Implications of direct protective factors for public health research and prevention strategies to reduce youth violence

Route Choices and Adolescent-Adult Connections in Mitigating Exposure to Environmental Risk Factors During Daily Activities

While adolescent-adult connections have been shown to be protective against violence perpetration and victimization, mechanisms through which these connections confer protection from violence are poorly understood. We assessed whether adolescent-adult connections protected youth in lower resource urban neighborhoods from exposure to environmental risk factors for violence during daily activities. We overlaid on the city landscape minute-by-minute activity paths from 274 randomly sampled predominantly African American male youth, ages 10 to 24, enrolled in a population-based study of daily activities in Philadelphia, PA, to calculate environmental exposures and to compare exposures along actual versus shortest potential travel routes. Adolescent-adult connections were defined using brief survey questions and detailed family genograms. Analyses demonstrated that youth's selected travel routes resulted in significantly lower exposure to several types of crime, including vandalism, narcotics arrests, and disorderly conduct, than would have occurred on shortest potential routes. On average, youth with adolescent-adult connections spent less time outdoors than youth without connections, although these differences did not reach statistical significance (p = .06). There were no significant differences in environmental risk factors encountered by youth with versus without adolescent-adult connections. Future mixed-methods research combining qualitative and geographic information systems (GIS) approaches should investigate which factors shape travel decisions during daily activities to guide multimodal violence prevention interventions.

Hospital youth workers for violence reduction

INTRODUCTION

Youth workers (YWs) can engage young people following hospital attendances with violence-related injuries. This study aimed to evaluate the efficacy of YWs in an urban district hospital and to explore the views of the young people engaged.

METHODS

Everyone referred to the hospital YWs during the 31-month study period was included and demographic data were collected. Those who engaged completed emotional disturbance, risk of criminality and feedback questionnaires.

RESULTS

There were 496 young people referred during the study period with a mean age of 14. 9 years (range 7-26). Of these, 85 (17%) engaged with YWs and 15/85 (18%) completed the programme. Most (14/15, 93%) showed reduced or no change in their criminality and emotional disturbance scores. Young people liked having credible, accessible mentors and learning effective coping strategies.

DISCUSSION

YWs based in a district hospital's emergency department can work effectively with vulnerable young people, and this is well received by young people.

Development and Validation of the Youth Violence Potential Scale

The assessment of violence risk among youth remains a priority for researchers and practitioners globally. The absence of scales designed or validated in developing countries drives the need for a psychometrically sound, alternative measure. The purpose of this article is to validate the Youth Violence Potential Scale (YVPS). The YVPS was administered twice over 12 months to 318 South African males, aged 12-24 years. Exploratory and confirmatory factor analysis of separate samples confirmed a 19-item, three-factor solution, comprised of a Deviant Peers subscale, a Pro-Gangs Attitude subscale, and a Pro-Violence Attitude subscale. The YVPS exhibited internal reliability (α = .91) and discriminant and convergent validity among its subscales. Correlation with self-reported problem behavior/offending (r = .48, p < .001) and risk assessment from the maternal caregiver (r = .39, p < .001) evidenced concurrent and external validity.

Protective Factors Among Transgender and Gender Variant Youth: A Systematic Review by Socioecological Level

Transgender and gender variant (GV) youth experience elevated risk for poor health and academic outcomes due mainly to social experiences of stigma and discrimination. To supplement the growing evidence on health risks encountered by transgender/GV youth, we identified factors theorized to be protective for these youth across all four levels of Bronfenbrenner's socioecological model (individual, relationship, community, societal). We conducted a systematic search of peer-reviewed research. The articles included in this review were published in peer-reviewed journals in English or Spanish between 1999 and 2014, analyzed data from a sample or subsample of transgender or GV participants with a mean age between 10 and 24 years, and examined the relationship of at least one theorized protective factor to a health or behavioral outcome. Twenty-one articles met inclusion criteria. Transgender/GV youth in included articles ranged from 11 to 26 years of age, were racially/ethnically diverse, and represented varied gender identities. Within these articles, 27 unique protective factors across four levels of the ecological model were identified as related to positive health and well-being. Self-esteem at the individual level, healthy relationships with parents and peers at the relationship-level, and gay-straight alliances at the community level emerged as protective factors across multiple studies. Our findings underscore the relative lack of research on transgender/GV youth and protective factors. Novel recruitment strategies for transgender/GV youth and better measurement of transgender identities are needed to confirm these protective relationships and identify others. Growth in these areas will contribute to building a body of evidence to inform interventions.

The neurobiology of aggression and violence

Aggression and violence represent a significant public health concern and a clinical challenge for the mental healthcare provider. A great deal has been revealed regarding the neurobiology of violence and aggression, and an integration of this body of knowledge will ultimately serve to advance clinical diagnostics and therapeutic interventions. We will review here the latest findings regarding the neurobiology of aggression and violence. First, we will introduce the construct of aggression, with a focus on issues related to its heterogeneity, as well as the importance of refining the aggression phenotype in order to reduce pathophysiologic variability. Next we will examine the neuroanatomy of aggression and violence, focusing on regional volumes, functional studies, and interregional connectivity. Significant emphasis will be on the amygdala, as well as amygdala-frontal circuitry. Then we will turn our attention to the neurochemistry and molecular genetics of aggression and violence, examining the extensive findings on the serotonergic system, as well as the growing literature on the dopaminergic and vasopressinergic systems. We will also address the contribution of steroid hormones, namely, cortisol and testosterone. Finally, we will summarize these findings with a focus on reconciling inconsistencies and potential clinical implications; and, then we will suggest areas of focus for future directions in the field.

Assessing protective factors of youth who sexually offended in singapore: preliminary evidence on the utility of the DASH-13 and the SAPROF

Sexual offending has attracted increasing public concern because of its long-term effects. Although there is an increasing amount of research on the risk factors for recidivism among youth who have sexually offended, there is a dearth of research on the protective factors for desistence from recidivism. The current study investigated the associations between protective factors and recidivism among 97 Singaporean youth who sexually offended (YSO). In addition, the predictive validity with regard to two new measures of protective factors-the Desistence for Adolescents Who Sexually Harm (DASH-13), and Structured Assessment of Protective Factors for Violence Risk (SAPROF)-were also evaluated. Results indicated that both the DASH-13 and the SAPROF were inversely related to the Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR). However, neither the DASH-13 nor the SAPROF were found to have adequate predictive validity or incremental validity for sexual or nonsexual recidivism. The implications for the assessment and management of YSO are discussed.

A prospective investigation of factors that predict desistance from recidivism for adolescents who have sexually offended

Current approaches to violence risk assessment are focused on the identification of factors that are predictive of future violence rather than factors that predict desistance. This is also true for the popular tools designed to predict adolescent sexual recidivism. Research on strengths-based variables with adolescents who have sexually offended that could serve a protective function is only recently underway. In the current prospective study, scores from clinician-completed assessments using the Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR) and the parent-completed form of the Behavioral and Emotional Rating Scale (BERS-2) were evaluated in a sample of 81 adolescent males with at least one sexual offense. As expected, the ERASOR was significantly correlated with sexual recidivism over an average 3.5-year follow-up. In terms of a protective function, the Affective Strength scale of the BERS-2 was significantly negatively correlated with sexual recidivism, although it did not have incremental validity over and above the ERASOR. The BERS-2 School Functioning scale was significantly negatively correlated with nonsexual recidivism. The results are discussed in terms of previous findings and theoretical work on attachment in sexual offending behavior and implications for risk assessment practice.

Prevention of injury and violence in the USA

In the first three decades of life, more individuals in the USA die from injuries and violence than from any other cause. Millions more people survive and are left with physical, emotional, and financial problems. Injuries and violence are not accidents; they are preventable. Prevention has a strong scientific foundation, yet efforts are not fully implemented or integrated into clinical and community settings. In this Series paper, we review the burden of injuries and violence in the USA, note effective interventions, and discuss methods to bring interventions into practice. Alliances between the public health community and medical care organisations, health-care providers, states, and communities can reduce injuries and violence. We encourage partnerships between medical and public health communities to consistently frame injuries and violence as preventable, identify evidence-based interventions, provide scientific information to decision makers, and strengthen the capacity of an integrated health system to prevent injuries and violence.

Youth violence and connectedness in adolescence: what are the implications for later sexually transmitted infections?

PURPOSE

To examine associations between (1) youth violence victimization and perpetration and later sexually transmitted infections (STI) and (2) parent-family and school connectedness and later STI, and to explore the moderating role of connectedness on the associations between youth violence victimization and perpetration and later STI.

METHODS

We used data from Waves I and IV of the National Longitudinal Study of Adolescent Health, which provided a baseline weighted sample of 14,800 respondents. We used logistic regression to examine associations between youth violence and connectedness with self-reported ever STI diagnosis, including gonorrhea, chlamydia, syphilis, genital herpes, genital warts or human papillomavirus, or human immunodeficiency virus. If participants reported having an STI at Wave I they were excluded from the analysis.

RESULTS

Controlling for biological sex, race/ethnicity, age, parent's highest education level, and parent's marital status, both youth violence victimization and perpetration were associated with an increased risk of later STI (adjusted odds ratio [AOR], 1.27, 95% confidence interval [CI], 1.07-1.52; and AOR, 1.21, 95% CI, 1.04-1.41, respectively). Parent-family and school connectedness in adolescence were associated with a decreased risk for later STI (AOR, .96, 95% CI, .95-.98; and AOR, .97, 95% CI, .95-.99, respectively); however, connectedness did not moderate the associations between nonsexual violence involvement and later STI.

CONCLUSIONS

These results indicate that youth violence victimization and perpetration may be risk factors for STI later in life. Conversely, parent-family and school connectedness in adolescence appear to protect against subsequent STI. The findings suggest that provider efforts to address youth violence and connectedness in adolescence can promote positive sexual health outcomes in adulthood.

Identifying direct protective factors for nonviolence

BACKGROUND

The CDC recently organized a panel to examine whether a series of constructs consistently acted as risk and/or direct protective factors for youth violence across four longitudinal studies. Analyses first examined constructs commonly assessed across all four studies and then included constructs unique to each study.

PURPOSE

This paper describes findings from the Pittsburgh Youth Study (PYS) as part of this supplement to the American Journal of Preventive Medicine documenting the findings from the project.

METHODS

Participants were boys in the youngest cohort of the PYS (N=503), which was initiated in 1987-1988. Constructs measured at age 12 years were trichotomized to test whether they acted as risk and/or direct protective factors in predicting violence (i.e., assault, rape, robbery) across ages 13-14 years and 15-18 years.

RESULTS

Multivariate logistic regressions with predictors present across studies indicated that depressed mood (OR=1.96) and low religious observance (OR=1.88) were risk factors for violence at ages 13-14 years, whereas peer delinquency acted as both a risk (OR=2.34) and direct protective factor (OR=0.44). Low peer delinquency was also a direct protective factor (OR=0.41) for violence at ages 15-18 years. Analyses including predictors specific to the PYS indicated that negative attitude toward delinquency (OR=0.50) was protective against violence at ages 13-14 years, whereas the risk factors of low perceived likelihood of being caught (OR=1.81) and high neighborhood disorder/crime (OR=1.77) predicted violence at ages 15-18 years.

CONCLUSIONS

Some factors may be best conceptualized as direct protective factors for nonviolence, whereas other constructs act primarily as risk factors that increase the probability of adolescent violence.

Centers for Disease Control and Prevention's Expert Panel on Protective Factors for Youth Violence Perpetration: background and overview

The CDC Expert Panel on Protective Factors for Youth Violence Perpetration was convened to review and advance the status of etiologic and prevention research on direct protective and buffering protective factors for youth violence perpetration. The current paper introduces Phase One of the panel's work, which focuses on direct protective factors and includes the papers in this supplement to the American Journal of Preventive Medicine. This paper provides the context for the panel's work, describes its practical and theoretic importance, and summarizes why independently defined direct protective factors and risk factors are important for the advancement of our understanding of youth violence and its prevention. Lastly, this paper briefly describes the organization of the work of the panel as well as the research products that comprise the contents of the supplement.