk reduction, promotion of protective factors may offer an effective approach to primary as well as secondary prevention of adolescent suicidal behavior.

Fighting among Jerusalem adolescents: personal and school-related factors

PURPOSE

To study the prevalence of physical fighting among youth and its association with personal and school-related factors.

METHODS

Pupils in the 8th and 10th grades (n = 1182, ages 13-16 years) in 11 Jerusalem secular and religious schools anonymously completed the World Health Organization questionnaire from the Health Behavior in School Children study. The unit of analysis was defined as the number of times the student was involved in physical fighting during the past year. The independent variables studied were sociodemographic characteristics, personal, and school-related factors including teachers, peers, and family.

RESULTS

Fighting at least once was reported by 76% of boys and 26% of girls; 6% of boys who were involved in fights at least once and 16% more than once required medical treatment. For boys, bullying others, poor health and mental health score, and perception of teachers that the pupil was a below-average student significantly increased the odds ratio (OR) for fighting more than once in the past year. Among girls, poor mental health, poor parental support on school matters, bullying, and being bullied by others increased the OR for fighting.

CONCLUSIONS

Fighting is a highly prevalent behavior among adolescents irrespective of their socioeconomic background. Determinants differ by gender, and intervention programs should focus on the gender-specific determinants.

Psychosocial and environmental correlates of violence perpetration among African-American urban youth

PURPOSE

To ascertain the proportion of youths involved in acts of violence; to examine individual, social, and environmental factors associated with perpetration; and to determine the relationship among victimization, witnessing, and perpetration of violence.

METHODS

A cross-sectional survey was completed by 349 volunteer males and females, aged 9-15 years, 96% of whom were African-American. The youths were recruited from recreation centers associated with 10 public-housing communities in an eastern city. Survey instruments included the Child Health and Illness Profile, Survey of Children's Exposure to Community Violence, and other standardized questionnaires. Statistical analyses included Chi-square, correlation, regression, and test for linear trends.

RESULTS

Half of the youths self-reported at least one act of violence perpetration, with similar distributions among males and females. One-third of the youths reported both personal victimization and the witnessing of violent events. Victim and witness status were moderately correlated. Individual risk behaviors and victimization made significant contributions to perpetration status. Further analysis demonstrated a linear relationship between acts of perpetration and number of victimization events.

CONCLUSIONS

Participation in problem behaviors may place youths in circumstances in which they may be victim, witness, or aggressor. The chronic and high levels of community violence to which many youths are exposed are likely to contribute to an individual's participation in acts of violence.

Risk behavior in a community sample of children and adolescents

OBJECTIVES

First, to investigate whether there is covariation between risk behaviors, including suicidality, in a community probability sample of children and adolescents; and second, to investigate whether risk behavior is associated with selected potential correlates.

METHOD

A sample of 9- to 17-year-old youths (N = 1,285) and their caretakers were interviewed in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. The risk behaviors were marijuana smoking, alcohol use, intercourse, fighting, cigarette smoking, and suicidal ideation/attempts. Relationships between the risk behaviors were described using odds ratios. Linear regression analyses of an index of risk behavior on the selected potential correlates of risk behavior were conducted.

RESULTS

There were significant relationships between all pairs of risk behaviors. The score on the index of risk behavior was associated with stressors, lack of resources, family psychiatric disorder, psychopathology, and functional impairment.

CONCLUSIONS

Clinicians should be alerted to the possibility of risk behaviors, especially in children and adolescents engaging in other risk behaviors and those with inadequate resources, stressors, functional impairment, or psychopathology.

The relationship between sexual abuse and sexual risk among high school students: findings from the 1997 Massachusetts Youth Risk Behavior Survey

OBJECTIVE

To assess whether adolescents with a history of sexual abuse were more likely than those with no such history to engage in sexual risk behaviors.

METHODS

Data for this study were obtained through the 1997 Massachusetts Youth Risk Behavior Survey, a self-report questionnaire administered to a representative sample of 9th through 12th graders (N = 4,014) to assess a variety of adolescent risk behaviors. Only sexually experienced adolescents (n = 1,610; female = 779, male = 831) were included in the present study. Logistic regression models were constructed to examine the relationship of sexual abuse history to sexual risk behaviors. Adolescents were considered as having a history of sexual abuse if they reported ever having had sexual contact against their will.

RESULTS

Almost one-third of sexually experienced adolescent girls (30.2%) and one-tenth (9.3%) of adolescent boys reported a history of sexual abuse. After controlling for related demographics and risk behaviors, sexually abused female students were significantly more likely than those without such a history to have had earlier first coitus (OR = 2.2, 95%CI = 1.46-3.47), to have had three or more sex partners ever (OR = 2.5, 95%CI = 1.71-3.68), and to have been pregnant (OR = 1.9, 95%CI = 1.21-2.92). Sexually abused male students were significantly more likely than those without such a history to have ever had multiple partners (OR = 3.2, 95%CI = 1.56-6.57), to have had multiple sex partners in the past 3 months (OR = 2.9, 95%CI = 1.71-3.68), and to have engaged in sex resulting in pregnancy (OR = 3.4, 95%CI = 1.53-7.34).

CONCLUSION

Both adolescent girls and boys with a history of sexual abuse report greater sexual risk-taking than those without such a history. However, although sexual abuse is more prevalent among girls than boys, the impact of sexual abuse on sexual risk appears to be even greater for boys. Programs addressing both sexual abuse and sexual risk must be made available to all adolescents.

Chronic low-dose cocaine treatment during adolescence facilitates aggression in hamsters

Cocaine abuse during adolescence represents a significant health risk because of the potential for both acute and long-term negative physical and psychological sequelae, including increased aggressive behavior. This study examined the effects of chronic adolescent cocaine exposure on aggression in an animal model. It was hypothesized that chronic cocaine exposure during adolescence predisposes animals to heightened levels of aggressive behavior. To test this hypothesis, adolescent male golden hamsters (Mesocricetus auratus) were administered cocaine hydrochloride during their entire adolescent development (Postnatal Days 27-54) and then tested for offensive aggression using the resident-intruder model. Animals treated with low-dose cocaine during adolescence showed significantly elevated measures of offensive aggression (i.e., increased number of bites, attacks, and decreased latencies to bite), whereas measures of social communication, sexual motivation and motor activity remained constant. Cocaine-treated animals did not differ in body weight gain from controls, suggesting no dramatic physiological effects of adolescent cocaine exposure on body growth at the doses tested.

Suicide ideation among US college students. Associations with other injury risk behaviors

Suicide, the endpoint of a continuum that begins with suicide ideation, is the third leading cause of death among the US college-aged population. The first and second leading causes of death among this age group, unintentional injury and homicide, may also be linked to suicide ideation. We used data from the National College Health Risk Behavior Survey to examine the association between suicide ideation and injury-related behaviors among 18- to 24-year-old college students. Students who reported suicide ideation were significantly more likely than students who did not report considering suicide to carry a weapon, engage in a physical fight, boat or swim after drinking alcohol, ride with a driver who had been drinking alcohol, drive after drinking alcohol, and rarely or never used seat belts. Given this clustering of injury-related risk behaviors, college prevention programs should aim to reduce risks for injuries comprehensively, rather than addressing each risk behavior separately.

The neglected link between eating disturbances and aggressive behavior in girls

OBJECTIVES

Research has linked eating disturbances with behavioral impulsivity. Little is known, however, about whether eating disturbances and aggressive behavior have a tendency to co-occur in the same girls. This article assesses the eating disturbance-aggressive behavior association and then examines the extent to which these factors confer a risk on drug use and attempted suicide.

METHOD

Survey data were gathered from 3,630 girls in grades 6 through 12 in the upper Midwest. Girls responded anonymously to questions regarding binge eating and purging, dietary restriction, aggressive behavior, drug use, and attempted suicide. Logistic regression analysis was used to assess the unique contribution of demographic variables, eating disturbances, and aggression on drug use and attempted suicide.

RESULTS

Eating disturbances were significantly associated with aggressive behavior. Girls who endorsed binge eating and purging or dietary restriction had odds of aggressive behavior 2 to 4 times higher than girls who did not endorse these items. Logistic regression revealed that eating disturbances and aggressive behavior were significantly associated with both drug use and attempted suicide.

CONCLUSIONS

Eating disturbances are significantly associated with aggressive conduct in adolescent girls. The constellation of eating disturbances and aggressive behavior is associated with a greater risk of drug use and attempted suicide.

Ten years after: examination of adolescent screening questions that predict future violence-related injury

PURPOSE

To determine which screening questions used in routine adolescent health care maintenance visits correlate with subsequent violence-related injury.

METHODS

A prospective cohort study was undertaken of adolescents initially seen at the East Boston Neighborhood Health Center (EBNHC) in 1986. Risk factor data were collected based on the adolescent health intake form in the medical records. The primary outcome measure, time until first violence-related injury was determined through identification on chart review of the treatment of any such injuries at the urgent care center at EBNHC in the subsequent 10 years. Kaplan-Meier survival statistics and Cox proportional hazards models were used to account for loss of patients to follow-up.

RESULTS

Median follow-up for this sample was >5 five years. Male gender, cigarette smoking, alcohol use, other drug use, poor relationships with parents, not being in school or failing school, and history of fighting in the past year, predicted violence-related injury within the follow-up period. The number of fights in the past year appeared to have a dose-response effect on risk of subsequent violence-related injury. A simple screening instrument consisting of items concerning school status, drug use, and fighting history was used to stratify youth into low, moderate, and high risk of violence-related injury during the follow-up period.

CONCLUSIONS

These results suggest that a simple three-item screening instrument may be used to stratify the risk of future injury at the time of adolescent health maintenance visits. Further research is indicated to validate this finding in other populations. Interventions designed to assist adolescents who are not in school or who have drug use problems should also incorporate violence prevention strategies.

Age-within-school-class and adolescent gun-carrying

BACKGROUND

Intentional injuries (suicide and homicide) are a leading causes of morbidity and mortality in the United States. Firearms cause approximately 70% of these fatal intentional injuries. Risk factors associated with gun-carrying in adolescent populations include male gender, smoking, alcohol use, drug use, and number of sexual partners. Current knowledge of these and other risk factors has provided limited benefit because many are no more obvious to the clinician a priori than is the tendency to carry guns. Increasing relative age of a student within school class is an easily measured parameter that has been associated with behavioral problems, absenteeism, negative self-image, and high dropout rates.

OBJECTIVE

To characterize the association between relative student age-within-class and tendency to carry firearms.

DESIGN

The Massachusetts Youth Risk Behavior Survey, which collects data on demographic characteristics, risk behaviors, and health outcomes.

PARTICIPANTS

A randomly selected group of 3153 Massachusetts students in grades 9 through 11.

PRIMARY OUTCOME MEASURE

The odds of firearms-carrying comparing older to average-age and younger students.

RESULTS

Using multivariate logistic regression, seven risk factors predicted gun-carrying with statistically significant results: older age-within-class (OR: 2.12; 95% CI: 1.09-4.12), male gender (OR: 4.95; 95% CI: 3.01-8.15), black race (OR: 2.49; 95% CI: 1.20-5.14), gang membership (OR: 7.22; 95% CI: 4.51-11.56), missing school out of concern for safety (OR: 2.50; 95% CI: 1.30-4.80), seeking medical treatment after a fight (OR: 4.47; 95% CI: 2.56-7. 78), and fighting without seeking medical treatment (OR: 5.73; 95% CI: 3.09-10.60).

CONCLUSION

Older 9th-, 10th-, and 11th-grade students are more likely than their classmates to carry firearms. This information may prove helpful in identifying high-risk students and targeting prevention strategies.

The role of the pediatrician in youth violence prevention in clinical practice and at the community level. American Academy of Pediatrics Task Force on Violence

Violence and violent injuries are a serious threat to the health of children and youth in the United States. It is crucial that pediatricians define their role and develop the appropriate skills to address this threat effectively. From a clinical perspective, pediatricians should incorporate into their practices preventive education, screening for risk, and linkages to necessary intervention and follow-up services. As advocates, pediatricians should become involved at the local and national levels to address key risk factors and assure adequacy of preventive and treatment programs. There are also educational and research needs central to the development of effective clinical strategies. This policy statement defines the emerging role of pediatricians in youth violence prevention and management. It reflects the importance of this issue in the strategic agenda of the American Academy of Pediatrics for promoting optimal child health and development.

Violence and associated high-risk health behavior in adolescents. Substance abuse, sexually transmitted diseases, and pregnancy of adolescents

The intricate relationship between the social and health behaviors of persons of all ages has long been described. In adolescent health care, the risk-taking behaviors that are recognized in the areas of sexuality, drug and alcohol abuse, and violence need to be addressed. This article discusses adolescent risk behaviors and their relationships to violence. Health care providers need to consider these risk behaviors as they care for adolescents.

Perceived risk of fighting and actual fighting behavior among middle school students

This study evaluated the association between perceived risk of fighting and actual fighting behavior among middle school students and determined if that relationship was modified by race, gender, or grade level. Survey data were obtained from a stratified random sample of 517 Black and White students in a county school district in Maryland. Most students (72%) perceived fighting to be high-risk, but 20% reported fighting on a regular basis. The effect of risk perception (RP) on fighting behavior varied by race. Independent of grade and gender effects, students who believed fighting to be low-risk were more likely to fight on a regular basis than those with high RP (odds ratio for Blacks = 3.1; odds ratio for Whites = 5.4). School violence prevention education must include an emphasis on the health risks of fighting and attention to cultural differences in risk perception.