Challenges in Evaluating a Community-Level Intervention to Address Root Causes of Youth Violence.

Violence disproportionately impacts Black American youth, representing a major health disparity. Addressing the possible root causes of structural inequities to reduce violence may increase the impact of prevention strategies. However, efforts to evaluate the impact of such interventions pose numerous methodological challenges, particularly around selecting an effective evaluation design to detect change at the community level, with adequate power and sampling, and appropriate constructs and measurement strategies. We propose a multiple baseline experimental design to evaluate the impact of a community-level youth violence and suicidality prevention strategy. A multiple baseline experimental design with multiple community units balances the need for scientific rigor with practical and values-based considerations. It includes randomization and plausible counterfactuals without requiring large samples or placing some communities in the position of not receiving the intervention. Considerations related to the conceptualization of the logic model, mechanisms of change, and health disparity outcomes informed the development of the measurement strategy. The strengths and weaknesses of a multiple baseline experimental design are discussed in comparison to versions of randomized clinical trials. Future health disparity intervention evaluation research will benefit from (1) building a shared sense of urgent public need to promote health; (2) respecting the validity of values- and partnership-based decision-making; and (3) promoting community-based and systems-level partnerships in scientific grant funding. The described study has been registered prospectively at clinicaltrials.gov, Protocol Record 21-454.

Relations Between Perceptions of Parental Messages Supporting Fighting and Nonviolence and Adolescents' Physical Aggression: Beliefs as Mediators.

The purpose of this study was to examine adolescents' beliefs about fighting as mediators of longitudinal relations between perceptions of parental support for fighting and nonviolence and changes in adolescents' physical aggression. Participants were 2,575 middle school students (Mage = 12.20, SD = 1.02; 52% female; 83% African American) from the southeastern U.S. attending schools in communities with high rates of violence. Participants completed four waves of assessments every 3 months (i.e., fall, winter, spring, and summer). Each belief subscale mediated relations between perceptions of parental support for fighting and nonviolence and changes in aggression. Parental support for nonviolence was negatively associated with beliefs supporting reactive aggression and positively associated with beliefs against fighting. Parental support for retaliation was positively associated with beliefs supporting reactive and proactive aggression, and negatively associated with beliefs against fighting. Parental support for fighting as sometimes necessary was positively associated with beliefs supporting reactive aggression and beliefs that fighting is sometimes necessary. Beliefs supporting reactive and proactive aggression and beliefs that fighting is sometimes necessary were positively associated with aggression, whereas beliefs against fighting was negatively associated with aggression. Parents' support for fighting and for nonviolence may directly and indirectly reduce adolescents' physical aggression by influencing beliefs about the appropriateness of using aggression for self-defense and to attain a goal. This highlights the importance of jointly investigating multiple types of parental messages and types of beliefs about fighting.

Childhood adversity and co-occurring post-traumatic stress and externalizing symptoms among a predominantly low-income, African American sample of early adolescents.

Although there is strong evidence supporting the association between childhood adversity and symptomatology during adolescence, the extent to which adolescents present with distinct patterns of co-occurring post-traumatic stress (PTS) and externalizing symptoms remains unclear. Additionally, prior research suggests that experiencing nonviolent, negative life events may be more salient risk factors for developing some forms of psychopathology than exposure to violence. The current study used latent profile analysis to identify subgroups of early adolescents with distinct patterns of PTS, physical aggression, delinquency, and substance use, and examined subgroup differences in exposure to three forms of violent and nonviolent childhood adversity. Participants were a predominantly low-income, African American sample of 2,722 urban middle school students (M age = 12.9, 51% female). We identified four symptom profiles: low symptoms (83%), some externalizing (8%), high PTS (6%), and co-occurring PTS and externalizing symptoms (3%). A higher frequency of witnessing violence was associated with increased odds of membership in subgroups with externalizing symptoms, whereas a higher frequency of nonviolent, negative life events was associated with increased odds of membership in subgroups with PTS symptoms. Interventions aimed to address childhood adversity may be most effective when modules addressing both PTS and externalizing symptoms are incorporated.

Relations between youths' community violence exposure and their physical aggression: The protective role of adults.

The purpose of this study was to examine whether adults moderated the relations between youths' community violence exposure and subsequent physical aggression. Participants were 2575 middle school students (Mage = 12.3, SD = 1.00; 52% female) in the southeastern U.S. who completed surveys collected in the fall, winter, spring, and summer. The sample was predominantly African American (72%). High adult support was associated with weaker relations between exposure to violence in the fall and aggression in the winter among male adolescents. High adult support was related to weaker relations between victimization in the fall and aggression in the winter among female adolescents. Strategies promoting supportive adult relationships may benefit male adolescents by buffering the adverse impact of community violence exposure.

Patterns of alcohol use among middle school students in rural communities: Associations with community violence exposure.

Stress-coping theory posits that exposure to stressors, such as community violence, increases risk for early alcohol initiation. The current study identified patterns of alcohol use in an ethnically diverse sample of early adolescents in rural communities, and examined relations between different forms of exposure to community violence and severity of adolescents' alcohol use patterns. Participants were 5011 middle school students (46.4% non-Hispanic White, 25.5% Latinx, and 13.4% Black; 50% female) living in rural communities in the southeastern United States. Latent class analysis identified subgroups that differed in their patterns of lifetime and past 30-day alcohol use, and subgroup differences in exposure to community violence. Five subgroups were identified: abstainers (56.5%), initiators of wine and beer (12.5%); moderately frequent wine and beer users (10.3%); moderately frequent wine, beer, and liquor users who got drunk (12.0%); and highly frequent wine, beer, and liquor users who got drunk (8.6%). Subgroups differed across sex, grade, and racial-ethnic background. Subgroups characterized by severe alcohol use reported more frequent exposure to community violence and physical victimization, while controlling for nonviolent stressors. Consistent with stress-coping theory, the results indicate that experiencing physical victimization and witnessing community violence robustly relate to adolescents' high-risk alcohol use.

Latent classes of aggression and peer victimization: Measurement invariance and differential item functioning across sex, race-ethnicity, cohort, and study site.

Peer victimization is common and linked to maladjustment. Prior research has typically identified four peer victimization subgroups: aggressors, victims, aggressive-victims, and uninvolved. However, findings related to sex and racial-ethnic differences in subgroup membership have been mixed. Using data collected in September of 2002 and 2003, this study conducted confirmatory latent class analysis of a racially-ethnically diverse sample of 5415 sixth graders (49% boys; 50.6% Black; 20.9% Hispanic) representing two cohorts from 37 schools in four U.S. communities to replicate the four subgroups and evaluate measurement invariance of latent class indicators across cohort, sex, race-ethnicity, and study site. Results replicated the four-class solution and illustrated that sociodemographic differences in subgroup membership were less evident after accounting for differential item functioning.

Patterns of community violence exposure among urban adolescents and their associations with adjustment.

Community violence exposure is prevalent among urban and marginalized adolescents. Although there is strong evidence that community violence exposure is associated with negative consequences, prior studies and theories suggest that these associations may differ as a function of specific characteristics of exposure. This study identified patterns of community violence exposure that differed in form (witnessing vs. victimization), familiarity with the victim, and severity, and in their associations with adolescents' frequency of physical aggression and anxiety symptoms. Participants were 681 eighth-grade adolescents (58% female, 95% African American). Latent class analysis identified five subgroups who reported distinct patterns of violence exposure: limited exposure; witnessed less severe violence, not victimized; witnessed severe violence, not victimized; witnessed less severe violence, some victimization; and high violence exposure. The witnessed less severe, some victimization, and high violence exposure subgroups reported the highest frequency of physical aggression and levels of anxiety compared with all other subgroups. The limited exposure subgroup reported the lowest frequencies of physical aggression. The findings suggest that the form of exposure (witnessing or victimization) is an important distinction in examining associations with adolescent adjustment. Limited support was found for differences related to familiarity with the victim and severity of violence.

Early Adolescents' Social Goals in Peer Conflict Situations: A Mixed Methods Study.

Identification of goals is a key social-cognitive process that guides whether adolescents engage in aggressive or nonviolent behavior during social conflicts. This study investigated early adolescents' goals in response to hypothetical social conflict situations involving close friends and peers. Participants (n = 160; Mage = 12.7, 53% female) were 7th graders from two urban and one rural middle school. On average, participants identified 2.5 goals for each situation. Qualitative analysis using a grounded theory approach identified nine themes representing the goals generated by participants: instrumental-control, relationship maintenance, maintain image and reputation/self-defense, conflict avoidance, seek more information, revenge, tension reduction, moral, and stay out of trouble. Quantitative analysis indicated that female participants identified more goals than male participants, but there were few differences in their types of goals. There were few differences across school sites. The findings highlight the variety of social goals specific to the developmental period of early adolescence.

Beliefs as Mediators of Relations Between Exposure to Violence and Physical Aggression During Early Adolescence.

This study examined beliefs about aggression and self-efficacy for nonviolent responses as mediators of longitudinal relations between exposure to violence and physical aggression. Participants were a predominantly African American (79%) sample of 2,705 early adolescents from three middle schools within urban neighborhoods with high rates of violence. Participants completed measures across four waves (fall, winter, spring, and summer) within a school year. Beliefs supporting proactive aggression, beliefs against fighting, and self-efficacy for nonviolence partially mediated relations between witnessing violence and physical aggression. Indirect effects for beliefs supporting proactive aggression and self-efficacy were maintained after controlling for victimization and negative life events. Beliefs supporting proactive aggression mediated the effects of violent victimization on physical aggression, but these effects were not significant after controlling for witnessing violence and negative life events. The findings underscore the importance of examining the unique pathways from witnessing community violence versus violent victimization to physical aggression.

Evaluation of the Olweus Bullying Prevention Program in US Urban Middle Schools Using a Multiple Baseline Experimental Design.

We evaluated the impact of the Olweus Bullying Prevention Program (OBPP) in an 8-year study in urban middle schools that served primarily African American students living in low-income areas. Participants included 2755 students and 242 teachers. We evaluated the OBPP with a multiple-baseline experimental design where the order and intervention start time was randomly assigned for each school. We assessed the frequency of bullying behaviors and experiences including physical, relational, and verbal aggression and victimization using teacher ratings of student behavior and student-reported data, as well as cyber aggression and victimization and school climate measures using student-reported data. For teacher ratings of student behavior, we found significant main effects across all subtypes of aggression and victimization, with some variability in the timing of effects. The pattern of findings showed delayed intervention effects for boys and a weaker impact of the OBPP on 6th graders. We found main effects for student-reported cyber aggression and victimization, relational aggression, and a composite of physical, verbal, and relational victimization. Decreases in victimization emerged in the 1st or 2nd year of intervention, and reductions in aggression emerged during the 3rd year. Across all findings, once intervention effects emerged, they remained significant in subsequent intervention years. The OBPP resulted in significant decreases in student- and teacher-reported aggression and victimization. However, this intervention had limited impact on general areas of school climate including teacher support, positive peer interactions, and school safety. Overall, the findings offer important prevention and research implications.

The influence of exposure to violence on adolescents' physical aggression: The protective influence of peers.

INTRODUCTION: This study examined the degree to which peers can serve as a protective factor to mitigate the negative effects of exposure to violence (i.e., victimization, witnessing violence) on adolescents' physical aggression. Four specific dimensions of peer influence were examined - friends' support for nonviolence, friends' support for fighting, peer pressure for fighting, and friends' delinquent behavior. METHODS: Analyses were conducted on four waves of data collected every 3 months (i.e., fall, winter, spring, summer) from a predominantly African-American (78%) sample of 2575 sixth, seventh, and eighth graders attending three public middle schools in the United States. The sample was 52% female, with a mean age of 12.3 years (SD = 1.00). RESULTS: Findings for relations with victimization differed by sex. For boys, low levels of friends' delinquent behavior attenuated the relation between victimization and changes in physical aggression across all three waves. The protective effect of low levels of peer pressure for fighting was only evident in the winter for boys, whereas the protective effect of friends' support for nonviolence was only evident in the summer. For girls, high levels of friends' support for nonviolence attenuated the relation between victimization in the winter and changes in physical aggression in the spring. In contrast, none of the peer factors moderated the relation between witnessing violence and physical aggression. CONCLUSIONS: Findings suggest that prevention and interventions that increase positive peer influences and decrease negative peer influences may benefit adolescents by reducing risks associated with victimization.

Patterns of Adolescents' Appraisals of Responses to Problem Situations: Associations with Aggression, Victimization, and Contextual Factors.

Although considerable research has examined factors that influence social-cognitive processes related to aggression, few studies have examined the factors that influence adolescents' appraisal of the effectiveness of responses, particularly nonviolent alternatives to aggression. This study addressed that gap by examining patterns of adolescents' perceived effectiveness of nonviolent and aggressive responses to hypothetical problem situations and their relations with aggression, victimization, and individual and contextual risk factors. The participants were a predominantly African American (90%) sample of 1469 students (55% female; mean age = 12.7 years; age range = 11-16) from three middle schools who completed measures of perceived effectiveness, self-efficacy, aggression and victimization, and contextual factors. Ratings of adolescents' physical, relational, and verbal aggression and victimization, nonviolent and prosocial behavior were also obtained from their teachers. Latent class analysis identified four subgroups of adolescents including distinguishes effective, mixed support, everything works, and nothing works. Subgroups differed on measures of aggression, victimization, prosocial and nonviolent behavior, self-efficacy for nonviolence, witnessing community violence, and parents' and peers' support for nonviolence and aggression. The findings underscore the importance of designing violence prevention programs to target the unique needs of subgroups of adolescents.

Deviant Peer Factors During Early Adolescence: Cause or Consequence of Physical Aggression?

This study investigated reciprocal relations between adolescents' physical aggression and their perceptions of peers' deviant behaviors and attitudes. Analyses were conducted on four waves of data from 2,290 adolescents (ages 10-16) from three urban middle schools. Autoregression models revealed reciprocal relations between peer factors (i.e., friends' problem behavior, peer pressure for fighting, friends' support for fighting) and adolescents' reporting of their aggressive behavior. Bidirectional relations were also found between peer pressure for fighting and adolescents' frequency of physical aggression based on teacher ratings. Findings were consistent across sex, grade, and time. Findings suggest that multiple dimensions of peers' behaviors uniquely play a role in the development of adolescents' aggression and have important implications for interventions to reduce problem behaviors.

Patterns of Parental Messages Supporting Fighting and Nonviolence Among Urban Middle School Students.

The purpose of this study was to identify subgroups of adolescents with distinct perceptions of parental messages supporting fighting and nonviolence. Latent class analysis identified four subgroups among 2,619 urban middle school students (90% African American; 52% female): messages supporting fighting (32%), messages supporting nonviolence (29%), mixed messages (23%), and no messages (16%). We found significant differences across subgroups in their frequency of physical aggression and peer victimization and beliefs about the use of aggressive and nonviolent responses to peer provocation. Beliefs significantly mediated the relation between parental messages subgroups and both aggression and victimization. Findings illustrate the heterogeneity in the messages urban adolescents perceive from their parents, as well as relations with adolescents' beliefs and behavior.

Bidirectional Relations between Witnessing Violence, Victimization, Life Events, and Physical Aggression among Adolescents in Urban Schools.

Although there is empirical evidence supporting associations between exposure to violence and engaging in physically aggressive behavior during adolescence, there is limited longitudinal research to determine the extent to which exposure to violence is a cause or a consequence of physical aggression, and most studies have not addressed the influence of other negative life events experienced by adolescents. This study examined bidirectional relations between physical aggression, two forms of exposure to violence-witnessing violence and victimization, and other negative life events. Participants were a sample of 2568 adolescents attending three urban public middle schools who completed measures of each construct every 3 months during middle school. Their mean age was 12.76 (SD = 0.98); 52% were female. The majority were African American (89%); 17% were Hispanic or Latino/a. Cross-lagged regression analyses across four waves of data collected within the same grade revealed bidirectional relations between witnessing violence and physical aggression, and between witnessing violence and negative life events. Although physical aggression predicted subsequent changes in victimization, victimization predicted changes in physical aggression only when witnessing violence was not taken into account. Findings were consistent across sex and grades. Overall, these findings highlight the need for interventions that break the connection between exposure to violence and aggression during adolescence.

Spatial Analysis of the Impact of a School-Level Youth Violence Prevention Program on Violent Crime Incidents in the Community.

This study investigated the effect of a school-based violence prevention program on community rates of violence for youth aged 10 to 18 in three urban communities with high rates of crime and poverty. We evaluated the impact of the Olweus Bully Prevention Program (OBPP) combined with a family intervention using a multiple baseline design in which we randomized the order and timing of intervention activities across three schools. Outcomes were police reports of violent crime incidents involving offenders aged 10 to 18 years (N = 2859 incidents) across a 6-year period. We used Bayesian hierarchical regression modeling to estimate the reduction of youth violence in the census blocks of the intervention middle school zones. Models controlled for percent female head-of-household, median household income, and percent renter-occupied housing units. Block groups within the attendance zones of schools receiving the intervention had a reduced risk of violence compared with those that did not (relative risk = 0.83, 95% credible interval = 0.71, 0.99). Our findings suggest that the school-level intervention was associated with a significant reduction in community-level youth violence. Public health professionals, program planners, and policy-makers should be aware of the potential community-wide benefit of school-level interventions.

Longitudinal relations between beliefs supporting aggression and externalizing outcomes: Indirect effects of anger dysregulation and callous-unemotional traits.

Aggression is prevalent in early- to mid-adolescence and is associated with physical health and psychosocial adjustment difficulties. This underscores the need to identify risk processes that lead to externalizing outcomes. This study examined the extent to which the effects of three dimensions of beliefs supporting aggression on physical aggression and externalizing behavior are mediated by anger dysregulation and callous-unemotional (CU) traits. Three waves of data were collected from a primarily African American (77%) sample of 265 middle school students between the ages of 11 and 15 (52% were female). We found evidence supporting mediation such that the effects of beliefs supporting instrumental aggression and beliefs that fighting is sometimes necessary at Wave 1 on student-reported physical aggression at Wave 3 were mediated by CU traits at Wave 2, and relations between beliefs supporting reactive aggression at Wave 1 and teacher-report of student frequencies of physical aggression and externalizing behavior at Wave 3 were mediated by anger dysregulation at Wave 2. Our findings demonstrated the importance of distinguishing between dimensions of beliefs supporting aggression, as differential paths emerged between specific beliefs, CU traits and anger dysregulation, and externalizing outcomes. These findings have important clinical implications, as they suggest that specific dimensions of beliefs supporting aggression could be targeted based on whether an individual is at risk for behavior patterns characterizing CU traits or anger dysregulation.

Longitudinal relations between trauma-related psychological distress and physical aggression among urban early adolescents.

There is convincing evidence that trauma-related psychological distress and aggressive behavior are highly related among adolescents. The evidence is less clear regarding the direction of this relation. OBJECTIVE: The purpose of this study was to examine reciprocal longitudinal relations between trauma-related distress and physical aggression. METHOD: A predominantly African American sample of early adolescents (N = 2,271; mean age = 12.9) living in an urban, under-resourced community participated in this investigation. The current study used autoregressive cross-lagged models to examine changes across four waves of data within each grade of middle school. RESULTS: Support was found for trauma-related distress uniquely predicting increased levels of physical aggression. This effect was consistent across gender and within and across middle school grades. Conversely, physical aggression did not predict changes in trauma-related distress. CONCLUSIONS: Violence prevention efforts should routinely screen for trauma-related distress.

Social and Emotional Adjustment Across Aggressor/Victim Subgroups: Are Aggressive-Victims Distinct?

Despite prior studies supporting the existence of "aggressive-victims", it remains unclear if they possess unique risk factors from adolescents who are mostly aggressive or victimized. The present study sought to determine whether aggressive-victims differ from adolescents with distinct patterns of involvement in aggression and victimization in their social and emotional adjustment. Secondary analyses were conducted on baseline data from 984 seventh grade students (54% female) from three schools. Most participants identified their race as White (49%) or African American (19%), with 24% identifying as Latino/a. Latent class analysis identified four subgroups: predominant-aggressors (25%), predominant-victims (17%), aggressive-victims (12%), and limited-involvement (47%). The findings did not provide evidence of unique social-emotional characteristics of aggressive-victims that were not accounted for by their involvement in both aggression and victimization. Further evidence of unique differences in risk factors is needed to support targeted interventions for aggressive-victims.

Victimization, Aggression, and Other Problem Behaviors: Trajectories of Change Within and Across Middle School Grades.

This study examined trajectories of victimization and problem behaviors within and across three grades of middle school. Participants were 2,166 adolescents from three urban middle schools in the United States who completed measures of victimization, physical and relational aggression, substance use, and delinquent behavior. Latent curve analyses modeled changes in each construct across 12 waves collected every 3 months. In each case, the best-fitting model required separate linear slopes to represent changes within each grade and a factor representing decreases in the summers. Positive cross-construct correlations were found for intercepts, linear slopes, and measures within waves. The findings suggest strong associations among victimization and problem behaviors, and individual differences in their patterns of change both within and across grades.