Community violence and children's development: toward a research agenda for the 1990s

An exploratory study of community violence and HIV care engagement among Black gay and bisexual men

This study examined the relationship between exposure to community violence and HIV care engagement among 107 Black gay or bisexual men living with HIV in Chicago. Measures assessed the importance of demographic covariates (age, annual income, health insurance status, and years living with HIV), community violence exposures, mental health, social support, in explaining variations in missed doses of antiretroviral therapy (ART) medication and missed HIV care appointments. Results showed that participants who reported higher rates of exposure to community violence were two times more likely to have missed ART doses and HIV care appointments. Participants who reported depression scores were two times more likely to have greater non-ART adherence. Finally, older participants were more likely to report fewer missed ART doses. More research is needed to clarify the mechanisms between age or depression and ART adherence given community violence exposure. Health care providers should screen for depression when attempting to promote better ART adherence and keeping HIV care appointments for Black gay and bisexual men living with HIV. Younger Black gay and bisexual men living with HIV may be more vulnerable than older men for missed ART doses and may require additional screening and follow-up.

Violent communities, family choices, and children's chances: An algorithm for improving the odds

Data are presented concerning the early predictors of adaptational success and failure among 72 children attending their 1st years of elementary school in a violent Washington, D.C., neighborhood. Adaptational failures were defined as those children who were doing poorly or failing in school and rated by their parents as suffering clinically significant levels of behavior problems. Adaptational successes were defined as children whose performance as students was rated in the average to excellent range and whose parent-rated levels of behavior problems were within the normal range. Despite the fact that these children were being raised in violent neighborhoods, had been exposed to relatively high levels of violence in the community, and were experiencing associated distress symptoms, community violence exposure levels were not predictive of adaptational failure or success. Instead, adaptational status was systematically related to characteristics of the children's homes. More specifically, the children's chances of adaptational failure rose dramatically as a function of living in unstable and/or unsafe homes. Moreover, it was not the mere accumulation of environmental adversities that gave rise to adaptational failure in these children. Rather, it was only when such adversities contaminated or eroded the stability and/or safety levels of the children's homes that the odds of their adaptational failure increased. We argue that this erosion of the quality of the child's microsystem (i.e., family) by adversities and pressures in the exosystem (i.e., community) is not an inevitable process. Although not yet well understood, it is a process over which families have and must exercise control. The implications of these data for improving children's chances of physical, psychological, and academic survival in violent neighborhoods are considered.

Mark Twain meets DSM-III-R: Conduct disorder, development, and the concept of harmful dysfunction

The Diagnostic and Statistical Manual (3rd ed., rev.) (DSM-III-R) diagnosis of conduct disorder assumes that all children who engage in three or more criterion antisocial behaviors for 6 months or more suffer from a mental disorder. It resists all contextual information about a child's developmental history, capacities, strengths and circumstances, and assumes that the antisocial behavior necessarily stems from an underlying disorder. In this review, we use Mark Twain's narrative of the lives of Tom Sawyer and Huckleberry Finn as a point of departure for questioning the reasonableness of this assumption, and for examining normal as well as pathological pathways to antisocial behavior. We begin by reviewing the status of earlier controversies about the mental disorder concept in the service of documenting the impressive progress of the field in conceptualizing disorder. Next, we examine Wakefield's (1992a, 1992b) recently introduced “harmful dysfunction” concept of mental disorder and employ its criteria to evaluate the hypothesis that chronic antisocial behavior in childhood as defined by DSM-III-R is caused by an underlying mental disorder. We also examine some of the difficulties in discriminating between disorder- and nondisorder-based antisocial behavior, and consider issues that warrant attention in future theoretical and empirical work. Finally, we explore the pragmatic rather than scientific basis for DSM-III-R's mental disorder claim and argue that regardless of its status as a mental disorder, this most troubling and harmful behavior syndrome of childhood deserves the intensive interest, concern, and resources of the scientific and public health communities.

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

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

Neighborhood-level factors and youth violence: giving voice to the perceptions of prominent neighborhood individuals

Youth violence is a significant public health problem. Although the relationship between neighborhood-level factors and urban youth violence is recognized, the specific mechanisms of this relationship are often unclear. Prominent neighborhood individuals were identified within four select low-income urban neighborhoods in Baltimore City. In-depth interviews were conducted to explore these individuals' perceptions of the relationship between social and structural neighborhood-level factors and urban youth violence. Employment opportunities, local businesses, trash management, vacant housing, and street lighting were perceived as important neighborhood factors influencing young people's experiences. The relationship between these neighborhood characteristics and the local illicit drug market and youth violence is highlighted. Results provide an enhanced understanding of the importance of using a participatory-based research approach and the mechanisms of the relationship between neighborhood-level factors and youth violence. Both are critical components in designing and implementing multilevel youth violence prevention efforts.

Urban youth violence: do definitions and reasons for violence vary by gender?

This study explored how young boys and girls living in low income urban neighborhoods defined and described reasons associated with youth violence. Five focus groups were conducted with 29 youth between the ages of 8 and 12 recruited from four selected study neighborhoods. Participants were asked to describe youth violence. Appropriate probes were used to explore similarities and differences by gender with regard to the reasons for violence. Definitions of youth violence were consistent across participants and included verbal threats, physical contact, and often the use of a weapon. Several common reasons for violence were found among both boys and girls; romantic relationships, respect, idle time, gangs/cliques, and witnessing violence. Reasons for violence unique to boys include fighting about issues related to money and illicit drugs. Gossip was identified as a reason specific to why girls engage in violence. Youth violence was perceived as a common problem impacting the lives of the boys and girls in this study. Although many of the reasons identified for violence are similar among boys and girls, select gender differences do exist. Future research and prevention efforts to address youth violence should engage young people in efforts to understand and address this important public health topic.

Exposure to community violence and upper respiratory illness in older adolescents

PURPOSE

To examine the relationship between exposure to chronic community violence and upper respiratory illness (URI) symptoms among urban adolescents of color; and to test the generality of a model of the relationship between social stress and URI.

METHOD

The research used a cross-sectional correlational design. The sample was 769 first-semester first-year students in an urban nonresidential 4-year college from the academic years 1999-2002. Data were collected by a group-administered questionnaire in academic classes. The research used three multi-item additive scales (each with high reliability and validity): exposure to community violence, psychological distress, and URI symptoms. Multiple regression procedures were used to analyze the data.

RESULTS

Positive correlations were obtained between: exposure to community violence and reporting of URI (r = .19), exposure and psychological distress (r = .22), and psychological distress and URI (r = .51). The relationship between exposure to community violence and URI is greatly reduced when level of psychological distress is statistically controlled.

CONCLUSIONS

Exposure to community violence is related to experiencing URI symptoms among older urban adolescents of color; the effect size of the relationship is small-medium. Psychological distress mediates the impact of exposure to community violence on URI. The findings expand the range of social stressors that are empirically related to URI, and populations in which a relationship between social stressors and URI may be found.

Exposure to violence and psychosocial adjustment among urban school-aged children

This study determines the relationship between psychosocial adjustment in school-aged children and one aspect of exposure to violence, the proximity of exposure, in terms of (1) "physical" proximity and (2) "emotional" proximity to the victims of violence. A convenience sample of 175 children aged 9 to 12 years from a primary care clinic of a large urban hospital were interviewed about their exposure to violence using the Children's Report of Exposure to Violence. Psychosocial adjustment was measured through maternal reports using the Child Behavior Checklist (CBCL) and the Personal Adjustment and Role Skills Scale (PARS III). Children were categorized into three groups according to their closest proximity to exposure to violence ("victim" > "witness" > exposure through other people's "report") and two groups according to emotional proximity (victim was a "familiar person" or "stranger"). All children (23/175) who scored above the CBCL clinical cutoff (T score > 63) were witnesses or victims of violence. The CBCL total T scores (higher score = more maladjustment) showed that the "victims" group (mean 52.4) scored significantly higher than the "witness" group (mean 50.0) and "report" group (mean 47.4). The PARS III total scores (lower scores = more maladjustment) showed that the "victims" group (mean 87.5) scored significantly lower than the "witness" group (mean 93.1) and "report" group (mean 98.2). The relationship of the child to the victim was not associated with significantly different CBCL and PARS III scores. Children exposed to more proximal forms of violence as victims or witnesses exhibited more psychosocial maladjustment.

Community violence exposure in young adults

The United States is one of the most violent countries in the world, and this is being reflected in rates of young adults' lifetime exposure ranging from 76% to 82% for victimization and 93% to 96% for witnessing. These high rates are found despite these studies being conducted on relatively low-risk samples from rural areas, and the majority of violent acts reported being less life threatening than those reported by high-risk urban adolescents. Nonetheless, young adults with high levels of exposure report more psychological maladjustment including depressed mood, aggressive behavior, posttraumatic stress disorder symptomatology, and interpersonal problems. The cycle from exposure to later perpetration of aggression is discussed in terms of psychophysiological processes that may emerge from chronic violence exposure or interact with victimization to increase risk. Last, theoretical, clinical, and policy implications are suggested that include intervention and prevention programs targeting all forms of violence in urban and rural areas.

The relationship between exposure to community violence and psychological distress among adolescents: a meta-analysis

This article is concerned with the "size of the relationship" between exposure to chronic community violence and psychological symptoms among adolescents. It analyzes all relevant empirical studies in the published literature during the last 20 years; uses quantitative methods to summarize findings; and estimates the effect size using meta-analysis. The 37 independent samples (n = 17,322) were coded on 19 categories, including size and characteristics of sample, and characteristics of the independent and dependent variables. Findings indicate that there is a positive correlation between exposure to community violence and psychological distress; and that the effect size (r = .25) of this relationship is low-medium. The estimated effect size of the relationship points to new issues such as the characteristics of the psychosocial dynamics of resilience in the face of exposure to community violence and how exposure to community violence interacts with other potentially traumatic experiences in the producing of psychological distress.

"Ignoring the violence": healthcare policy recommendations for the prevention of community violence re-victimization

Medical centers see 1.4 million serious violent crime victims every year and are the most likely places to intervene for preventing and reducing violence. However, very few medical centers evaluate patients beyond physical conditions, and very few complete toxicology or psychosocial screens to evaluate for substance abuse and psychological conditions as a result of trauma. Unfortunately, victims of violence are given medical assistance and discharged without recognition of the serious after effects of trauma both for themselves and their families. This manuscript discusses the chronicity and consequences of violent victimization, related health care policies that impede violence prevention and victim intervention, and concludes with a proposal for improved policies in the health care arena.

Violence exposure among school-age children in foster care: relationship to distress symptoms

OBJECTIVE

To describe the amount and nature of violence exposure and examine the relationship between violence exposure and distress symptoms among children in foster care.

METHOD

Violence exposure and distress symptoms were evaluated in interviews, conducted between July 1996 and March 1998, of 300 children from Los Angeles County living in out-of-home placement.

RESULTS

Interviews were successfully completed in 91% of eligible children. The majority of children (85%) reported having been a witness to violence, and 51% had been a victim of violence during their lifetime. Of these youths, 54% and 41%, respectively, reported having been exposed to such violence in the past 6 months. Girls, victims of assaultive violence and weapon related violence, and those reporting exposure to mild violence were more likely (p < .05) to have higher levels of distress symptoms than those without such characteristics, after age was controlled for.

CONCLUSIONS

Children in foster care continue to have high levels of violence exposure, even after removal from their biological parents' home. The relationship between violence exposure and distress symptoms underscores the need for clinicians to inquire about multiple forms of violence exposure among children living in out-of-home placement.

Child resiliency in inner-city families affected by HIV: the role of family variables

This study examined the role of family variables in child resiliency within a sample of African-American, inner-city children whose mothers are HIV-infected. Variables from three dimensions of the family were included: family structural variables, maternal variables, and mother-child (parenting) variables. The participants were 82 children between the ages of 6 and 11 and their HIV-infected mothers. Correlational analyses indicated that resiliency was associated only with three parenting variables: parent-child relationship, parental monitoring, and parental structure in the home. Hierarchical regression analyses indicated a multiplicative relationship between parental monitoring and parent-child relationship and between parental monitoring and parental structure in the home, suggesting that parenting variables potentiate each other. Clinical implications of the findings are considered.

Treating inner-city families of homicide victims: a contextually oriented approach

Violence, including youth homicide, has assumed near epidemic proportions in US inner cities, with few signs that such violence is abating. Professionals working with families after the murder of a family member, are faced with the task of helping such families achieve a meaningful restoration of functioning. At the same time, there is a need to prevent retaliatory violence by surviving siblings and other family members. A treatment model will be discussed that uses the basic, theoretical principles of Boszormenyi-Nagy's Contextual Therapy (CT) while incorporating White and Epston's technique of "therapeutic certificates" in work with young people coping with loss via homicide. Case examples, drawn from the author's work at a unique, predominantly African American agency in an urban inner city will be used to illustrate applications of CT principles, and to show how therapeutic certificates can provide tools to clinicians working with this deeply troubling problem.