Risk and direct protective factors for youth violence: results from the National Longitudinal Study of Adolescent Health

Associations Between Mother-Adolescent and Father-Adolescent Relationships and Young Adult Health

IMPORTANCE

Studies linking the quality of parent-adolescent relationships with young adult health outcomes could inform investments to support these complex relationships.

OBJECTIVE

To evaluate whether consistently measured, modifiable characteristics of parent-adolescent relationships are associated with young adult health across multiple domains.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used data from waves I (1994-1995; ages 12-17 years) and IV (2008-2009; ages 24-32 years) of the US National Longitudinal Study of Adolescent to Adult Health. Of 20 745 adolescents enrolled in wave I, 15 701 of 19 560 who were eligible completed wave IV (response rate, 80.3%). Data analyses were conducted from February 2019 to November 2020.

EXPOSURES

Parental warmth, parent-adolescent communication, time together, relationship and communication satisfaction, academic expectations, and maternal inductive discipline as reported at wave I by adolescent participants.

MAIN OUTCOMES AND MEASURES

Wave IV participant-reported self-rated health, depression, stress, optimism, nicotine dependence, substance abuse symptoms (alcohol, cannabis, or other drugs), unintended pregnancy, romantic relationship quality, physical violence, and alcohol-related injury. Separate regression models were run for mother-adolescent and father-adolescent relationships while controlling for age, biological sex, race and ethnicity, parental educational level, family structure, and child maltreatment experiences.

RESULTS

A total of 10 744 participants (mean [SD] age at wave IV, 28.2 [1.8] years; 52.0% female; 67.3% non-Hispanic White) and 8214 participants (mean [SD] age at wave IV, 28.2 [1.8] years; 50.8% female; 71.9% non-Hispanic White) had valid sampling weights and complete data for mother-adolescent and father-adolescent relationship characteristics, respectively. Adolescents who reported higher levels of mother-adolescent warmth (β = 0.11 [95% CI, 0.06-0.15]), communication (β = 0.02 [95% CI, 0.00-0.04]), time together (β = 0.07 [95% CI, 0.05-0.09]), academic expectations (β = 0.05 [95% CI, 0.02-0.08]), relationship or communication satisfaction (β = 0.07 [95% CI, 0.04-0.10]), and inductive discipline (β = 0.03 [95% CI, 0.01-0.05]) reported significantly higher levels of self-rated general health in young adulthood. Adolescents who reported higher levels of father-adolescent warmth (β = 0.07 [95% CI, 0.03-0.11]), communication (β = 0.03 [95% CI, 0.01-0.05]), time together (β = 0.06 [95% CI, 0.03-0.08]), academic expectations (β = 0.04 [95% CI, 0.01-0.06]), and relationship satisfaction (β = 0.07 [95% CI, 0.04-0.10]) also reported significantly higher levels of self-rated general health in young adulthood. Adolescents reporting higher levels of all exposures also reported significantly higher levels of optimism and romantic relationship quality in young adulthood (β coefficient range, 0.02 [95% CI, 0.00-0.04] to 0.24 [95% CI, 0.15-0.34]) and lower levels of stress and depressive symptoms (β coefficient range, -0.07 [95% CI, -0.12 to -0.02] to -0.48 [95% CI, -0.61 to -0.35]). Higher levels of parental warmth, time together, and relationship or communication satisfaction were significantly associated with lower levels of nicotine dependence (odds ratio range, 0.78 [95% CI, 0.72-0.85] to 0.89 [95% CI, 0.81-0.98]) and substance abuse symptoms (incidence rate ratio range, 0.60 [95% CI, 0.50-0.73] to 0.94 [95% CI, 0.89-0.99]), as well as lower odds of unintended pregnancy (odds ratio range, 0.81 [95% CI, 0.74-0.88] to 0.93 [95% CI, 0.86-0.99]). Patterns were less consistent for physical violence and alcohol-related injury. Characteristics of mother-adolescent and father-adolescent relationships were similarly associated with young adult outcomes.

CONCLUSIONS AND RELEVANCE

The findings of this cohort study suggest that adolescents' positive perceptions of their relationships with their mothers and fathers are associated with a wide range of favorable outcomes in young adulthood. Investments in improving parent-adolescent relationships may have substantial benefits for young adult population health.

Adolescent risk and protection profiles for violence perpetration: Insights for family- and community-based prevention

Youth violence continues to be a major developmental and health concern. Preventative resources at individual, family, and community levels may reduce risk, yet the extent to which youth violence perpetration differs by patterns of risk and protective factors remains unknown. Using data from the Florida Youth Substance Abuse Survey (N = 4630; 49% female; M_age  = 14.69), we conducted person-centered, latent profile analyses to identify four patterns for risk of violence perpetration among middle and high school youth. Youth in the Low Risk-High Protection profile (37%) had low likelihood of violence perpetration. Youth in the Low Risk-Low Protection profile (4%) were characterized by poor family functioning, low school belonging, and low community protection. These youth had similar odds of violence perpetration as youth in the Moderate Risk-Moderate Protection profile (44%), which were elevated compared to the Low Risk-High Protection profile. Youth in the High Risk-Low Protection profile (15%), which had the highest levels of risk factors and lowest levels of protective factors, had the highest likelihood of violence perpetration. The High Risk-Low Protection profile was expected based on past research, but the emergence of the Low Risk-Low Protection profile is a unique contribution to the research. Findings contribute to the literature by going beyond a cumulative risk model, identifying subgroups with various patterns of risk and protection in the population, and highlighting the importance of selected prevention for subgroups of youth with high risk or challenging family and community environments.

Similarities and Differences between Psychosocial Determinants of Bullying and Cyberbullying Perpetration among Polish Adolescents

Despite the extensive literature on the psychosocial determinants of bullying and cyberbullying among adolescents, there is not sufficient comprehensive analysis of the differences between perpetrators. This study aims to assess the psychosocial similarities and differences between bullies and cyberbullies. Data of 3650 students from two grades, K9 and K11 (47% females, mean age = 16.53), were used from a survey conducted in Poland in 2018 as part of the Health Behaviour in School-aged Children study. Perpetration was measured by questions adapted from the Olweus Bully/Victim Questionnaire. The following predictors were analyzed: demographic, socioeconomic status measured with the Family Affluence Scale-III (FAS), and individual and social factors. Multiple binary logistic regression was applied. The random sampling design was based on stratification according to the local deprivation index of the region where the school was located. Male gender, younger age, and non-intact family were associated with a higher risk of bullying and cyberbullying. Family support, empathy, school performance, and school attachment had a protective effect against both aggressive behaviors. Life dissatisfaction and high FAS were revealed as determinants of cyberbullying and local deprivation of bullying only. Bullying and cyberbullying school prevention programs should take into account these psychosocial differences and consider the economic deprivation of the region.

Intervening at the Right Level to Improve Student Health: An Analysis of Levels of Influence on Sexual Behavior of High School Students

This study adopts a socio-ecological framework and examines school- and district-level influences on sexual behaviors among high school students from 16 school districts that were federally funded to conduct a school-based, multilevel sexual health program. We drew cross-sectional data from the 2015 and 2017 Youth Risk Behavior Survey from funded school districts containing 648 schools and 101,728 students. We used multilevel modeling to determine the percentage of variance in sexual health outcomes explained at school and district levels, overall and by race/ethnicity and biological sex. We found protective behaviors such as using hormonal birth control had considerable district-level variance (10.1%) while sexual risk behaviors such as having multiple sex partners showed considerable school-level variance (12.7%). We also found significant subgroup heterogeneity in the variance. Findings indicate school-based interventions should address all levels of influences of the educational system to effectively improve a myriad of student sexual health outcomes.

Religiosity as a potential mediator for violence in childhood and adulthood: results from a Brazilian nationally representative survey

OBJECTIVES

Although previous studies have investigated the role of religiosity in violence outcomes, there is a lack of studies including this aspect as a mediator for violence in childhood and adulthood. This study aimed to investigate the relationship between religiosity and violence in childhood, as well as the possible mediating role of religiosity between suffering violence in childhood and suffering and/or perpetrating violence in adulthood.

DESIGN

Cross-sectional population-based study carried out from November 2011 to March 2012.

SETTING

Face-to-face surveys (at participants' homes) were performed in a Brazilian nationally representative sample.

PARTICIPANTS

A total of 3378 adults (aged 19 years and above) were included.

PRIMARY AND SECONDARY OUTCOMES MEASURES

The association between suffering violence in childhood and religiosity, and the mediating role of religiosity between childhood and adulthood violence were analysed using logistic regression models.

RESULTS

Religiosity was associated with childhood violence, showing that those who suffered less violence in childhood were more religious in adulthood and considered religion more important in their lives. However, while there was a significant association between suffering violence during childhood and suffering and/or perpetrating violence in adulthood, religiosity did not mediate this relationship.

CONCLUSIONS

Although religious individuals self-reported less violence suffered in childhood, religiosity did not show evidence of being a potential mediator for childhood and adulthood violence (experienced and/or perpetrated). These results could help researchers explore this phenomenon, and aid health professionals and managers when proposing future interventions.

Individual Resilience: A Major Protective Factor in Peer Bullying and Victimization of Elementary School Children in Israel

Peer violence in school has become a major issue for schools around the world. The present study examined the impacts of cultural settings and of protective individual attributes on peer bullying and victimization in school. These protective attributes were self-esteem, sense of autonomy, emotional regulation, and individual resilience. Participants were 112 Jewish and 55 Arab Bedouin pupils 10 to 11 years old. It was hypothesized that Jewish pupils would score lower than Bedouin pupils on bullying and on victimization, and will score higher than them on these protective individual attributes. It was also hypothesized that despite these differences, the investigated attributes would correlate with reduced peer violence in both groups. It was hypothesized further that individual resilience will be the major predictor of both bullying and victimization in both groups. Results have generally supported these hypotheses, suggesting alternative ways for curtailing peer aggression in school.

Good Lives Model: Importance of Interagency Collaboration in Preventing Violent Recidivism

Violence is a complex and multifaceted problem requiring a holistic and individualized response. The Good Lives Model (GLM) suggests violence occurs when an individual experiences internal and external obstacles in the pursuit of universal human needs (termed primary goods). With a twin focus, GLM-consistent interventions aim to promote attainment of primary goods, whilst simultaneously reducing risk of reoffending. This is achieved by improving an individuals’ internal (i.e., skills and abilities) and external capacities (i.e., opportunities, environments, and resources). This paper proposes that collaborations between different agencies (e.g., psychological services, criminal justice systems, social services, education, community organizations, and healthcare) can support the attainment of primary goods through the provision of specialized skills and resources. Recommendations for ensuring interagency collaborations are effective are outlined, including embedding a project lead, regular interagency meetings and training, establishing information sharing procedures, and defining the role each agency plays in client care.

Assessing Violence Risk in Adolescents in the Pediatric Emergency Department: Systematic Review and Clinical Guidance

Introduction

Violence risk assessment is one of the most frequent reasons for child and adolescent psychiatry consultation with adolescents in the pediatric emergency department (ED). Here we provide a systematic review of risk factors for violence in adolescents using the risk factor categories from the MacArthur Violence Risk Assessment study. Further, we provide clinical guidance for assessing adolescent violence risk in the pediatric ED.

Methods

For this systematic review, we used the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2009 checklist. We searched PubMed and PsycINFO databases (1966–July 1, 2020) for studies that reported risk factors for violence in adolescents.

Results

Risk factors for adolescent violence can be organized by MacArthur risk factor categories. Personal characteristics include male gender, younger age, no religious affiliation, lower IQ, and Black, Hispanic, or multiracial race. Historical characteristics include a younger age at first offense, higher number of previous criminal offenses, criminal history in one parent, physical abuse, experiencing poor child-rearing, and low parental education level. Among contextual characteristics, high peer delinquency or violent peer-group membership, low grade point average and poor academic performance, low connectedness to school, truancy, and school failure, along with victimization, are risk factors. Also, firearm access is a risk factor for violence in children and adolescents. Clinical characteristics include substance use, depressive mood, attention deficit hyperactivity disorder, antisocial traits, callous/unemotional traits, grandiosity, and justification of violence.

Conclusion

Using MacArthur risk factor categories as organizing principles, this systematic review recommends the Structured Assessment of Violence Risk in Youth (SAVRY) risk- assessment tool for assessing adolescent violence risk in the pediatric ED.

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

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

Confía en mí, Confío en ti: Applying developmental theory to mitigate sociocultural risk in Latinx families

Ed Zigler was a champion for underprivileged youth, one who worked alongside communities to fight for long-lasting systemic changes that were informed by his lifespan and ecological perspective on the development of the whole child. This paper reports on the development, implementation, and preliminary outcomes of an intervention that embodied the Zigler approach by adopting a community participatory research lens to integrate complementary insights across community-based providers (promotoras), Latinx immigrant families, and developmental psychologists in the service of promoting parent-child relationship quality and preventing youth aggression and violence. Analyses from the first 112 Latinx mother-youth dyad participants (46% female children, ages 8-17) in the resultant, Confía en mí, Confío en ti, eight-week intervention revealed significant pre-post increases in purported mechanisms of change (i.e., attachment security, reflective functioning) and early intervention outcomes (i.e., depressive, anxiety, and externalizing problems). Treatment responses varied by youth age. A case analysis illustrated the lived experiences of the women and children served by this intervention. We discuss future directions for the program, as well as challenges to its sustainability. Finally, we consider Ed's legacy as we discuss the contributions of this work to developmental science and our understanding of attachment relationships among low-income immigrant Latinx families.

The Role of ADHD in Predicting the Development of Violent Behavior Among Juvenile Offenders: Participation Versus Frequency

Past research has identified attention-deficit/hyperactivity disorder (ADHD) as a risk factor for engagement in violent offending. Despite the link between the disorder and violent offending, this risk factor has yet to be examined as a predictor of heterogeneity in the development of violent offending among juvenile offenders. It is likely that the impulsivity, genetic link, and generally chronic disorder course which are characteristics of the disorder play roles in predicting violent offending, which is consistent with both self-control theory and general developmental theory related to early life deficits and life-course persistent offending. Past research has also elucidated a developmental trajectory model of violent offending, which is utilized by the present research. The present research examines ADHD as a risk factor predicting trajectory group assignment. The Pathways to Desistance data followed 1,354 juvenile offenders for 84 months following conviction for a serious offense. Using multinomial logistic regression, this study extends past research on the development of violent offending among juvenile offenders by examining ADHD as a risk factor predicting assignment to violent offending trajectory groups. Results indicate that meeting criteria for ADHD at baseline predicted membership to all trajectory groups relative to the Abstaining group when all covariates were included. This increase in risk is highest for the trajectory group characterized by the highest frequency of violent offending. This indicates the relevance of identifying and treating ADHD among juvenile offenders to best mitigate risk of violent recidivism throughout adolescence and early adulthood.

Childhood homelessness, resilience, and adolescent mental health: A prospective, person-centered approach

School districts and other service providers are increasingly aware of the substantial mental health needs of students experiencing family homelessness. Past findings are mixed regarding whether homelessness conveys unique risk beyond the risks associated with extreme poverty. With prospective longitudinal data on homelessness experiences across childhood, we utilized latent profile analysis as a person-centered approach to conceptualizing mental health outcomes in adolescence for 3,778 youth. We considered literal family homelessness as well as families living doubled-up, and we employed propensity score matching to identify a comparison group of non-homeless students balanced across a range of covariates to address systematic bias. Results indicated that students who experienced literal homelessness during childhood were significantly less likely to demonstrate profiles of resilience in mental health functioning. We considered our approach and findings in light of challenges and opportunities particularly relevant to the school context.

Gender differences and the correlates of violent behaviors among high school students in a post-conflict area in Indonesia

INTRODUCTION

Adolescent violence is a public health problem worldwide. Studies show that challenging environments, such as poverty and war, increase the risk of adolescent violence. This paper aims to assess gender differences in violent behaviors among adolescents in a post-conflict area in Indonesia. The other aim of this study is to investigate the correlates of adolescents' violent behaviors using the socio-ecological framework.

METHODS

This is a school-based study involving 511 students from six randomly selected high schools in Kotamadya Ambon. Active and verbal violent behaviors and the potential correlates were measured and assessed using backward linear regression analyses.

RESULTS

Boys were involved in more violent behaviors than girls. However, some of the boys and girls reported being involved in all types of violent behaviors. The most significant correlates of violent behaviors across genders were community violence exposure and some types of behavioral problems.

DISCUSSION

This study highlighted the interconnectedness between community violence exposure and violent behaviors among adolescents living in a post-conflict area. The study also emphasizes the association between problem behaviors and violent behaviors. The results demonstrate the importance of both reducing community violence exposure and identifying adolescents with behavioral problems in the prevention of violent behaviors.

Violence typologies and sociodemographic correlates in South African adolescents: a three-wave cross-sectional study

Background

Violence victimisation and violence perpetration may co-occur in adolescents. Understanding the sociodemographic correlates of the independent and joint profiles of victimisation and perpetration may inform preventive interventions. This study examined the associations of sociodemographic factors with four violence typologies, namely, 1) non-involvement in both victimisation and perpetration, 2) victims only, 3) perpetrators only, and 4) victim-perpetrators. Trends in the prevalence of the four violence typologies over the three survey years were also examined.

Methods

We used data from the three nationally representative South African Youth Risk Behaviour Surveys conducted in 2002, 2008, and 2011 and included a multi-ethnic sample of adolescents (n = 30,007; boy: 46.9%, girls: 53.1%; M age = 16 years, SD = .06).

Results

The sample consisted of 8030 (30.8%) adolescents who had non-involvement in both victimisation and perpetration, 8217 were victims only (29.8%), 2504 were perpetrators only (9.0%), and 7776 were victim-perpetrators (24.6%). Logistic regression analyses showed that being a girl increased the odds of non-involvement (OR: 1.47, 99% CI: 1.36–1.58) and being victims only (OR: 1.90, 99% CI: 1.76–2.05). Being a boy increased the odds of being perpetrators only (OR: 0.42, 99% CI: 0.37–0.47) and victim-perpetrators (OR: 0.51, 99% CI: 0.47–0.55). Adolescents who did not have an absent mother had higher odds of non-involvement (OR: 0.78, 99% CI: 0.62–0.97). Lower monthly allowance increased the odds of victimisation only (OR: 0.99, 99% CI: 0.97–1.00), whereas higher monthly allowance increased the odds of perpetration only (OR: 1.05, 99% CI: 1.03–1.08). Trend analysis showed that between 2002 to 2011, there was an increase in the prevalence of non-involvement in adolescents (p < .001), a decrease in the prevalence of victims only (p < .05) and victim-perpetrators (p < .001), and no changes in the prevalence of perpetrators only (p > .05).

Conclusions

Sociodemographic factors are uniquely associated with different violence typologies suggesting the need for tailored interventions to target adolescents with differed risks to violence victimisation and perpetration. Strengthening family relations, particularly between mother and child, may protect adolescents from the experiences of victimisation and perpetration.

Childhood abuse and community violence: Risk factors for youth violence

OBJECTIVE

To investigate the joint effect of child abuse and neglect (CAN) and community violence (CV) on adolescents with peers that commit youth violence (YV).

METHODS

This is a school-based cross-sectional study of 699 students enrolled in four public and nine private schools in the municipality of Rio de Janeiro, Brazil. Participants were selected through a complex cluster sampling procedure. CAN was identified using the Childhood Trauma Questionnaire (CTQ). Exposure to CV was assessed by asking students if they have witnessed cases of lethal violence in the community. YV was measured indirectly through questions about having friends who have committed acts of crime. Multivariate logistic models were used to study the effects of emotional, physical, and sexual abuse and emotional and physical neglect in childhood on YV, controlled for confounders, according to different levels of CV.

RESULTS

Emotional abuse OR = 3.32 (CI 95%: 1.79-6.17), sexual abuse OR = 2.33 (CI 95%: 1.20-4.54), and physical neglect OR = 1.81 (CI 95%: 1.02-3.20) increased the odds of YV in adolescents, whether cooccurring with CV or not. Physical abuse OR = 3.95 (CI 95%: 2.29 - 6.80) and emotional neglect OR = 2.93 (CI 95%: 1.83-4.72) are only risk factors for YV involvement when associated with CV.

CONCLUSIONS

These findings highlight the relevance of CAN and CV as risk factors for YV and the potential increase in adolescents' vulnerability when exposed to both. Policies aiming at preventing and dealing with CAN are essential strategies to reduce YV, especially in areas with high levels of CV.

Adolescent Connectedness and Adult Health Outcomes

BACKGROUND

Because little is known about long-term effects of adolescent protective factors across multiple health domains, we examined associations between adolescent connectedness and multiple health-related outcomes in adulthood.

METHODS

We used weighted data from Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (n = 14 800). Linear and logistic models were used to examine associations between family and school connectedness in adolescence and self-reported health risk behaviors and experiences in adulthood, including emotional distress, suicidal thoughts and attempts, physical violence victimization and perpetration, intimate partner physical and sexual violence victimization, multiple sex partners, condom use, sexually transmitted infection (STI) diagnosis, prescription drug misuse, and other illicit drug use.

RESULTS

In multivariable analyses, school connectedness in adolescence had independent protective associations in adulthood, reducing emotional distress and odds of suicidal ideation, physical violence victimization and perpetration, multiple sex partners, STI diagnosis, prescription drug misuse, and other illicit drug use. Similarly, family connectedness had protective effects for emotional distress, all violence indicators, including intimate partner violence, multiple sex partners, STI diagnosis, and both substance use indicators. Compared to individuals with low scores for each type of connectedness, having high levels of both school and family connectedness was associated with 48% to 66% lower odds of health risk behaviors and experiences in adulthood, depending on the outcome.

CONCLUSIONS

Family and school connectedness may have long-lasting protective effects across multiple health outcomes related to mental health, violence, sexual behavior, and substance use. Increasing both family and school connectedness during adolescence has the potential to promote overall health in adulthood.

Community violence exposure and determinants of adolescent mental health: A school-based study of a post-conflict area in Indonesia

INTRODUCTION

Studies have shown the adverse impact of exposure to community violence on adolescent health. However, most of the studies were conducted in high-income countries. This study aimed at assessing the community violence exposure and the determinants of mental health problems among adolescents in Ambon, a post-conflict area in Indonesia.

MATERIAL AND METHODS

We conducted a cross-sectional, school-based study involving 511 of 10th-graders from six randomly selected high schools in Kotamadya Ambon. Our participants were assessed using a set of questionnaires including the Strength Difficulties Questionnaire (SDQ) to measure mental health problems, and the child version of the Screen for Adolescent Violence Exposure (KID-SAVE) to measure community violence exposure. The hierarchical regression analyses were used to explore the determinants of mental health problems.

RESULTS

In this study, boys reported more exposure to community violence (both in frequency and severity) than girls. Meanwhile, the girls reported higher emotional problems than boys. The hierarchical regression analyses revealed that in the total sample and among boys, the community violence exposure was associated with mental health problems. However, it was the perceived impact of community violence exposure which showed an association with mental health problems among girls.

CONCLUSIONS

This study revealed the high community violence exposure among adolescents living in a post-conflict setting in Indonesia. The study also found gender differences in the determinants of mental health problems among adolescents who were exposed to CVE.

The influence of parents and schools on developmental trajectories of antisocial behaviors in Caucasian and African American youths

African American youths are overrepresented in the American juvenile justice system relative to Caucasians. Yet, research on antisocial behaviors (ASB) has focused on predominantly Caucasian populations. Furthermore, relatively little is known about how environmental factors, such as supportive parenting (e.g., how close adolescents feel to their parent) and school connectedness (e.g., how supported adolescents feel at school), affect trajectories of ASB in Caucasians versus African Americans. This study mapped developmental trajectories of ASB in Caucasians (n = 10,764) and African Americans (n = 4,091) separately, using four waves of data from the National Longitudinal Study of Adolescent to Adult Health. We then examined supportive parenting and school connectedness on the trajectories of ASB. Four trajectories of ASB were identified for both Caucasians and African Americans: negligible, adolescence-peaked, low-persistence, and high-persistence ASB, although prevalence rates differed by racial-ethnic status. Supportive parenting reduced the risk of membership into the adolescence-peaked trajectory for both Caucasians and African Americans. However, school connectedness was less protective for African Americans than for Caucasians because it only predicted a lower risk of adolescence-peaked membership for African Americans. Findings may reflect the complex social dynamics between race and schools in the development of ASB.

Perceived Weight Discrimination and School Connectedness Among Youth: Does Teacher Support Play a Protective Role?

BACKGROUND

Weight discrimination has been associated with poor academic performance and decreased school attendance. Little is known about weight discrimination and students' feelings of belonging to their school. This study examined the association between weight discrimination and school connectedness among adolescents. Teacher support was examined as a protective factor.

METHODS

Middle school students (N = 639; 57% white; Mean age = 12.16 years) completed a health behaviors survey. Weight discrimination from peers and/or good friends was dichotomized into never versus experienced weight discrimination. The mean of 5 school connectedness items assessed level of school connectedness. Teacher support was measured by taking the mean of 4 teacher support items. Hierarchical linear regression was used to examine the association between weight discrimination and school connectedness. Teacher support was tested as a moderator.

RESULTS

Weight discrimination was associated with lower levels of school connectedness (p < .05). Teacher support was associated with higher levels of school connectedness (p < .001) but did not moderate the association between weight discrimination and school connectedness.

CONCLUSION

The association between weight discrimination and low levels of school connectedness is important as students spend most of their time at school and should benefit from the positive effects of feeling connected to school.

Trauma, Race, and Risk for Violent Felony Arrests Among Florida Juvenile Offenders

This study tests the assumptions of the The Childhood Trauma Model, which proposes that marginalized populations are both more likely to have traumatic childhoods and more criminalized than those in the upper echelons of society. It hypothesizes that traumatic childhood experiences increase risk of being sanctioned for violent behavior, and risks are amplified for minority and disadvantaged groups. The study finds that experiencing three or more traumas had a 200% to 370% increased chance of being arrested for a violent felony as youth who experienced a single traumatic event, and Blacks had up to 300% increased risk than Whites with equal trauma scores.

Connecting the Dots: State Health Department Approaches to Addressing Shared Risk and Protective Factors Across Multiple Forms of Violence

Violence takes many forms, including intimate partner violence, sexual violence, child abuse and neglect, bullying, suicidal behavior, and elder abuse and neglect. These forms of violence are interconnected and often share the same root causes. They can also co-occur together in families and communities and can happen at the same time or at different stages of life. Often, due to a variety of factors, separate, "siloed" approaches are used to address each form of violence. However, understanding and implementing approaches that prevent and address the overlapping root causes of violence (risk factors) and promote factors that increase the resilience of people and communities (protective factors) can help practitioners more effectively and efficiently use limited resources to prevent multiple forms of violence and save lives. This article presents approaches used by 2 state health departments, the Maryland Department of Health and Mental Hygiene and the Colorado Department of Public Health and Environment, to integrate a shared risk and protective factor approach into their violence prevention work and identifies key lessons learned that may serve to inform crosscutting violence prevention efforts in other states.

School Environment Is Related to Lower Health and Safety Risks Among Sexual Minority Middle and High School Students

PURPOSE

The objective of this study was to examine the relationship between school involvement and connectedness with measures of sexual risk, substance use, and experience of violence among students who had sexual contact with the same sex or with both sexes.

METHODS

A sample of middle school and high school students who participated in a study conducted in a large urban school district were selected based on their reported experience of having initiated sexual activity with same-sex partners. In classroom-based surveys, we assessed self-reported involvement in school-based activities and feelings of school connectedness, as well as self-reported sexual risk, substance use, and experience of violence.

RESULTS

Significant protective associations were found between school involvement and lifetime alcohol and marijuana use, and between school connectedness and ever having been in a fight, feeling safe at school, and drug use other than marijuana (all p < .05).

CONCLUSIONS

Findings suggest that efforts to increase school involvement and connectedness provide a starting point for addressing significant health and safety concerns among students with same-sex sexual activity.

Neighborhood Interventions to Reduce Violence

Violence is a widespread problem that affects the physical, mental, and social health of individuals and communities. Violence comes with an immense economic cost to its victims and society at large. Although violence interventions have traditionally targeted individuals, changes to the built environment in places where violence occurs show promise as practical, sustainable, and high-impact preventive measures. This review examines studies that use quasi-experimental or experimental designs to compare violence outcomes for treatment and control groups before and after a change is implemented in the built environment. The most consistent evidence exists in the realm of housing and blight remediation of buildings and land. Some evidence suggests that reducing alcohol availability, improving street connectivity, and providing green housing environments can reduce violent crimes. Finally, studies suggest that neither transit changes nor school openings affect community violence.

A multilevel analysis of risk and protective factors for Canadian youth injured or killed by interpersonal violence

PURPOSE

The study's purpose was to determine individual-level and neighbourhood-level risk and protective factors for severe intentional injury among youth.

METHODS

We conducted a multilevel case-control study using registry data to determine individual-level and neighbourhood-level social determinants associated with severe violent injury/homicide among youth from Winnipeg, Manitoba.

RESULTS

The study includes 13 206 youth, aged 12-24 years (1222 cases, 11 984 controls). Individual-level risk predictors of being a victim of violence were male sex (OR 5.72 (95% CI 4.77 to 6.86)) and First Nations (OR 2.76 (95% CI 2.32 to 3.29)). Education was inversely associated with victimisation for individuals under (OR 0.36 (95% CI 0.26 to 0.51)) and over (OR 0.58 (95% CI 0.49 to 0.69)) 18 years. Ever having been in protective care (OR 1.66 (95% CI 1.39 to 1.99)), receiving income assistance from the government (OR 1.26 (95% CI 1.05 to 1.51)) or ever having criminal charges (OR 4.76 (95% CI 4.08 to 5.56)) were also significant predictors of being a victim of violence. Neighbourhood-level risk factors for victimisation included low socioeconomic status (OR 1.14 (95% CI 1.04 to 1.25)) and high levels of assault (OR 1.07 (95% CI 1.04 to 1.10)).

CONCLUSIONS

This study demonstrates a complex web of risk and protective factors among youth injured by violence. It underscores the ongoing, injurious effects of historical trauma experienced by many Canadian First Nations people. Strong victim-perpetrator overlap suggests that intersectoral policies are needed to address these issues. Our findings highlight the need to improve education and family supports.

Improving risk management for violence in mental health services: a multimethods approach

Background

Mental health professionals increasingly carry out risk assessments to prevent future violence by their patients. However, there are problems with accuracy and these assessments do not always translate into successful risk management.

Objectives

Our aim was to improve the accuracy of assessment and identify risk factors that are causal to be targeted by clinicians to ensure good risk management. Our objectives were to investigate key risks at the population level, construct new static and dynamic instruments, test validity and construct new models of risk management using Bayesian networks.

Methods and results

We utilised existing data sets from two national and commissioned a survey to identify risk factors at the population level. We confirmed that certain mental health factors previously thought to convey risk were important in future assessments and excluded others from subsequent parts of the study. Using a first-episode psychosis cohort, we constructed a risk assessment instrument for men and women and showed important sex differences in pathways to violence. We included a 1-year follow-up of patients discharged from medium secure services and validated a previously developed risk assessment guide, the Medium Security Recidivism Assessment Guide (MSRAG). We found that it is essential to combine ratings from static instruments such as the MSRAG with dynamic risk factors. Static levels of risk have important modifying effects on dynamic risk factors for their effects on violence and we further demonstrated this using a sample of released prisoners to construct risk assessment instruments for violence, robbery, drugs and acquisitive convictions. We constructed a preliminary instrument including dynamic risk measures and validated this in a second large data set of released prisoners. Finally, we incorporated findings from the follow-up of psychiatric patients discharged from medium secure services and two samples of released prisoners to construct Bayesian models to guide clinicians in risk management.

Conclusions

Risk factors for violence identified at the population level, including paranoid delusions and anxiety disorder, should be integrated in risk assessments together with established high-risk psychiatric morbidity such as substance misuse and antisocial personality disorder. The incorporation of dynamic factors resulted in improved accuracy, especially when combined in assessments using actuarial measures to obtain levels of risk using static factors. It is important to continue developing dynamic risk and protective measures with the aim of identifying factors that are causally related to violence. Only causal factors should be targeted in violence prevention interventions. Bayesian networks show considerable promise in developing software for clinicians to identify targets for intervention in the field. The Bayesian models developed in this programme are at the prototypical stage and require further programmer development into applications for use on tablets. These should be further tested in the field and then compared with structured professional judgement in a randomised controlled trial in terms of their effectiveness in preventing future violence.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.

Characteristics of Youth With Combined Histories of Violent Behavior, Suicidal Ideation or Behavior, and Gun-Carrying

BACKGROUND

Youth reporting combined histories of nonfatal violence, suicidal ideation/behavior, and gun-carrying (VSG) are at risk for perpetrating fatal interpersonal violence and self-harm.

AIMS

We characterized these youth to inform prevention efforts.

METHOD

We analyzed 2004 data from 3,931 seventh-, ninth-, and 11-12th-grade youth and compared VSG youth (n = 66) with non-gun carrying youth who either had no histories of violence or suicidal thoughts/behavior (n = 1,839), histories of violence (n = 884), histories of suicidal thoughts/behaviors (n = 552), or both (n = 590). We compared groups based on demographic factors, risk factors (i.e., friends who engage in delinquency, peer-violence victimization, depressive symptoms, illicit substance use), and protective factors (i.e., school connectedness, parental care and supervision). Regression models identified factors associated with VSG youth.

RESULTS

Illicit substance use and having friends who engage in delinquency were more common among VSG youth in all comparisons; almost all VSG youth had high levels of these factors. Depressive symptoms were positively associated with VSG youth versus youth without either violent or suicide-related histories and youth with violent histories alone. School connectedness and parental supervision were negatively associated with VSG youth in most comparisons.

CONCLUSION

Family-focused and school-based interventions that increase connectedness while reducing delinquency and substance use might prevent these violent tendencies.

Examining Protective Factors Against Violence among High-risk Youth: Findings from the Seattle Social Development Project

PURPOSE

This paper examined proximal and distal effects of protective factors specified in the social development model (SDM) on youth violence among high-risk youth.

METHODS

Data come from the Seattle Social Development Project, a longitudinal study of development from childhood into adulthood. A community sample of 808 participants from the Seattle Public School District was surveyed from the 5th grade through adulthood. This paper uses data from participants' adolescent years, ages 10-18.

RESULTS

Higher levels of protective factors in early and middle adolescence reduced the odds of violence during late adolescence in the full sample and in two different risk groups (high cumulative risk and low SES). Although risk exposure increased the odds of violence, protective factors in middle adolescence predicted lower odds of violence during late adolescence. Importantly, protective factors had a greater effect in reducing violence among youth exposed to high levels of cumulative risk than among youth exposed to lower levels of cumulative risk. This difference was not observed between youth from higher and lower SES families.

CONCLUSION

Protective factors specified in the SDM appear to reduce violence in late adolescence even among youth from low SES families and youth exposed to high levels of cumulative risk.

Defining and distinguishing promotive and protective effects for childhood externalizing psychopathology: a systematic review

PURPOSE

We examine evidence for whether decreases in externalizing behaviors are driven by the absence of risk (e.g., lack of poor housing quality) or the presence of something positive (e.g., good housing quality). We also review evidence for whether variables have promotive (main) effects or protective (buffering) effects within contexts of risks.

METHODS

We conducted a systematic review of longitudinal studies. First, we review studies (n = 7) that trichotomized continuous predictor variables. Trichotomization tests whether the positive end of a variable (e.g., good housing quality) is associated with lower delinquency compared with the mid-range, and whether mid-range scores are associated with fewer problems than the "risky" end (e.g., poor housing quality). We do not review dichotomous variables, because the interpretation of results is the same regardless of which value is the reference group. To address our second aim, we review studies (n = 53) that tested an interaction between a risk and positive factor.

RESULTS

Both the absence of risk and the presence of positive characteristics were associated with low externalizing problems for IQ, temperament, and some family variables. For other variables, associations with low delinquency involved only the presence of something positive (e.g., good housing quality), or the absence of a risk factor (e.g., community crime). The majority of studies that tested interactions among individual and family characteristics supported protective, rather than promotive, effects. Few studies tested interactions among peer, school, and neighborhood characteristics.

CONCLUSIONS

We discuss implications for conceptual understanding of promotive and protective factors and for intervention and prevention strategies.

Modifiable Neighborhood Features Associated With Adolescent Homicide

IMPORTANCE

Homicide is a leading cause of adolescent mortality. To our knowledge, relatively little has been studied in terms of the association between environmental neighborhood features, such as streets, buildings, and natural surroundings, and severe violent injury among youth.

OBJECTIVE

To assess associations between environmental neighborhood features and adolescent homicide in order to identify targets for future place-based interventions.

DESIGN, SETTING, AND PARTICIPANTS

Population-based case-control study conducted in Philadelphia, Pennsylvania, from April 15, 2008, to March 31, 2014. We identified adolescents who died by homicide at 13 to 20 years of age from 2010 to 2012 while residing in Philadelphia. We used incidence-density sampling and random-digit dialing to recruit control participants ages 13 to 20 years matched on sex and indoor-outdoor location at the time of each index case participant's homicide.

EXPOSURES

To obtain environmental data about modifiable features that were present in the immediate surroundings of our case and control participants, blinded field researchers used standardized techniques to photograph case and control participant outdoor locations. Photographic data were stitched together to create 360° panoramic images that were coded for 60 elements of the visible environment.

MAIN OUTCOME AND MEASURE

Adolescent homicide.

RESULTS

We enrolled 143 homicide case participants (mean [SD] age, 18.4 [1.5] years) and 155 matched control participants (mean [SD] age, 17.2 [2.1] years) who were both outdoors at the time of the homicide. In adjusted analyses, multiple features of Philadelphia streets, buildings, and natural surroundings were associated with adolescent homicide. The presence of street lighting (odds ratio [OR], 0.24; 95% CI, 0.09-0.70), illuminated walk/don't walk signs (OR, 0.16; 95% CI, 0.03-0.92), painted marked crosswalks (OR, 0.17; 95% CI, 0.04-0.63), public transportation (OR, 0.13; 95% CI, 0.03-0.49), parks (OR, 0.09; 95% CI, 0.01-0.88), and maintained vacant lots (OR, 0.17; 95% CI, 0.03-0.81) were significantly associated with decreased odds of homicide. The odds of homicide were significantly higher in locations with stop signs (OR, 4.34; 95% CI, 1.40-13.45), security bars/gratings on houses (OR, 9.23; 95% CI, 2.45-34.80), and private bushes/plantings (OR, 3.44; 95% CI, 1.18-10.01).

CONCLUSIONS AND RELEVANCE

Using a population-based case-control design, we identified multiple modifiable environmental features that might be targeted in future randomized intervention trials designed to reduce youth violence by improving neighborhood context.

Predictors of Weapon-Related Behaviors among African American, Latino, and White Youth

OBJECTIVE

To identify risk and protective factors for weapon involvement among African American, Latino, and white adolescents.

STUDY DESIGN

The National Longitudinal Study of Adolescent to Adult Health is a nationally representative survey of 7th-12th grade students. Predictors at wave 1 and outcome at wave 2 were analyzed. Data were collected in the mid-1990s, when rates of violent crime had been declining. The outcome was a dichotomous measure of weapon-involvement in the past year, created using 3 items (weapon-carrying, pulled gun/knife, shot/stabbed someone). Bivariate and multilevel logistic regression analyses examined associations of individual, peer, family, and community characteristics with weapon involvement; stratified analyses were conducted with African American, Latino, and white subsamples.

RESULTS

Emotional distress and substance use were risk factors for all groups. Violence exposure and peer delinquency were risk factors for whites and African Americans. Gun availability in the home was associated with weapon involvement for African Americans only. High educational aspirations were protective for African Americans and Latinos, but higher family connectedness was protective for Latinos only.

CONCLUSIONS

Interventions to prevent weapon-related behaviors among African American, Latino, and white adolescents may benefit from addressing emotional distress and substance use. Risk and protective factors vary by race/ethnicity after adjusting for individual, peer, family, and community characteristics. Addressing violence exposure, minimizing the influence of delinquent peers, promoting educational aspirations, and enhancing family connectedness could guide tailoring of violence prevention interventions.

Finding Color in Conformity: A Commentary on Culturally Specific Risk Factors for Violence in Australia

This article outlines the current utility of Indigenous culturally specific risk factors for violence and the ramifications for cross-cultural risk prediction. The Indigenous culturally specific violence risk factor literature has provided a rich body of contextual information outlining Indigenous patterns of criminal behaviour. This information has the capacity to facilitate offender responsivity and treatment targets in addition to assisting clinicians identify the presence of risk markers among Indigenous clients. However, if intended for inclusion in risk prediction models, culturally specific risk items then require further quantitative analysis to establish robust associations and probability estimates for recidivistic outcome.

Chronic conditions and coexisting ADHD-a complicated combination in adolescents

Adolescents with chronic conditions (CCs) take more health risks than peers. However, coexisting ADHD has not sufficiently been considered. The aim of the present study was to investigate the impact of different CCs on protective factors and health-risk behaviors, taking coexisting ADHD into account. A school-based study among 6895 15- and 17-year-old students was performed in the county of Sörmland, Sweden in 2011 (response rate 80 %). The questionnaire explored background factors, CCs, protective factors, and health-risk behaviors. CCs were reported by 11 %, while 55 % were healthy. Students with CCs more often reported coexisting ADHD than healthy students. In adolescents with neurological conditions, the odds ratio for having ADHD was 7.34 (95 % CI 3.00-17.99) as compared to healthy peers. Few protective factors (<4) and clustered health-risk behaviors (≥4) were more common among students with CCs, especially if ADHD or a combination including ADHD was reported.

CONCLUSION

CCs and coexisting ADHD are associated with few protective factors and clustered-health risk behaviors. Adolescents with ADHD-in addition to a chronic condition-should be specially acknowledged by health care professionals in order to prevent health risk behaviors. ADHD should be considered when studying these outcomes in adolescents.

WHAT IS KNOWN

• Youth with chronic conditions (CCs)-especially ADHD-are reported to take more health risks than peers. • In earlier studies of youth with CCs, the presence of coexisting ADHD has not been taken into account.

WHAT IS NEW

• In this study, we showed that ADHD was more prevalent among adolescents with different types of CCs. • CCs and coexisting ADHD were associated with few protective factors and clustered health-risk behaviors.

Fighting With Siblings and With Peers Among Urban High School Students

Understanding the determinants of fighting is important for prevention efforts. Unfortunately, there is little research on how sibling fighting is related to peer fighting. Therefore, the aim of this study was to evaluate the association between sibling fighting and peer fighting. Data are from the Boston Youth Survey 2008, a school-based sample of youth in Boston, MA. To estimate the association between sibling fighting and peer fighting, we ran four multivariate regression models and estimated adjusted prevalence ratios and 95% confidence intervals. We fit generalized estimating equation models to account for the fact that students were clustered within schools. Controlling for school clustering, race/ethnicity, sex, school failure, substance use, and caregiver aggression, youth who fought with siblings were 2.49 times more likely to have reported fighting with peers. To the extent that we can confirm that sibling violence is associated with aggressive behavior, we should incorporate it into violence prevention programming.

The Relationship of Parental Education with Knowledge and Practice Level of Middle School and High School Students of Isfahan Regarding Violent Behaviors

Background:

It can be concluded from the existing theories that parental education status, by affecting socioeconomical status of families, can impact the incidence of violent behaviors in teenagers. Therefore, this study was conducted aiming at investigating the relationship between parental education and teenagers’ knowledge of violent behaviors and their incidences.

Methods:

For this cross-sectional, descriptive-correlational study, a sample of 5500 teenager students from Isfahan province were selected by random cluster sampling and responded to a 61-item questionnaire. The data collected from by questionnaire was analyzed by Spearman's statistical correlation and multiple regression methods.

Results:

Most of the students under study (89.1%) were living in cities and the rest were rural dwellers. In terms of gender, female to male ratio was approximately equal (49.8% vs. 50.2%). The statistical results showed that there is a significant positive relationship between practice and knowledge (R = 0.092 and P = 0.00), but there is no significant relationship between parental education and practice and there is a significant relationship between parental education and knowledge (Mothers’ education P = 0.00 and R = 0.121 and fathers’ education P = 0.00 and R = 0.109). Moreover, there was a positive significant relationship between teenagers’ knowledge of violence consequences (P = 0.005 and B = 0.048) violent behavior causes (P = 0.00 B = 0.085) and methods of preventing violent behaviors (P = 0.00 and B = 0.085) with teenagers’ practice.

Conclusions:

Based on the results of the present study that indicates teenagers are less aware of the consequences of violent behavior compared to other subscales of knowledge, it is better that teenagers’ education about the violent behaviors are more about the consequences of violent behavior rather than its definitions. Moreover, parental education is related to teenagers’ knowledge of the violent behavior so it is better that in various grades more comprehensive and suitable information regarding violent behaviors be presented.

Parsing protection and risk for problem behavior versus pro-social behavior among US and Chinese adolescents

This study investigates the different roles played by protective factors and risk factors-and by particular protective and risk factors-when the concern is with accounting for adolescent problem behavior than when the concern is with accounting for adolescent pro-social behavior. The protective and risk factor literature on adolescent problem behavior reveals considerable conceptual and operational ambiguity; an aim of the present study was to advance understanding in this domain of inquiry by providing a systematic conceptualization of protection and risk and of their measurement. Within the systematic framework of Problem Behavior Theory, four protective and four risk factors are assessed in a cross-national study of both problem behavior and pro-social behavior involving large adolescent samples in China (N = 1,368) and the US (N = 1,087), in grades 9, 10, and 11; females 56 %, US; 50 %, China. The findings reveal quite different roles for protection and risk, and for particular protective and risk factors, when the outcome criterion is problem behavior than when it is pro-social behavior. The protective factor, Controls Protection, which engages rule and regulations and sanctions in the adolescent's ecology, emerges as most important in influencing problem behavior, but it plays a relatively minor role in relationship to pro-social behavior. By contrast, Models Protection, the presence of pro-social models in the adolescent's ecology, and Support Protection, the presence of interest and care in that same ecology, have no significant relationship to problem behavior variation, but they are both the major predictors of variation in pro-social behavior. The findings are robust across the samples from the two very diverse societies. These results suggest that greater attention be given to protection in problem behavior research and that a more nuanced perspective is needed about the roles that particular protective and risk factors play in reducing problem behavior and in promoting pro-social behavior.

Protective Factors Against the Impact of School Bullying Perpetration and Victimization on Young Adult Externalizing and Internalizing Problems

School-based bullying perpetration and victimization is common worldwide and has profound impacts on student behavior and mental health. However, few studies have examined young adult outcomes of bullying perpetration or victimization. Research on factors that protect students who have bullied or been bullied is also lacking. This study examined young adult externalizing and internalizing problems (aged 18-19 years) and adolescent protective factors related to self-reported bullying perpetration and victimization among over 650 Victorians aged 16-17 years. Opportunities for prosocial involvement in the family lessened subsequent involvement in nonviolent antisocial behavior, as an outcome of prior bullying. High academic performance and having strategies to cope with stress reduced young adult depressive symptoms for participants who had been victims of bullying. The implications for bullying prevention and early intervention programs are discussed.

Adult attention deficit hyperactivity disorder and violence in the population of England: does comorbidity matter?

Background

It is unclear whether the association between Attention Deficit/Hyperactivity Disorder (ADHD) and violence is explained by ADHD symptoms or co-existing psychopathology. We investigated associations of ADHD and its symptom domains of hyperactivity and inattention, among individuals reporting violence in the UK population.

Methods

We report data from the Adult Psychiatric Morbidity Survey (2007), a representative sample of the household population of England. A randomly selected sample of 7,369 completed the Adult Self-Report Scale for ADHD and the self-reported violence module, including repetition, injury, minor violence, victims and location of incidents. All models were weighted to account for non-response and carefully adjusted for demography and clinical predictors of violence: antisocial personality, substance misuse and anxiety disorders.

Results

ADHD was moderately associated with violence after adjustments (OR 1.75, p = .01). Hyperactivity, but not inattention was associated with several indicators of violence in the domestic context (OR 1.16, p = .03). Mild and moderate ADHD symptoms were significantly associated with violence repetition, but not severe ADHD where the association was explained by co-existing disorders. Stratified analyses further indicated that most violence reports are associated with co-occurring psychopathology.

Conclusions

The direct effect of ADHD on violence is only moderate at the population level, driven by hyperactivity, and involving intimate partners and close persons. Because violence associated with severe ADHD is explained by co-existing psychopathology, interventions should primarily target co-existing disorders.

Adolescent caffeine consumption and self-reported violence and conduct disorder

Caffeine is the most widely used psychoactive substance in the world and currently the only one legally available to children and adolescents. The sale and use of caffeinated beverages has increased markedly among adolescents during the last decade. However, research on caffeine use and behaviors among adolescents is scarce. We investigate the relationship between adolescent caffeine use and self-reported violent behaviors and conduct disorders in a population-based cross-sectional sample of 3,747 10th grade students (15-16 years of age, 50.2 % girls) who were enrolled in the Icelandic national education system during February 2012. Through a series of multiple regression models, while controlling for background factors, Attention Deficit Hyperactivity Disorder symptoms and current medication and peer delinquency, and including measures on substance use, our findings show robust additive explanatory power of caffeine for both violent behaviors and conduct disorders. In addition, the association of caffeine to the outcomes is significantly stronger for girls than boys for both violent behaviors and conduct disorders. Future studies are needed to examine to what extent, if at all, these relationships are causal. Indication of causal connections between caffeine consumption and negative outcomes such as those reported here would call into question the acceptability of current policies concerning the availability of caffeine to adolescents and the targeting of adolescence in the marketing of caffeine products.

Direct protective and buffering protective factors in the development of youth violence

This article discusses conceptual issues and reviews knowledge about direct and buffering protective factors in the development of youth violence. Direct protective factors predict a low probability of violence, whereas buffering protective factors predict a low probability of violence in the presence of risk (and often interact with risk factors). Individual, family, school, peer, and neighborhood factors are reviewed. Heterogeneity of variables, measurement, contexts, study design, sample, and other characteristics limit generalizations. However, there were various evidence-based candidates for having a direct protective or buffering protective effect such as above-average intelligence, low impulsivity/easy temperament, enhanced anxiety, prosocial attitudes, high heart rate, close relationship to at least one parent, intensive parental supervision, medium SES of the family, sound academic achievement, strong school bonding, a positive school/class climate, nondeviant peers, and living in a nondeprived and nonviolent neighborhood. The probability of violence decreases as the number of protective factors increases (a dose-response relationship). Implications for future research and practice concern adequate research designs to detect nonlinear relationships; conceptually and methodologically homogeneous studies; differentiated analyses with regard to age, gender, and other characteristics; and greater integration of longitudinal correlational research with (quasi-)experimental intervention studies.

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

The development of work on direct protective factors for youth violence has been delayed by conceptual and methodologic problems that have constrained the design, execution, and interpretation of prevention research. These problems are described in detail and actively addressed in review and analytic papers developed by the CDC's Expert Panel on Protective Factors for youth violence. The present paper synthesizes findings from these papers, specifies their implications for public health research and prevention strategies to reduce youth violence, and suggests directions for future research.

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.