Youth violence prevention comes of age: research, training and future directions

Say Something, Do Something: Evaluating a Forum Theater Production to Activate Youth Violence Prevention Strategies in Schools

BACKGROUND

Youth violence that takes place within school settings exposes youth to serious social, mental and physical consequences that affect education performance, and life opportunities. Previous work shows positive youth development frameworks can promote social-emotional learning by enhancing empathy and building problem-solving and conflict management skills. Theater-based interventions have been shown to enhance social emotional development by privileging youth voices, and building youth capacities and strengths. The current manuscript presents the evaluation of an arts-based and public health framework conducted to assess the development, implementation and impact of a forum theater production, Say Something, Do Something (SSDS) in St. Louis, Missouri.

METHODS

An iterative mixed methods approach was used, starting with observations of productions. Using convenience sampling, we then conducted post interviews of the theater team (n = 8) and school personnel (n = 10).

RESULTS

Respondents highlighted that as a result of engagement of school personnel in program development, the language and scenarios presented were relevant to students. Data indicated that SSDS increased student knowledge and changed attitudes, developed student conflict management and problem-solving skills, and improved interpersonal behavior. SSDS also raised awareness of the importance of, and created the foundation for, additional system and policy changes in the schools.

CONCLUSION AND IMPLICATIONS

Forum theater is an approach that can enhance socio-emotional learning and conflict management among youth. Collaborative initiatives between public health and the arts are poised to uniquely engage community partners, animate interventions, and impact critical public health issues including youth violence prevention.

Organizational and coalition strategies for youth violence prevention: A longitudinal mixed-methods study

This longitudinal study identifies espoused change orientations and actual youth violence prevention (YVP) practices over five years by 99 public and nonprofit organizations in one city. Annual key informant interviews provided both qualitative and quantitative data, including organizational collaborative network data. Data were also obtained on participation in a citywide YVP coalition, juvenile arrests and court referrals. On average, organizations both in and outside the coalition adopted a problem-focused as often as a strengths-based change orientation, and were only marginally more oriented toward empowering community members than professionals and changing communities than individual youth. Most surprisingly, YVP coalition members adopted more of a tertiary (reactive/rehabilitative) than primary prevention orientation compared to nonmembers. The number of different YVP strategies implemented increased over five years from mainly positive youth development and education interventions to those strategies plus mentoring, youth activities, events and programs, and counseling youth. Network analysis reveals dense initial collaboration with no critical gatekeepers and coalition participants more central to the city-wide organizational network. Coalition participation and total network collaboration declined in Years 3-5. Youth violence arrests and court referrals also declined. The coalition was marginally involved in successful community-collaborative, school-based interventions and other strategies adopted, and it disbanded a year after federal funding ended. Despite, or possibly due to, both national and local government participation, the coalition missed opportunities to engage in collective advocacy for local YVP policy changes. Coalitions should help nonprofit and public organizations develop more effective change orientations and implement commensurate strategies at the community level.

Dusk to Dawn: Evaluating the effect of a hospital-based youth violence prevention program on youths' perception of risk

BACKGROUND

Historically, youth violence prevention strategies used deterrence-based programming with limited success. We developed a youth violence prevention program, Dusk to Dawn (D2D), intended to improve youths' recognition of high-risk situations and teach new skills in conflict resolution. The aim of this study was to evaluate the effect of D2D on youths' perceptions of personal risk factors and high-risk situations.

METHODS

Youth ages 12 years to 18 years were referred to D2D by community-based organizations, probation, or youth detention center. The youth completed a self-report survey before and after participating in D2D.

RESULTS

One hundred eight youth participated in D2D. Pretest and posttest results for self-reported personal risk factors and high-risk situations for violence are presented. For personal risk factors, a statistically significant increase in the perception that family (p < 0.01) and other issues (p < 0.05), and a decrease in the perception that school problems (<0.05) were seen as important personal risk factors. For high-risk situations, increases in the perception that peer violence and substance use as high-risk situations were seen as significant at the trend level (p < 0.10). Of the 60% of participants who answered questions regarding satisfaction with D2D, 83.3% agreed or strongly agreed that D2D helped them to better understand violence and 83.3% would recommend D2D to others.

CONCLUSION

Youth violence prevention programming including an explicit discussion of how violence is learned and the role of family, friends, school, and a community in shaping youths' attitudes toward violence can effectively raise awareness of one's own risk factors. Risk factors for youth violence are often preventable or modifiable, making awareness of one's own risk factors a realistic target for youth violence prevention programs.

LEVEL OF EVIDENCE

Therapeutic/Care Management, Level III.

Youth Violence and Related Risk Factors: A Cross-sectional Study in 2800 Adolescents

Background:

Youth violence is an important public health challenge, and the literature on this problem in developing countries has been limited. The present study aims to determine the prevalence of violence its related risk factors in in a sample of students in Isfahan, Iran.

Materials and Methods:

In this cross-sectional study, 2800 middle and high school, aged 11–18 years in urban and rural areas selected in a multistage sampling procedure and were questioned using a self-administered questionnaire. Collected data included sociodemographic and family characteristics, students' knowledge, verbal and physical violence (as a perpetrator and/or victim), risk-taking behaviors (weapon carrying, threatening behaviors), family violent status, watching movies, and accessibility of sport facilities.

Results:

The prevalence of verbal and physical violence in studied students was 45% and 33.3%, respectively. The prevalence of verbal and physical victimization was 45.8% and 23.6%, respectively. The prevalence of physical violence was higher in middle school students than high school students (P = 0.0001) and in boys was higher than in girls (P = 0.0001). Being boy, carried a weapon out of home or in school, victimization, feel unsafe at school, and violence in the family are the significant related risk factors with students violence (P < 0.05).

Conclusion:

The prevalence of students' violence in Iranian students is similar to the most of other developing countries, although, high rate violence and related risk factors emphasize the need for comprehensive and interventional prevention programs to reduce and manage student violence and associated risk behaviors.

Youth's Daily Activities and Situational Triggers of Gunshot Assault in Urban Environments

PURPOSE

Although previous research has made progress in identifying individuals predicted to face an elevated risk of being shot, it is not clear how that risk varies within individuals based on the contexts they encounter as they navigate daily life. The current study examines how the convergence of individual risk activity and neighborhood disadvantage and disorder triggers the risk of being shot.

METHODS

Using a novel geographic information system application, 123 male gunshot assault victims between 10 and 24 years old in Philadelphia, Pennsylvania, described their minute-by-minute movements over the course of the day of the gunshot assault. Through latent class analysis, the primary exposure was real-life circumstance where nine theoretically informed risk factors converged, compared with two other circumstances. Case-crossover analyses of subjects' 10-minute segments of full-day activities compared gunshot assault victims at the time of assault with themselves earlier in the day.

RESULTS

Compared to when individuals were exposed to minimal situational risk or were mainly exposed to neighborhood disadvantage and disorder, the concurrence of risk activity and neighborhood disadvantage and disorder was associated with a 9.90 (95% CI: 2.72-36.14) and 6.06 (95% CI: 2.78-13.22) times higher risk of being shot. Importantly, the likelihood of being in the high-risk circumstance increased systematically over the course of the day leading up to the time when young individuals were shot.

CONCLUSIONS

After controlled individual's propensity to be shot (e.g., inherent traits), the concurrence of situational risks emerged as significant triggers of gunshot assault. The findings suggest potential for community-based gunshot violence interventions.

Physical Fighting and Associated Factors among Adolescents Aged 13-15 Years in Six Western Pacific Countries

Youth violence is an important public health challenge around the world, yet the literature on this problem in low- and middle-income countries (LMICs) has been limited. The present study aims to examine the prevalence of adolescent physical fighting (defined as having been involved in at least one physical fight during the past 12 months) in selected LMICs, and its relations with potential risk factors. We included 6377 school-going adolescents aged 13–15 years from six Western Pacific (WP) countries that had recently conducted a Global School-based Student Health Survey. Information was gathered through a self-administered anonymous closed-ended questionnaire. The prevalence of adolescent physical fighting varied across countries, ranging from 34.5% in Kiribati to 63.3% in Samoa. The prevalence was higher in boys than in girls, and lower at age 15 than 13–14 years. Physical fighting was significantly associated (pooled odds ratios (ORs), 95% confidence intervals (CIs)) with smoking (1.78, 1.53–2.06), drinking (1.57, 1.33–1.85), drug use (1.72, 1.33–2.23), and missing school (1.72, 1.51–1.95). The association with physical fighting increased with increasing number of joint adverse behaviors (increased from 1.99 (1.73–2.29) for one risk behavior to 4.95 (4.03–6.07) for at least 3 risk behaviors, versus having none of the 4 risk behaviors). The high prevalence of physical fighting and the associations with risk behaviors emphasize the need for comprehensive prevention programs to reduce youth violence and associated risk behaviors.

“I’m Not Just Runnin’ the Streets”

This article examines the experiences of 25 youth of color living in East Oakland, California. Building on empirical studies examining violence prevention efforts on the behalf of and among youth and using an ethnographic approach, this study samples young people, with varying levels of education, income, and motivation for involvement, attending the same youth-serving organization in East Oakland. The findings offer a frame of “violence management strategies” for the active ways in which youth strategically avoid unsafe spaces and people and seek out safe spaces and people on a daily basis within their neighborhoods marked by high rates of crime, violence, and physical disorder. These findings lift up youth as experts of their own neighborhoods. The implications of these findings for adolescent research, practice, and policy 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.

Interpersonal youth violence perpetration and victimization in a diverse Asian American and Pacific Islander adolescent sample

This study was the first to examine ethnic, sex, and ethnicity-by-sex differences for under-researched, Asian American and Pacific Islander, adolescent groups on youth violence outcomes other than cyberbullying. This effort included the less researched, emotional violence, and included socioeconomic status (SES) measures as covariates. The sample size from 2 high schools in spring 2007 was 881, using an epidemiologic survey design. The pattern of results was higher rates of violence victimization for ethnic groups, with lower representation in the 2 schools' population, and ethnic groups that more recently moved or immigrated to Hawai'i. For emotional victimization, girls of European American and "other", ethnicities self-reported higher rates than boys. Several implications (e.g., need for ethnically and gender-based approaches) and further research (e.g., ethnocultural identity) are discussed.

Boston Violence Intervention Advocacy Program: a qualitative study of client experiences and perceived effect

OBJECTIVES

This study intended to explore clients' experiences and provide a contextual basis for understanding their perceptions of the effectiveness of the Boston Medical Center (BMC) Violence Intervention Advocacy Program (VIAP).

METHODS

This was an exploratory, qualitative study conducted in an urban, Level I trauma center from July 1, 2011 to February 24, 2012. Emergency department (ED) patients older than 18 years with penetrating trauma, and who were enrolled in the VIAP, were eligible. Two trained, qualitative interviewers who were not part of the VIAP obtained consent and conducted in-depth, semistructured interviews. Interviews were audiotaped, transcribed, deidentified, coded, and analyzed. Thematic content analysis consistent with grounded theory was used to identify themes related to client experiences with VIAP, life circumstances, challenges to physical and emotional healing postinjury, services provided by VIAP, and perceptions of VIAP's effectiveness.

RESULTS

Twenty subjects were interviewed. Most were male, African American, and younger than 30 years of age, reflecting the overall program's clientele. Most subjects perceived their advocates as caring adults in their lives and cited aspects of the peer support model that helped establish trusting relationships. Major challenges to healing were fear and safety, trust, isolation as a coping mechanism, bitterness, and symptoms of posttraumatic stress disorder (PTSD). Every subject noted important services provided by VIAP advocates. Most subjects explicitly stated that they had positive experiences with the VIAP and perceived advocates' roles as a positive influence, providing client-centered advocacy, education, and support.

CONCLUSIONS

This study provides insight into the lives of 20 BMC VIAP clients and contextualizes their unique challenges. Participants described positive, life-changing behaviors on their journey to healing through connections to caring, supportive adults. Information gained from this study will help the VIAP to further support its clients. However, future research is needed to identify best practices for ED-based violence intervention programs and to measure community-wide efficacy in different settings.

Problem behavior and urban, low-income youth: a randomized controlled trial of positive action in Chicago

BACKGROUND

Youth problem behaviors remain a public health issue. Youth in low-income, urban areas are particularly at risk for engaging in aggressive, violent, and disruptive behaviors.

PURPOSE

To evaluate the effects of a school-based social-emotional learning and health promotion program on problem behaviors and related attitudes among low-income, urban youth.

DESIGN

A matched-pair, cluster RCT.

SETTING/PARTICIPANTS

Participants were drawn from 14 Chicago Public Schools over a 6-year period of program delivery with outcomes assessed for a cohort of youth followed from Grades 3 to 8. Data were collected from Fall 2004 to Spring 2010, and analyzed in Spring 2012.

INTERVENTION

The Positive Action program includes a scoped and sequenced K-12 classroom curriculum with six components: self-concept, social and emotional positive actions for managing oneself responsibly, and positive actions directed toward physical and mental health, honesty, getting along with others, and continually improving oneself. The program also includes teacher, counselor, family, and community training as well as activities directed toward schoolwide climate development.

MAIN OUTCOME MEASURES

Youth reported on their normative beliefs in support of aggression and on their bullying, disruptive, and violent behaviors; parents rated youths' bullying behaviors and conduct problems; schoolwide data on disciplinary referrals and suspensions were obtained from school records.

RESULTS

Multilevel growth-curve modeling analyses conducted on completion of the trial indicated that Positive Action mitigated increases over time in (1) youth reports of normative beliefs supporting aggressive behaviors and of engaging in disruptive behavior and bullying (girls only) and (2) parent reports of youth bullying behaviors (boys only). At study end-point, students in Positive Action schools also reported a lower rate of violence-related behavior than students in control schools. Schoolwide findings indicated positive program effects on both disciplinary referrals and suspensions. Program effect sizes ranged from -0.26 to -0.68.

CONCLUSIONS

These results extend evidence of the effectiveness of the Positive Action program to low-income, minority, urban school settings, and to middle school-aged youth.

Homicide among young Black men in Toronto: an unrecognized public health crisis?

This commentary addresses the high homicide rates among young Black men in Toronto, Ontario. It posits that homicide among this population is an unrecognized major public health crisis that should be a priority for the field. The author suggests that the dramatic rate of Black homicides in Toronto is a consequence of income inequality, poverty, poor quality of life, mental health risks, and sustained racism. The commentary calls upon public health scientists to prioritize research about violence and homicide among young Black men in Toronto. It suggests that current and future policy making would be better served by their enquiries into the nature and causes of the persisting dilemma.

Violence and school shootings

Multiple-homicide school shootings are rare events, but when they happen they significantly impact individuals, the school and the community. We focus on multiple-homicide incidents and identified mental health issues of shooters. To date, studies of school shootings have concluded that no reliable profile of a shooter exists, so risk should be assessed using comprehensive threat assessment protocols. Existing studies primarily utilize retrospective case histories or media accounts. The field requires more empirical and systematic research on all types of school shootings including single victim incidents, those that result in injury but not death and those that are successfully averted. We discuss current policies and practices related to school shootings and the role of mental health professionals in assessing risk and supporting surviving victims.

Social ecological determinants of youth violence among ethnically diverse Asian and Pacific Islander students

This study assesses the relative fit of risk/protective and social ecological models of youth violence among predominantly Asian and Pacific Islander students. Data from a 2007 survey of two multi-ethnic high schools in Hawai'i were used. The survey assessed interpersonal youth violence, suicidality and risk and protective factors. Two models of youth violence (risk/protective and social ecological) were tested using structural equation modeling. We found good fits for the risk/protective model (χ(2) = 369.42, df = 77, P < .0001; CFI = .580; RMSEA = .066) and the ecological model (χ(2) = 1763.65, df = 292, P < .0001; CFI = .636; RMSEA = .076). The risk/protective model showed the importance of coping skills. However, the ecological model allowed examination of the interconnectivity among factors. Peer exposure to violence had no direct influence on individuals and peer influence was fully mediated by school climate. Furthermore, family factors directly contributed to peer exposure, community, and individual risk/protection. These findings have significant implications for intervention and prevention efforts and for the promotion of positive, competent, and healthy youth development. While few family and school-based programs have been developed and evaluated for adolescents, they have the greatest potential for success.

Cornered: an approach to school bullying and cyberbullying, and forensic implications

Bullying is an abuse of power and control that can cause significant harm to individuals. School systems have the difficult task of trying to police this behavior to maintain a safe learning environment for their students. Although there may be an identified bully, the ramifications of the behavior affect the system as a whole. Bullies, targeted victims, and bystanders play an integral role in ameliorating this problem. A change of culture within the school system is often the best, yet often the most difficult, intervention. In addition, cyberbullying has become a powerful avenue for bullying, resulting in significant morbidity within schools.

Alcohol availability and violence among inner-city adolescents: A multi-level analysis of the role of alcohol outlet density

Researchers recognize that the connection between alcohol and peer violence may relate to community level ecological factors, such as the location of businesses that sell alcohol. Building on previous research among adults, this study examines the relationship between alcohol outlet density and violent behaviors among adolescents, taking into account demographic characteristics, individual alcohol use, and neighborhood level socioeconomic indicators. Data drawn from a diverse Emergency Department based sample of 1,050 urban adolescents, combined with tract level data from the state liquor control commission and U.S. Census, were analyzed. Results of multivariate multi-level regression analysis indicate that alcohol outlet density is significantly related to adolescents' violent behaviors, controlling for demographic characteristics and individual alcohol use. Census tract level socioeconomic indicators were not significantly associated with youth violence. Findings suggest that alcohol outlet density regulation should be considered as part of broader violence prevention strategies for urban adolescents.

Moving toward comprehensiveness and sustainability in a social ecological approach to youth violence prevention: lessons from the Asian/Pacific islander youth violence prevention center

Youth violence is a serious public health problem affecting communities across the United States. The use of a social ecological approach has helped reduce its prevalence. However, those who have put the approach into practice often face challenges to effective implementation. Addressing social ecology in all its complexity presents one obstacle; the ability of private non-profit and public agencies to sustain such comprehensive efforts presents another. Here, we provide an example of our efforts to prevent youth violence. We worked with the Asian/Pacific Islander Youth Violence Prevention Center (APIYVPC) and two communities on O'ahu. We provide a case example from the Asian/Pacific Islander Youth Violence Prevention Center (APIYVPC) of our work, in collaboration with two communities on O;ahu, to develop and implement a youth violence prevention initiative that is becoming both comprehensive and sustainable. We illustrate the incremental nature of what it means to be comprehensive and we underscore the importance of reaching sustainability as the project unfolds.

Implementation and Evaluation of a Youth Violence Prevention Program for Adolescents

Youth violence in the city of Philadelphia, PA, has reached epidemic proportions. The majority of homicides related to gun violence is most prevalent among African American males aged 19 to 24 years. Therefore, it is essential to implement youth violence prevention programs to a target population several years younger than this age group to decrease teen violence in the city. A violence prevention program for 9th and 10th graders was developed, implemented, and evaluated at a local urban charter school. Presentations were given on gun and gang violence, dating violence, and anger management/conflict resolution as well as role playing, group activities, and a field trip to a trauma program for youth at a local hospital. Posttest scores showed an increase in knowledge and skills in several areas, such as therapeutically resolving violent disputes and methods to prevent different types of dating violence. This program provides a blueprint for an adolescent violence prevention program that school nurses could adopt in their communities.