Risk and direct protective factors for youth violence: results from the Centers for Disease Control and Prevention's Multisite Violence Prevention Project

Evidence That Selecting an Appropriate Item Response Theory-Based Approach to Scoring Surveys Can Help Avoid Biased Treatment Effect Estimates

Considerable thought is often put into designing randomized control trials (RCTs). From power analyses and complex sampling designs implemented preintervention to nuanced quasi-experimental models used to estimate treatment effects postintervention, RCT design can be quite complicated. Yet when psychological constructs measured using survey scales are the outcome of interest, measurement is often an afterthought, even in RCTs. The purpose of this study is to examine how choices about scoring and calibration of survey item responses affect recovery of true treatment effects. Specifically, simulation and empirical studies are used to compare the performance of sum scores, which are frequently used in RCTs in psychology and education, to that of approaches rooted in item response theory (IRT) that better account for the longitudinal, multigroup nature of the data. The results from this study indicate that selecting an IRT model that matches the nature of the data can significantly reduce bias in treatment effect estimates and reduce standard errors.

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.

School Refusal Behavior and Aggression in Spanish Adolescents

In order to reduce school attendance problems and aggressive behavior, it is essential to determine the relationship between both variables. The aim of this study was twofold: (1) to examine the mean differences in scores on aggression, based on school refusal behavior, and (2) to analyze the predictive capacity of high scores on aggression, based on school refusal behavior factors. The sample consisted of 1455 Spanish secondary school students, aged 13–17 (M = 14.85; SD = 1.56). The School Refusal Assessment Scale-Revised (I. Avoidance of negative affectivity, II. Escape from aversive social and/or evaluative situations, III. Pursuit of attention from significant others, and IV. Pursuit of tangible reinforcement outside of school) and the Aggression Questionnaire (I. Physical Aggression, II. Verbal Aggression, III. Anger, and IV. Hostility) were used. Results indicated that students having high levels of Physical Aggression, Verbal Aggression, Anger, and Hostility received significantly higher scores on school refusal behavior. In most cases, school refusal behavior was found to be a positive and statistically significant predictor of aggression. Students that base their school refusal on the pursuit of tangible reinforcements outside of school earned higher scores, and other functional conditions underlying school refusal behavior were found to be associated with aggression issues. The role of aggression as a risk factor for school refusal behavior is discussed.

Protective and Risk Factors Associated With Youth Attitudes Toward Violence in Canada

Adolescents and young adults are the main perpetrators and victims of violence in almost all parts of the world. Theories of human behavior predict that the intention to behave violently is formed in part by the individual's attitude toward violent behavior. The purpose of this study was thus to investigate factors which both promote and protect against violent youth attitudes in Toronto, Canada's largest urban center. Multinomial logit models were fit separately for males and females in Grades 7 to 9 using cross-sectional data from the 2006 International Youth Survey. Odds ratios were estimated for the associations between levels of attitude toward violence and select factors in each of the biological, familial, peer-related, school and community domains. A graded effect of school attachment on violent attitude was observed for both sexes; male and female students who do not like school at all are 9.89 (3.15-31.0) and 6.49 (2.19-19.2) times as likely as those who like school a lot to have the "most" versus "least" violent attitude, respectively. For every one-unit increase in (negative) perception of neighborhood score, male and female students are 1.15 (1.07-1.23) and 1.20 (1.12-1.28) times as likely to have the "most" versus "least" violent attitude. The number of victimization events was associated with attitude toward violence in males but not females, while the reverse was true for academic performance and exposure to prejudice. Our findings highlight the important relationships between connections to social environments and youth attitudes toward violence, and identify modifiable factors which may be amenable to intervention. Sex-specific differences in the predictors of violent youth attitudes warrant additional investigation and have implications for policy design.

Youth and weapons: Patterns, individual and neighborhood correlates of violent crime arrests in Miami-Dade County, Florida

This study uses arrest data from the Miami-Dade County Police Department (n = 13 districts) for 2014-2017 to identify census tracts in which weapon violence arrests among young people aged 10-24 is high, and models area-level predictors of the total number of violent weapons crimes by census tract (greenness and socioeconomic status indices, population density and weapon dealers), after adjusting for arrestee-level factors (age, race and gender). Combined, handguns and firearms accounted for 23.2% (n = 1330) of all arrests (including murder and non-negligent manslaughter, rape, robbery, and aggravated assault). Arrests for weapon -related violent crime are concentrated in census tracts located in the north and south neighborhoods of Miami-Dade County. Findings indicate that arrestee factors and a neighborhood greenness index are more important than population density, weapon dealers and poverty in predicting arrests for weapon-related violent crime at the census tract level.

Commentary: Enabling efficient and full application of prevention strategies for population mental health - reflections on Dodge (2020)

Dodge (2020) provides a challenging and compelling formulation for more systematic determination of prevention component selection. The essay reminds us that population impact should be front and center in prevention specifically and public health organization in general. Dodge brings forth numerous issues in the science and the application of knowledge about prevention that warrant more research support and study. These issues include the need to recognize the existence of and increase the number of proven programs, the need for better and more extensive knowledge about impact variation across populations, and more attention to strengths and capabilities as guides for prevention. His essay also reminds us of the nuance and complexities in attempting to compare effect sizes and cost-benefit ratios of universal versus selective efforts. In addition, he provides compelling rationale for formalization of how prevention is organized and implemented in local community efforts. Further, in refocusing on the centrality of population effects in intervention application, Dodge also reminds us of the attendant principles of health equity and social justice in how we implement and judge the benefits of interventions. This essay provides a compelling argument for a strategy to realize the potential of the accumulating evidence of prevention as vital for addressing mental health and development.

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.

Feasibility and acceptability of a future-oriented empowerment program to prevent substance use and school dropout among school-disengaged youth

OBJECTIVE

To evaluate the feasibility and acceptability of a health promotion program to prevent school dropout and substance use among middle school-aged youth who display early warning signs of school disengagement.

INTERVENTION

Youth Empowerment Solutions for Positive Futures (YES-PF), an intensive, theoretically driven, 5-week summer enrichment program, aims to prevent school dropout and substance use by promoting youth empowerment, school engagement, and future orientation.

DESIGN AND SAMPLE

Using a pre-post-intervention design, we test feasibility and acceptability with 6th and 7th grade students (n = 43) who exhibited early warning signs for school disengagement (e.g., chronic absenteeism) in two school districts.

MEASURES

Program evaluation components included: (a) program session forms completed by facilitators; (b) post-program interviews with facilitators; (c) post-intervention program evaluation surveys with youth; (d) attendance; and (e) baseline and post-intervention surveys with youth to assess behavioral and psychosocial outcomes.

RESULTS

Facilitators routinely delivered core component lesson activities. Acceptability and program satisfaction were evidenced in strong program attendance by youth. Youth participants reported higher levels of leadership efficacy (p < .05) and a greater sense of control over their lives and potential problems (p < .01).

CONCLUSIONS

YES-PF was feasible and acceptable to school personnel and youth. Program refinement, based on implementation findings, is discussed.

Two-Year Changes in Neighborhood Juvenile Arrests After Implementation of a Park-Based Afterschool Mental Health Promotion Program in Miami-Dade County, Florida, 2015-2017

Objectives. To examine the association of Fit2Lead, an afterschool park-based youth mental health promotion program, and neighborhood juvenile arrests (2015-2017) in Miami-Dade County, Florida. Methods. We tracked juvenile (ages 12-17 years) arrest rates over 2 years of program implementation across zip codes matched by (1) park and (2) baseline sociodemographics and youth arrests. Fit2Lead mental and physical health, meditation, resilience, and life skills activities were offered in 12 high-need areas for youths (n = 501) aged 12 to 17 years. We tested the association of Fit2Lead implementation (binary variable) and change in juvenile arrest rates by zip code, adjusting for area-level gender, age, race/ethnicity, single-parent households, and poverty. Results. Fit2Lead was offered in areas composed of 48% male youths, 60% Hispanics, 29% non-Hispanic Blacks, 33% single-parent households, and 33% of residents living in poverty. After covariate adjustment, zip codes with Fit2Lead implementation showed a significant mean reduction (P < .001) in youth arrests per 10 000 youths aged 12 to 17 years per year compared with zip codes without program implementation (b = -6.9; 95% confidence interval = -9.21, -4.65). Conclusions. Park-based programs may have the potential to promote mental health and resilience, and also to prevent violence among at-risk youths.

Associations of Parental Monitoring and Violent Peers with Latino Youth Violence

This study aimed to examine the associations of parental monitoring and violent peers with violence among Latino youth, and whether these associations varied by acculturation. 133 adolescents were surveyed. Associations between parental monitoring, peer violence, and physical and non-physical violence were examined using bivariate and multivariable negative binomial regression. Multivariable analysis was stratified by age and acculturation. A path model examined whether peer violence mediated the relationship between parental monitoring and youth violence. Stratified analysis demonstrated that peer violence increased the risk of physical (RR = 1.24; 95% CI 1.02-1.20) and non-physical violence (RR = 1.32; 95% CI 1.08-1.62) for high-acculturated youth, whereas parental monitoring was protective for low-acculturated youth (physical RR = 0.88; 95% CI 0.78-0.99; non-physical RR = 0.80; 95% CI 0.68-0.93). In path analysis, low parental monitoring increased risk of involvement with violent peers, which was associated with increased risk of youth violence. Interventions may benefit from focusing on parental monitoring, peer violence, and tailoring by acculturation.

Gender Differences in the Influence of Parenting on Youth Antisocial Behavior through Deviant Peers

The aim of this study was to assess gender differences in direct and indirect effects of parental knowledge, family support, family conflict, and deviant peers on violent and nonviolent antisocial behavior among youngsters. The total sample was composed of 584 young people, 274 males and 310 females, aged 14 to 20 from High Schools of Galicia (NW Spain). The variables were assessed with different scales of the protocol Valoración del Riesgo en Adolescentes Infractores [Juvenile Offender's Risk Assessment]. Several structural equation models were conducted to clarify the relationships between these variables for males and females. The results showed a better fit for the mediated model. Significant direct effects were found for parental knowledge (β = -.35, p < .01, males; β = -.16, p < .05, females) and parental support (β = .26, p < .05, males) on nonviolent behavior. Significant direct effects were also found for parental knowledge (β = -.36, p < .05, males; β = -.42, p < .05, females) and parental support (β = .32, p < .05, males; β = .24, p < .05, females) on violent behavior. Not significant direct effects were found for family conflict. Moreover, significant indirect effects through deviant peers were found for knowledge (β = -.23, p < .01, males; β = -.21, p < .01, females), support (β = .20, p < .05, males; β = .21, p < .05, females), and conflict (β = .28, p < .01, males; β = .26, p < .05, females) on nonviolent behavior, as well as for knowledge (β = -.20, p < .01, males; β = -.10, p < .01, females), support (β = .18, p < .01, males; β = .10, p < .01, females), and conflict (β = .24, p < .05, males; β = .12, p < .01, females) on violent behavior. Thus, significant gender differences were found, specifically in the direct effects of family support on nonviolent antisocial behavior. The implications of these results for prevention of antisocial behaviors in youth based on gender differences are discussed.

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.

Building social capital to promote adolescent wellbeing: a qualitative study with teens in a Latino agricultural community

Background

Latino youth, particularly in rural settings, experience significant disparities in rates of teen pregnancy and violence. Few data are available regarding social and structural influences on Latino youth’s developmental trajectories, specifically on factors that promote wellbeing and protect them from engagement in high-risk sexual and violence-related behaviors.

Methods

Forty-two youth aged 13 to 19 years old were recruited from middle schools and youth leadership programs to participate in one of eight community-based focus groups in Salinas, a predominantly Latino, urban center in California’s rural central coast. Focus groups covered youths’ experiences with the risk and protective factors associated with exposure to violence and romantic relationships. Four researchers completed coding with a Grounded Theory approach, informed by the theoretical frameworks of the social ecological model and social capital. The study’s design and participant recruitment were informed by a community advisory board of local youth-serving organizations and health care providers.

Results

Participants described family lives rich in bonding social capital, with strong ties to parents and near-peer family members. They reported that while parents had a strong desire to promote healthful behaviors and social mobility, they often lacked the bridging or linking social capital required to help youth navigate structural systems, such as college applications and access to confidential health care. Youth also reported that some families link their children to negative social capital, such as exposure to gang affiliation.

Conclusion

Adolescents in this agricultural community identified robust sources of bonding social capital within their families. However, they identified limitations in their families’ capacities to link them to structural resources in education, employment, and health care that could support healthful behaviors and upward social mobility.

Increasing the Delivery of Preventive Health Services in Public Education

The delivery of prevention services to children and adolescents through traditional healthcare settings is challenging for a variety of reasons. Parent- and community-focused services are typically not reimbursable in traditional medical settings, and personal healthcare services are often designed for acute and chronic medical treatment rather than prevention. To provide preventive services in a setting that reaches the widest population, those interested in public health and prevention often turn to school settings. This paper proposes that an equitable, efficient manner in which to promote health across the life course is to integrate efforts from public health, primary care, and public education through the delivery of preventive healthcare services, in particular, in the education system. Such an integration of systems will require a concerted effort on the part of various stakeholders, as well as a shared vision to promote child health via community and institutional stakeholder partnerships. This paper includes (1) examination of some key system features necessary for delivery of preventive services that improve child outcomes; (2) a review of the features of some common models of school health services for their relevance to prevention services; and (3) policy and implementation strategy recommendations to further the delivery of preventive services in schools. These recommendations include the development of common metrics for health outcomes reporting, facilitated data sharing of these metrics, shared organization incentives for integration, and improved reimbursement and funding opportunities.

Latino Youth and the School-to-Prison Pipeline

Latinos are one of the fastest growing sectors in the American population, and Latinos figure prominently in many political, economic, and educational social systems. Unfortunately, the juvenile justice system is no exception. At least 18,000 Latino youth are incarcerated annually, and they are 2 to 3 times more likely to be incarcerated than White youth. This article discusses three broad topics that relate specifically to Latino youth and their families who are served by juvenile justice facilities: language development and communication between Latino families and professionals in the educational and justice systems, sociocultural variables specific to Latino families, and ethical considerations for professionals who interact with Latino youth. Specific strategies for both the educational and juvenile justice systems are suggested that might enable these groups to better serve Latino youth and their families. Both research and case studies of Latino youth served in the court diversion program, Reading for Life, are considered.

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.

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.

The Influence of Culture-Specific Personality Traits on the Development of Delinquency in At-Risk Youth

The association between culture-specific personality variables and family factors, and juvenile delinquency, was assessed in a sample of 402 adolescents of Chinese ethnicity between 12 and 17 years of age (Mage = 15.13, SD = 1.41; 135 girls), a subgroup of whom were considered at risk for juvenile delinquency owing to addictive behavior tendencies. Culture-specific personality variables were assessed using the Chinese Personality Assessment Inventory-Adolescent version Interpersonal Relatedness factor. The General Function subscale of the Chinese version of the Family Assessment Device was utilized to assess the influence of perceived levels of family functioning. Both culture-specific personality variables and non-culture-specific familial factors were significantly and negatively associated with self-reported juvenile delinquency (p < .001). However, in a sample of at-risk adolescents, only a culture-specific variable measuring orientation toward the family was able to predict self-reported juvenile delinquency (p < .001). Implications of the current results are discussed.

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.

Callous-unemotional traits, proactive aggression, and treatment outcomes of aggressive children with attention-deficit/hyperactivity disorder

OBJECTIVE

Stimulant treatment improves impulse control among children with attention-deficit/hyperactivity disorder (ADHD). Decreased aggression often accompanies stimulant pharmacotherapy, suggesting that impulsiveness is integral to aggressive behavior in these children. However, children with high callous-unemotional (CU) traits and proactive aggression may benefit less from ADHD pharmacotherapy, because their aggressive behavior seems more purposeful and deliberate. This study's objective was to determine whether pretreatment CU traits and proactive aggression affect treatment outcomes among aggressive children with ADHD receiving stimulant monotherapy.

METHOD

We implemented a stimulant optimization protocol with 160 children 6 to 13 years of age (mean [SD] age of 9.31 [2.02] years; 78.75% male) with ADHD, oppositional defiant or conduct disorder, and significant aggressive behavior. Family-focused behavioral intervention was provided concurrently. The primary outcome was the Retrospective Modified Overt Aggression Scale. The Antisocial Process Screening Device and the Aggression Scale, also completed by parents, measured CU traits and proactive aggression, respectively. Analyses examined moderating effects of CU traits and proactive aggression on outcomes.

RESULTS

In all, 82 children (51%) experienced remission of aggressive behavior. Neither CU traits nor proactive aggression predicted remission (CU traits: odds ratio [OR] = 0.94, 95% CI = 0.80-1.11; proactive aggression, OR = 1.05, 95% CI = 0.86-1.29). Children whose overall aggression remitted showed decreases in CU traits (effect size = -0.379, 95% CI = -0.60 to -0.16) and proactive aggression (effect size = -0.463, 95% CI = -0.69 to -0.23).

CONCLUSIONS

Findings suggest that pretreatment CU traits and proactive aggression do not forecast worse outcomes for aggressive children with ADHD receiving optimized stimulant pharmacotherapy. With such treatment, CU traits and proactive aggression may decline alongside other behavioral improvements. Clinical trial registration information--Medication Strategies for Treating Aggressive Behavior in Youth With Attention Deficit Hyperactivity Disorder; http://clinicaltrials.gov/; NCT00228046; and Effectiveness of Combined Medication Treatment for Aggression in Children With Attention Deficit With Hyperactivity Disorder (The SPICY Study); http://clinicaltrials.gov/; NCT00794625.

An experimental trial exploring the impact of continuous transdermal alcohol monitoring upon alcohol consumption in a cohort of male students

OBJECTIVE

To examine the impact of continuous transdermal alcohol monitoring upon alcohol consumption in male students at a Scottish university.

METHOD

Using a within-subject mixed-methods design, 60 male university students were randomly allocated into three experimental conditions using AUDIT score stratified sampling. Participants in Conditions A and B were asked not to consume alcohol for a 14-day period, with those in Condition A additionally being required to wear a continuous transdermal alcohol monitoring anklet. Condition C participants wore an anklet and were asked to continue consuming alcohol as normal. Alcohol consumption was measured through alcohol timeline follow-back, and using data collected from the anklets where available. Diaries and focus groups explored participants' experiences of the trial.

RESULTS

Alcohol consumption during the 14-day trial decreased significantly for participants in Conditions A and B, but not in C. There was no significant relative difference in units of alcohol consumed between Conditions A and B, but significantly fewer participants in Condition A drank alcohol than in Condition B. Possible reasons for this difference identified from the focus groups and diaries included the anklet acting as a reminder of commitment to the study (and the agreement to sobriety), participants feeling under surveillance, and the use of the anklet as a tool to resist social pressure to consume alcohol.

CONCLUSIONS

The study provided experience in using continuous transdermal alcohol monitors in an experimental context, and demonstrated ways in which the technology may be supportive in facilitating sobriety. Results from the study have been used to design a research project using continuous transdermal alcohol monitors with ex-offenders who recognise a link between their alcohol consumption and offending behaviour.

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.