Effects of community violence exposure and parental mental health on the internalizing problems of urban adolescents

Development of a Differential Assessment Guide to Improve Engagement with Youths & Families Living with Chronic Trauma

Youths and parents/caregivers who have experienced multiple forms of severe interpersonal trauma may demonstrate severe and persistent symptoms of complex trauma including high-risk behaviors. Engagement, and sustaining engagement, of these youths and parents/caregivers in evidence-supported trauma treatment is a critical challenge, especially when youths or parents/caregivers have experienced chronic traumas that may be expected to continue into the foreseeable future. An extensive literature review was conducted leading to development of an assessment framework that could increase engagement of youths and parents/caregivers in trauma treatment based on research on chronic trauma, complex trauma, Developmental Trauma Disorder (DTD), and factors that promote engagement. A multi-dimensional assessment guide was developed to enable clinicians to differentiate types of chronic trauma based on a continuum of past, current and expected exposure over time and then to use this guide collaboratively with youths and parents/caregivers to develop priorities for treatment and service planning that matches their needs and strengths. The assessment guide incorporates exposure to intra-familial and community forms of interpersonal trauma, attachment disruptions, established symptoms of PTSD, Complex PTSD and DTD, as well as social-emotional development. The assessment and treatment planning guides proposed in this article expand applicability of evidence-supported trauma-informed therapy to youths and families who have not been engaged by programs offering treatments that are focused on past or single incident traumas or do not address disrupted attachments, multi-generational experiences of adversity, discrimination and community violence, life-threatening dangers or the impact of chronic trauma on youth, parent/caregiver and family development.

The Development of Maternal Psychological Control in Early Adolescence: Maternal, Youth, and Neighborhood Antecedents

Despite abundant research documenting negative associations between parental psychological control and youth adjustment, little is known about precursors of parental psychological control. The current study evaluated maternal, youth, and neighborhood predictors of changes in maternal psychological control across the transition to adolescence. Mother-youth dyads (N = 211, 50.2% female children; 46.4% Latinx, 17.5% Black, 11.4% white, and 24.7% multiracial) reported on maternal psychological control at youth ages 10 and 12. Controlling for youth ethnicity and race, family income-to-needs, and prior levels of maternal psychological control at age 10, structural equation models showed that maternal problems (i.e., anxiety, alcohol dependence, caregiving helplessness) predicted increases and youth externalizing problems (e.g., attention problems, rule-breaking) predicted decreases in maternal reports of psychological control. Neighborhood risks (i.e., poverty, crime, single-parent households) predicted increases in youth reports of maternal psychological control. Exploratory analyses by gender indicated that neighborhood risks predicted decreases in maternal reports of psychological control for girls, but increases in maternal reports of psychological control for boys. This study identified specific antecedents of maternal psychological control that can be targeted in future intervention efforts to reduce negative parenting to promote positive youth development.

Relational Factors Associated With Posttraumatic Stress Among Emerging Adults of Color Exposed to Community Violence

The relationship between trauma exposure and posttraumatic stress symptoms (PTSS) is well-documented, but less is known about factors that contribute to the expression of PTSS following community violence exposure, particularly among emerging adults of color. Utilizing the Person-Environment Interaction model (Slaug et al., 2018), this study examined the role of relational factors, specifically ethnic identity, community cohesion, and social support, associated with PTSS following exposure to community violence. Participants included 243 emerging adult university students of color (M_age = 20.27, SD = 1.95, 83.5% female). Linear regression analyses indicated that less frequent trauma exposure and greater perceived social support were related to lower PTSS. A significant interaction was also found between social support and exposure to community violence, such that at low levels of social support, individuals with more community violence exposure had the highest levels of PTSS. Regression and moderation analyses indicated that ethnic identity and community cohesion were not significantly associated with PTSS in this sample. Findings highlight the importance of incorporating social support strategies in treatments for PTSS following community violence exposure.

Expanding Collective Efficacy Theory to Reduce Violence Among African American Adolescents

Community violence is a complex phenomenon, and many theories have been put forth to explain the causes of community violence and disparities in community violence across neighborhoods. One notable theory, collective efficacy theory (CET), posits that collective efficacy (i.e., a neighborhood's social cohesion and informal social control) mediates the association between concentrated disadvantage and community violence. As CET theorizes an inverse feedback loop between collective efficacy and community violence, collective efficacy could mitigate the link between neighborhood disadvantage and community violence. The current study examines the reciprocal association between collective efficacy and community violence exposure using data from 604 low-resourced, urban African American ninth-grade students from a large Midwestern city. Data were collected at 6-month intervals over 2 years. Significant cross-sectional associations were found between each of the collective efficacy constructs (social cohesion and informal social control) and community violence exposure, although no significant longitudinal cross-lagged associations were found. There were positive cross-sectional associations between (a) collective efficacy and community violence exposure and (b) informal social control and community violence exposure; however, the association between social cohesion and community violence exposure was negative. Associations between overall collective efficacy, as well as its subscales, and community violence exposure were consistent with hypothesized directions for social cohesion, but not for collective efficacy or informal social control. Findings support the use of collective efficacy as two constructs, rather than a single construct as proposed by Sampson et al. Implications for expanding original assumptions of CET are discussed.

Ecological Predictors of Parental Beliefs about Infant Crying in a Randomized Clinical Trial of ABC

Objective: Attachment theory suggests that parent responsiveness to infant distress predicts secure parent-child attachment and subsequent healthy child development. While much is known about microsystem factors that interfere with responsive caregiving, there is a paucity of research investigating how exosystem factors, such as neighborhood crime, affect parenting.Method: In a sample of 200 diverse caregivers and their 5- to 21-month-old infants (M = 11.82; 49% male), we leveraged data from a randomized clinical trial of Attachment and Biobehavioral Catch-up (ABC), an attachment-based intervention, to assess whether individual level burden (indicated by single-parent status, low income, residential instability, young parenthood, parental psychopathology, and own history of early adversity) and neighborhood crime density (geocoded within a 500 ft radius of parent's residence) were associated with their beliefs about infant crying, an indicator of responsive parenting.Results: Consistent with Bronfenbrenner's ecological systems' theory of development, both greater exposure to individual burden indicators and greater neighborhood crime density predicted greater maladaptive beliefs about infant crying, suggesting that contextual factors outside the household are associated with parenting cognitions. Further, when accounting for the effect of crime and individual burden on parental beliefs about infant crying, participation in the ABC intervention was effective in reducing maladaptive parenting beliefs.Conclusions: We consider implications for multi-level intervention approaches that target family processes, neighborhood-level factors, and policy initiatives to promote community wellbeing and positive child development.

Trauma Symptoms and Social Support Mediate the Impact of Violence Exposure on Parenting Competence Among Substance-Dependent Mothers

Women with substance use disorders (SUDs) experience high rates of violence exposure and posttraumatic stress disorder (PTSD), which are associated with parenting anxiety and lower parenting satisfaction among mothers. Although social support may buffer the impact of violence and PTSD on parenting, violence exposure and PTSD may impair mothers' ability to create, perceive, and utilize social support. We examined the impact of violence exposure, trauma symptoms, and interpersonal support on parenting competence among 291 mothers with substance dependence, using ordinary least squares regression and path analysis. Greater violence exposure and trauma symptoms were associated with lower parenting competence. Greater interpersonal support was associated with greater parenting competence. Trauma symptoms and interpersonal support sequentially mediated the impact of violence exposure on parenting competence, suggesting one pathway through which violence exposure may affect parenting among substance-dependent mothers. Implications for practice include the need to utilize trauma-informed interventions that modify social support.

Validation of the Brief Symptom Inventory-18 Among Low-Income African American Adolescents Exposed to Community Violence

African American youth, especially those who reside in low resourced communities, are exposed to higher levels of exposure to community violence relative to their counterparts from other race/ethnic groups. However, appropriate measures for assessing psychological stress related to such exposures are underresearched in the extant literature for this population. The aim of the current study was to examine the reliability and validity of the Brief Symptom Inventory (BSI-18) scale among African American youth exposed to community violence through classical test theory and item response theory methods. Internal reliability and construct validity were examined. Results indicated good internal reliability (α = .93). Construct validity of the BSI-18 was established through confirmatory factor analysis with the three-factor somatic, depression, and anxiety model. Construct validity was also determined with all items indicating adequate fit. Our study indicates good reliability and validity of the BSI-18 to assess psychological distress among African American youth exposed to community violence.

Informal Support, Health, and Burden Among Parents of Adult Children With Autism

BACKGROUND AND OBJECTIVES

Many adults with autism spectrum disorders require lifelong reliance on caregiver support. As these caregivers age and experience health challenges, social support can be critical. This study seeks to understand if caregiver health moderates the relationship between informal social support and caregiver burden.

RESEARCH DESIGN AND METHODS

A total of 320 parents (age 50+ years) of adult children diagnosed with ASD were recruited from autism organizations and support groups and completed a web-based survey. Separate moderation analyses were used to determine if caregiver health was moderating the relationship between informal social support and composite caregiver burden, as well as the separate domains of developmental, time dependence, emotional burden, and impact of caregiving on finances. For each analysis, perceptions of available informal social support were the independent variable, composite and domains of caregiver burden were dependent variables, and parents' self-reported general health was the moderating variable.

RESULTS

Caregiver health had a statistically significant moderating effect when predicting the relationships between informal social support and composite caregiver burden, as well as time dependence burden and impact of caregiving on finances.

DISCUSSION AND IMPLICATIONS

Increased attention should be focused on supporting the current and future needs of both aging caregivers and their adult children with ASD. Future research on the dynamics of social support, health, and burden is also urgently needed to address the growing number of aging caregivers of adults diagnosed with ASD.

Trajectories of maternal symptoms of posttraumatic stress disorder predict long-term mental health of children following the Wenchuan earthquake in China: A 10-year follow-up study

BACKGROUND

Maternal psychopathology can be an important factor associated with psychological adjustment of children. However, there is limited research on long-term impacts of maternal posttraumatic stress disorder (PTSD) on children's mental health. This study examined how PTSD trajectories of women exposed to the 2008 Wenchuan earthquake in China predicted their children's mental health symptoms 10 years after the earthquake.

METHODS

410 dyads of mothers and their adolescent children who exposed to the Wenchuan earthquake were investigated at 12 and 18 months post-earthquake. While the mothers completed measures of earthquake exposure and PTSD symptoms, the children completed measures of earthquake exposure, PTSD, depression and anxiety symptoms. In the 10-year follow up, 257 out of the 410 children completed measures of PTSD, depression and anxiety symptoms. Data were analyzed using linear regression.

RESULTS

Four trajectories of maternal PTSD symptoms were identified: (a) chronic (9.5%); (b) resilient (66.3%); (c) delayed (7.6%); and (d) recovery (16.6%); More importantly, the findings demonstrated that children whose mothers experienced chronic PTSD reported higher level of PTSD and anxiety symptoms 10 years after the earthquake.

LIMITATIONS

Only two waves of maternal PTSD were collected, self-reported tools other than clinical reviews were used to collect data, and a significant proportion of participants did not respond at the 10-year follow-up.

CONCLUSIONS

This study identified maternal PTSD trajectories following the Wenchuan earthquake. Chronic PTSD symptoms in mothers were associated with increased risk of children's PTSD and anxiety 10 years after the earthquake.

Parental Depressive Symptoms Potentiate the Effect of Youth Negative Mood Symptoms on Gene Expression in Children with Asthma

Depressive symptoms in parents and in youths have been found to relate to disease comorbidity processes in children, including greater disease-related impairment and poorer clinical outcomes. The current study sought to assess whether coming from a family characterized by more depressive symptoms on average would potentiate the effects of changes in youths' own negative mood on the expression of two receptor genes relevant to asthma that are the primary targets of asthma medication, such that the combination of low child negative mood in the context of greater parental depressive symptoms would relate to the lowest levels of gene expression. One-hundred-twenty youths with diagnosed asthma and their parents participated every 6 months for 2 years. Parents reported on their depressive symptoms, children reported negative mood symptoms, and youths completed blood draws from which expression of Glucocorticoid Receptor (GR) and Beta2 Adrenergic Receptor (β2-AR) genes was extracted. Multilevel linear modeling revealed significant interactions between average levels of parental depressive symptoms and changes in youths' negative mood symptoms predicting gene expression, such that youths expressed significantly less GR and β2-AR during times when they experienced more negative mood symptoms, but this was only true if they came from families with higher levels of average parental depressive symptoms. The current study identifies novel and biologically-proximal molecular signaling patterns that connect depressive symptoms to pediatric asthma while also highlighting the important role of family environment for biological processes that may operate within depression comorbidity.

The Roles of Family and Teacher Support in Moderating and Mediating Externalized and Internalized Outcomes of Exposure to Community Violence Among Arab and Jewish Adolescents in Israel

The study examined family and teacher support as factors that can protect adolescents from internalized and externalized problems after exposure to community violence (ECV). Self-administered questionnaires were filled out by a sample of 1,832 Arab and Jewish Israeli high school students. The Arab adolescents reported significantly higher levels of community violence victimization, internalized problems, externalized problems, family support, and teacher support than the Jewish adolescents. The girls reported higher levels of internalized problems, and the boys reported higher levels of externalized problems. ECV predicted high levels of internalized and externalized problems, family support predicted low levels of internalized and externalized problems, and teacher support had no predictive role. Path analysis confirmed the significance of the relationships between ECV effects, support variables, and gender. The limitations of the study and implications of the findings for future research and for the development of family care and family intervention programs are discussed.

Youth violence and mental health: repeating exposures

Purpose

The purpose of this paper is to discover and describe salient repeating and less common features of the recent medical literature about youth violence as it relates to mental health. How the relationship between youth violence and mental health is commonly conceptualized, investigated, and reported is summarized. Negative cases, unique approaches, and concepts are discussed.

Design/methodology/approach

An Ovid Medline literature search was conducted with the search parameters of “adolescent and violence” and “psychiatry or psychology or mental health.” In total, 66 articles met inclusion criteria and were analyzed using grounded theory procedures and techniques.

Findings

In all, 49 articles were reports of original research, 14 were literature reviews, and three were editorials. The articles included discussions of youth violence and mental health among young people in 49 countries. Most original research used cross-sectional designs that tested and supported the core hypothesis that greater exposure to violence is associated with more mental health issues. The relationship is robust even though characterizations of “exposure to violence” and “mental health” were highly variable. Meta-analytic and intervention studies were rare.

Originality/value

The core feature of the last decade of medical research has been the repeated testing and confirmation that a relationship between exposure to violence and mental health exists. Future youth violence research should move beyond continuing to test this hypothesis with cross-sectional study designs.

Profiles of Community Violence Exposure Among African American Youth: An Examination of Desensitization to Violence Using Latent Class Analysis

The current study employed latent class analysis (LCA) to identify distinct profiles of community violence exposure and their associations to desensitization outcomes in 241 African American early adolescents (M age = 12.86, SD = 1.28) in the sixth through eighth grade from under-resourced urban communities. Participants self-reported on their exposure to community violence, as well as on depressive and anxiety symptoms. The LCA revealed three distinct classes: a class exposed to low levels of violence (low exposure class), a class exposed to moderately high levels of victimization (victimization class), and a class exposed to high levels of all types of violence (high exposure class). Consistent with predictions, the high exposure class showed the lowest levels of depressive symptoms, suggesting a desensitization outcome. Gender and age were also examined in relation to the classes, and age was significantly associated with an increased risk of being a member of the high exposure class relative to the low exposure class. Using person-based analyses to examine desensitization outcomes provides useful information for prevention and intervention efforts, as it helps to identify a specific subgroup of youth that may be more likely to show desensitization outcomes in the context of community violence.

Interparental Violence and the Mediating Role of Parental Availability in Children's Trauma Related Symptoms

This cross-sectional study examined the hypothesis that parental psychopathology in Interparental Violence (IPV) families crosses over to children, because parental psychopathology spills over to parental functioning. In a high-risk sample of IPV exposed families, we tested whether parental psychopathology spills over to parental availability, which, in turn, shows a crossover effect to children's trauma-related symptoms. The study population consisted of 78 IPV exposed children (4-12 years), and their 65 custodial parents referred to outpatient Children's Trauma Centers in the Netherlands for intervention. Consistent with our hypotheses, parental psychopathology was negatively related to parental availability, suggesting a spillover effect. Although parental psychopathology was not associated with children's trauma-related symptoms directly, we found evidence for the predicted indirect, crossover effects. We found an indirect crossover effect from parental psychopathology to children's trauma-related anxiety, depression, and anger, through the spillover effect of parental availability. Clinical implications for treatment and study limitations are discussed.

Youth services: meeting the mental health needs of adolescents

Objectives

Youth mental health services are poised for a paradigm shift. Recent epidemiological evidence confirms the seriousness of adolescence as a risk period for mental ill-health - 50% of all adult mental disorders begin before the age of 16% and 75% before the age of 25. Here, we identify issues with transition of care between CAMHS-AMHS service, and effectiveness of early intervention services.

Methods

We provide a selective review providing evidence of adolescence as a risk period, discuss CAMHS-AMHS service transition problems, and discuss avenues for change to implement the early intervention model across youth mental health.

Results

Traditional service structures,with paediatric -adult split at 16–18 years increasingly appear not fit for purpose. A radical redesign of youth mental health services is not only necessary, it is also feasible and achievable, as illustrated by a pilot Birmingham youth service – Youthspace.

Conclusions

Pilot youth mental projects currently underway can help radically redesign the existing child and adolescent services. This will in turn lead to an improvement in the young people's experience of engagement with the services so that they too have a positive future.

Comparing factors associated with maternal and adolescent reports of adolescent traumatic event exposure

Existing research indicates that there is very little agreement between youth and their parents on youth trauma exposure and subsequent treatment. Few studies, however, have attempted to examine factors that may contribute to this lack of agreement. This study addressed this gap by examining youth and maternal-reported youth traumatic event exposure using a sample of 100 urban, African American adolescent-maternal dyads. Cumulative report of youth potentially traumatic event exposure (57%) was higher than youth (41%) and maternal (27%) reports. Findings indicate that there was agreement for sexual assault, being shot or stabbed, and auto accidents. Maternal depression was the only factor that was associated with both youth and maternal report of youth qualifying event. Other factors that distinguished youth reports included maternal event exposure, substance use disorder, antisocial personality behaviors, and youth reports of arguments with the mother and running away from home. Implications for reconciling reports of trauma exposure among youth and their mothers are discussed.

Effects of Exposure to Community Violence and Family Violence on School Functioning Problems among Urban Youth: The Potential Mediating Role of Posttraumatic Stress Symptoms

Adolescents who are exposed to violence during childhood are at an increased risk for developing posttraumatic stress (PTS) symptoms. The literature suggests that violence exposure might also have negative effects on school functioning, and that PTS might serve as a potential mediator in this association. The purpose of the current study was to replicate and extend prior research by examining PTS symptoms as a mediator of the relationship between two types of violence exposure and school functioning problems among adolescent youth from an urban setting. Participants included a sample of 121 junior high and high school students (M = 15 years; range = 13–16 years; 60 males, 61 females) within high-crime neighborhoods. Consistent with our hypotheses, community violence and family violence were associated with PTS symptoms and school functioning problems. Our data suggest that community and family violence were indirectly related to school functioning problems through PTS symptoms. Findings from this study demonstrate that PTS symptoms potentially mediate the relationship between violence exposure and school functioning problems across two settings (community and home). Future research should further examine protective factors that can prevent youth violence exposure as well as negative outcomes related to violence.

Offspring psychological and biological correlates of parental posttraumatic stress: review of the literature and research agenda

Millions of individuals with posttraumatic stress disorder (PTSD) are parents. A burgeoning literature suggests that offspring of parents with this condition may be at increased risk for psychological problems. The current paper provides an integrative and comprehensive review of the diverse research literature examining the sequelae of parental posttraumatic stress among offspring. Over 100 studies that evaluated psychological and/or biological variables among children of parents with PTSD are reviewed. Findings suggest parental symptoms of posttraumatic stress are uniquely related to an array of offspring outcomes, including internalizing-type problems, general behavioral problems, and altered hypothalamic-pituitary-adrenal axis functioning. Although very little work has directly evaluated mechanisms of transmission, there is increasing support for genetic and epigenetic effects as well as parenting behaviors. These and other mechanisms are discussed; drawing upon findings from other literatures to consider how parental PTSD may impart psychobiological vulnerability upon offspring. We conclude with a detailed discussion of the methodological strengths and challenges of the extant research, along with a recommended agenda for future research in this important area of study.

Sintomas internalizantes na adolescência e as relações familiares: uma revisão sistemática da literatura

Este artigo teve como objetivo realizar uma revisão sistemática de literatura, nacional e internacional, no período de 2005 a 2010, sobre os sintomas internalizantes na adolescência e as relações familiares. Inicialmente, foi realizado um levantamento dos artigos indexados nas bases de dados Academic Search Premier, Education Resources Information Center (ERIC), ISI Web of Knowledge, Lilacs, MEDLINEwith Full Text e SciELO (Scientific Electronic Library Online), utilizando-se os descritores, em português, "problemas internalizantes" ou "sintomas internalizantes" e "adolescência ou adolescente ou jovem" e "família"; e, em inglês, "internalizing problems or internalizing symptoms" and "adolescence or adolescent or teenager" and "family". Os artigos foram classificados de acordo com o ano de publicação, o país, a metodologia, o instrumento de mensuração para comportamentos internalizantes e, ainda, quanto à temática principal. Na literatura internacional, constatou-se um predomínio de estudos empíricos e de caráter quantitativo, realizados preponderantemente pelos Estados Unidos. No Brasil, observou-se uma grande escassez de estudos integrando as temáticas da sintomatologia internalizante na adolescência e as relações familiares. Foram encontrados somente dois artigos, o que indica a necessidade de realização de mais pesquisas nesta área em nosso país.

The association between parent PTSD/depression symptoms and child PTSD symptoms: a meta-analysis

OBJECTIVE

The present article presents a meta-analysis of studies examining the association between parent posttraumatic stress disorder (PTSD)/depression symptoms and child PTSD symptoms (PTSS) after a child's exposure to a traumatic event while considering multiple moderating factors to explain heterogeneity of effect sizes.

METHODS

35 studies were included: 32 involving the association between parent and child PTSS and 9 involving the association between parent depression and child PTSS.

RESULTS

Across existing studies, both parent and child PTSS (r = 0.31) and parent depression and child PTSS (r = 0.32) yielded significant effect sizes. Parent gender, assessment type (interview vs. questionnaire), differences in assessment type for parents and children, and study design (cross-sectional vs. longitudinal) moderated the relationship between parent and child PTSS.

CONCLUSIONS

The current findings confirm the associations between parental posttraumatic responses and child PTSS and highlight important moderating factors to include in future studies of child PTSS.

The impact of parental trauma exposure on community violence exposed adolescents

Previous research has documented an association between adolescent community violence (CV) exposure and poor psychological functioning. The purpose of this study was to delineate the relations of adolescent CV, parent trauma exposure (PTE), and adolescent internalizing and externalizing symptomatology while controlling for adolescent-reported home violence and parental self-reported posttraumatic stress disorder (PTSD). Participants consisted of 101 pairs of junior high school and high school students and their parents or caretakers. Adolescents completed measures to assess their history of violence exposure in the community and home setting and current internalizing symptoms. Parents or caretakers completed a demographic questionnaire, a measure assessing their trauma exposure and related symptomatology, and a measure of child externalizing symptoms. Hierarchical regression analyses were conducted; results indicated that after controlling for demographic variables, home violence exposure, and parental PTSD symptoms, PTE emerged as a moderator variable in the relationship between CV and adolescent-rated internalizing symptoms but not in the association between adolescent CV and externalizing symptoms.

Parents' retrospective reports of youth psychological responses to the sniper attacks in the Washington, DC, area

A random-digit-dial telephone survey was conducted in May 2003, with 355 parents of children ages 2-17 years old, living in Washington, DC, or in the two surrounding counties during the October 2002 sniper shootings, to examine parent retrospective reports of child event-related psychological distress. An estimated 32% of parents reported that children experienced at least one psychological distress symptom related to sniper shootings. Older children, females, children with a history of trauma exposure prior to sniper attacks, children whose parents reported routine disruption as the result of attacks, children whose parents perceived them as at great risk for harm from sniper attacks, and those children whose parents reported more traumatic stress symptoms in response to attacks were at greatest risk for reported psychological distress.

Pathways among exposure to violence, maternal depression, family structure, and child outcomes through parenting: a multigroup analysis

The present study examined the impact of proximal (maternal depression, family structure) and distal (exposure to violence) risk factors on parenting characteristics (warmth, control), which were in turn hypothesized to affect child social-emotional functioning. Using the Family and Child Experiences Study (FACES) 2000 cohort, findings revealed that study variables were significant predictors of child social-emotional functioning. Despite limited significant pathways in the structural equation models, the cumulative effect of the variables resulted in models accounting for 21%-37% of the outcome. Multigroup analysis revealed that although the amount of variance explained varied, the model held across subgroups. Findings support theories such as the family stress model that suggest that family risk factors negatively influencing children's development through influencing parenting behaviors. Findings also support considering both warmth and control as key parenting dimensions. It may be impractical for practitioners to address the myriad of potential risks encountered by low-income families, but parents can be equipped with mental health services, parent education, and other assistance to help them maintain positive parenting practices in the face of challenges.

Toward a stress process model of children's exposure to physical family and community violence

Theoretically informed models are required to further the comprehensive understanding of children's ETV. We draw on the stress process paradigm to forward an overall conceptual model of ETV (ETV) in childhood and adolescence. Around this conceptual model, we synthesize research in four dominant areas of the literature which are detailed but often disconnected including: (1) exposure to three forms of physical violence (e.g., child physical maltreatment, interparental violence, and community ETV); (2) the multilevel correlates and causes of ETV (e.g., neighborhood characteristics including concentrated disadvantage; family characteristics including socio-economic status and family stressors); (3) a range of consequences of ETV (e.g., internalizing and externalizing mental health problems, role transitions, and academic outcomes); and (4) multilevel and cross domain mediators and moderators of ETV influences (e.g., school and community factors, family social support, and individual coping resources). We highlight the range of interconnected processes through which violence exposures may influence children and suggest opportunities for prevention and intervention. We further identify needed future research on children's ETV including coping resources as well as research on cumulative contributions of violence exposure, violence exposure modifications, curvilinearity, and timing of exposure.

Exposure to community violence and adolescents' internalizing behaviors among African American and asian American adolescents

Exposure to community violence can seriously threaten healthy adolescent development. This longitudinal study examines the relationship between exposure to violence in the community and the internalizing behaviors of Asian American and African American adolescents. Data analyzed was from 901 adolescents (57.9% female and 42.1% male, and 84.7% African American and 15.3% Asian American) who had participated in both Wave I and II interviews of the National Longitudinal Survey of Adolescent Health conducted between 1994 and 1996. Being female, having prior internalizing behaviors at baseline, and being exposed to violence significantly predicted African American adolescents' subsequent report of internalizing behaviors and their symptoms. Being female and having prior internalizing behaviors also predicted Asian American adolescents' subsequent internalizing behaviors and their symptoms. However, exposure to violence was not associated with Asian American adolescents' internalizing behaviors. Findings suggested a need to conceptualize mental health risk in a more nuanced context of cultural diversity.

The relationship between community violence exposure and mental health symptoms in urban adolescents

Urban adolescents are exposed to a substantial amount of community violence which has the potential to influence psychological functioning. To examine the relationship between community violence exposure and mental health symptoms in urban adolescents, a literature review using MEDLINE, CINAHL, PubMed, PsycINFO, CSA Social Services and CSA Sociological Abstracts was conducted. Search terms included adolescent/adolescence, violence, urban, mental health, well-being, emotional distress, depression, anxiety, posttraumatic stress disorder and aggression. Twenty-six empirical research articles from 1997 to 2007 met inclusion criteria for review. Findings indicate an influence of community violence exposure on mental health symptoms, particularly posttraumatic stress and aggression. Mediators and moderators for community violence exposure and mental health symptoms help explain relationships. Limitations in the literature are the lack of consistency in measurement and analysis of community violence exposure, including assessment of proximity and time frame of exposure, and in analysis of victimization and witnessing of community violence. Knowledge about identification of urban adolescents exposed to chronic community violence and who experience mental health symptoms is critical to mental health nursing practice and research.