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.

A trauma-informed approach to understanding firearm decision-making among Black adolescents: Implications for prevention.

Firearm violence remains a public health crisis in marginalized, urban communities, with Black adolescents bearing the burden of firearm homicides and injuries. As such, the prevention of firearm violence among adolescents has moved to a high priority of the U.S. public health agenda. The current paper reviews recent literature to highlight the heterogeneity in firearm behavior among Black adolescents and underscore the need for additional research on decision-making and firearm behavior to better understand how adolescents make decisions to acquire, carry, and use firearms. Through a discussion of the disproportionate levels of trauma exposure and trauma symptoms experienced by Black adolescents, the current paper also proposes a trauma-informed approach to understanding decision-making for risky firearm behavior. We discuss the broader impacts of this approach, including the development of a more comprehensive and contextually relevant understanding of the variability in risky firearm behavior and improvements in risk screening capabilities and preventive intervention strategies.

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.

Patterns of Community Violence Exposure among African American Adolescents Living in Low-Resourced Urban Neighborhoods.

African American adolescents living in neighborhoods with concentrated economic disadvantage are disproportionately exposed to community violence. This study builds upon previous research and examines patterns, severity, and chronicity of violence exposure, within a sample of African American adolescents living in low-resourced, urban neighborhoods (n = 327). The influence of both individual- and contextual-level factors on community violence exposure (CVE) is examined. Data were collected across four time points at 6-month intervals. Latent transition analysis identified three patterns of CVE at each time point: low witnessing and low victimization (LW-LV), high witnessing and low victimization (HW-LV), and high witnessing and high victimization (HW-HV), as well as transitions between each class. Although a stable LW-LV class membership over time was the most prevalent pattern, most adolescents experienced some change in exposure. Nearly one-third of the participants were classified in the HW-HV group at some point in time. Analyses on individual- and contextual-level factors revealed that more depressive symptoms, community problems (e.g., drugs, graffiti, noise), or community resources (e.g., schools, parks, recreational facilities) were associated with an increased likelihood of experiencing high levels of violent victimization. Implications for intervention and prevention of CVE are discussed.

Adverse childhood experiences (ACEs) on mental disorders in young adulthood: Latent classes and community violence exposure.

Adverse childhood experiences (ACEs) have significant impacts on mental health outcomes. There is a growing interest in expanding the scope of ACEs beyond household environments. To date, few studies examine multidimensional ACEs with community violence. This study aims to (1) identify underlying ACE classes including exposure to community violence, and (2) investigate the associations of ACE classes with mental disorders in adulthood: depression, anxiety, and Post-Traumatic Stress Disorder (PTSD). We employed Latent Class Analysis (LCA) and logistic regression analyses using the data from the National Longitudinal Study of Adolescent and Adult Health (Add Health). The LCA identified four heterogeneous ACE classes: (1) child maltreatment (17.47%), (2) household dysfunction (14.39%), (3) community violence (5.36%), and (4) low adversity (62.79%). Three logistic analyses showed that the "child maltreatment" class was more likely to report a depression (OR = 1.56, CI = 1.26-1.92), anxiety (OR = 1.31, CI = 1.06-1.62), and PTSD (OR = 1.97, CI = 1.35-2.87) in adulthood compared to the "low adversity" class. Also, the "community violence" class was more likely to have PTSD (OR = 2.15, CI = 1.14-4.06) in adulthood, compared to the "low adversity" class. However, the "household dysfunction" class was not significantly different in all three mental disorders from the "low adversity" class. Findings supported the differences in mental disorders in young adulthood by types of exposures to ACEs. The study highlights the importance of considering types of ACEs exposure for promoting mental health of young adults.

Does community violence exposure moderate the associations between maternal spanking and early child behavior problems?

A robust research literature links parental spanking with negative behavioral outcomes for children, however, it remains unclear whether conditions in the community may moderate the associations between spanking and behavior problems in early childhood. In the current study, we examined whether community violence exposure moderated the associations of maternal spanking with externalizing and internalizing behavior problems of young children. The sample used in this study was urban families and their children ages 3-5 (n = 2,472). We used fixed effects regression models, which yield stronger statistical control for baseline behavior problems, selection bias, and omitted variables bias. Mother's spanking was associated with elevated levels of both externalizing (ß = .037, p < .001) and internalizing (ß = .016, p < .001) behavior problems. Community violence exposure also predicted higher levels of externalizing (ß = .071, p < .01) and internalizing (ß = .043, p < .05) behavior problems. Community violence exposure did not moderate the associations between maternal spanking and behavior problems. Professionals working with families should promote the use of nonphysical disciplinary practices, regardless of the level of violence and crime in the community in which the family resides.

Effortful Control and Community Violence Exposure as Predictors of Developmental Trajectories of Self-serving Cognitive Distortions in Adolescence: A Growth Mixture Modeling Approach.

Self-serving cognitive distortions are biased or rationalizing beliefs and thoughts that originate from the individual persistence into immature moral judgment stages during adolescence and adulthood, increasing the individual's engagement in antisocial or immoral conducts. To date, the literature examining trajectories of cognitive distortions over time and their precursors is limited. This study sought to fill this gap, by examining effortful control and community violence exposure as individual and environmental precursors to developmental trajectories of cognitive distortions in adolescence. The sample consisted of 803 Italian high school students (349 males; Mage = 14.19, SD = 0.57). Three trajectories of cognitive distortions were identified: (1) moderately high and stable cognitive distortions (N = 311), (2) moderate and decreasing cognitive distortions (N = 363), and (3) low and decreasing cognitive distortions (N = 129). Both low effortful control and high exposure to community violence were significant predictors for moderately high and stable trajectory of cognitive distortions. These results point to the importance of considering moral development as a process involving multiple levels of individual ecology, highlighting the need to further explore how dispositional and environmental factors might undermine developmental processes of morality.

Community violence exposure and substance use: cross-cultural and gender perspectives.

The negative effects of community violence exposure on child and adolescent mental health are well documented and exposure to community violence has been linked both to a number of internalizing and externalizing symptoms. Our aim was, therefore, to investigate cross-cultural and gender differences in the relationship between community violence exposure and substance abuse. A self-report survey was conducted among 10,575, 12-18 year old adolescents in three different countries, Czech Republic (N = 4537), Russia (N = 2377) and US (N = 3661). We found that in all three countries both substance use and problem behavior associated with it increased similarly along with severity of violence exposure and this association was not gender-specific. It was concluded that in spite of the differences in the levels of violence exposure and substance use cross-culturally and by gender, the pattern of their association is neither culturally nor gender bound.

Temperament Moderators of Prospective Associations Between Community Violence Exposure and Urban African American Adolescents' Aggressive Behavior.

Research suggests that neighborhood risks are associated with internalizing symptoms for adolescents high on temperament characteristics related to the behavioral inhibition system (BIS). However, it is unclear whether newer conceptualizations of the BIS distinguishing fear from anxiety operate similarly. Furthermore, it is unclear whether the BIS attenuates community violence exposure effects on externalizing problems. The current study examined whether the BIS or the fight-flight-freeze system (FFFS) moderated associations between community violence exposure and internalizing and externalizing problems. Participants were 367 urban African American adolescents who reported on temperament characteristics in grade 9, and community violence exposure and adjustment problems in grades 9 and 10. Hierarchical linear regression analyses indicated that the FFFS, but not the BIS, moderated the association between community violence exposure and aggressive behavior. Grade 9 community violence exposure was positively associated with grade 10 aggression for adolescents low on FFFS, suggesting that the FFFS may partly differentiate community violence-exposed adolescents' aggressive behavior.

Community Violence Exposure and Risk Taking Behaviors Among Black Emerging Adults: A Systematic Review.

Black emerging adults ages 18-29, particularly those residing in predominantly black urban communities, are at risk for community violence exposure (CVE). This potentially traumatic event may induce traumatic stress reactions for black emerging adults that contribute to their engagement in violence perpetration, substance use and/or sexual risk-taking behaviors as a way to cope with their experiences. To address these identified concerns and make recommendations for future research, this article identifies and synthesizes results from studies that have examined CVE and its association with violence perpetration, substance use, and sexual risk-taking behaviors among black emerging adults. We use the term "black" throughout the article to refer to a socially constructed racial group or identity and recognize that this group, like all other racial groups in the United States, are ethnically heterogeneous. A systematic review of the literature was conducted to identify studies that (1) included a measure of CVE (2) included a measure of violence perpetration, substance use, or sexual risk-taking behaviors, and (3) included primarily black emerging adults. Results showed CVE rates as high as 83% for black emerging adults. CVE was significantly associated with substance use, but findings on the association of CVE with violence perpetration and sexual risk-taking behaviors were mixed. Also, there was a lack of consistency in measures used to assess CVE, suggesting that future research should seek to identify "gold standard" measures and consider whether they have been examined with black emerging adults or similar populations and whether they capture the experiences of this unique population. Furthermore, studies investigating factors that might moderate and/or mediate the relationship between CVE, violence perpetration, substance use, and sexual risk-taking behaviors among black emerging adults are warranted.

Longitudinal Trajectory of Adolescent Exposure to Community Violence and Depressive Symptoms Among Adolescents and Young Adults: Understanding the Effect of Mental Health Service Usage.

Research on the impact of exposure to community violence tends to define victimization as a single construct. This study differentiates between direct and indirect violence victimization in their association with mental health problems and mental health service use. This study includes 8947 individuals from four waves of the National Longitudinal Study of Adolescent to Adult Health and examines (1) whether sub-types of adolescent victimization are linked to depressive symptoms; (2) whether adolescent victimization is linked with mental health service use; and (3) the role of mental health service use in attenuating symptoms arising from victimizations. Adolescents witnessing community violence were more likely to experience depressive symptoms during adolescence but not during their young adulthood; direct exposure to violence during adolescence does not predict depressive symptoms in adolescence but does in adulthood. Use of mental health service mediates report of depressive symptoms for adolescent witnessing community violence.

Community Violence Exposure and Adolescent Delinquency: Examining a Spectrum of Promotive Factors.

This study examined whether promotive factors (future expectations, family warmth, school attachment, and neighborhood cohesion) moderated relationships between community violence exposure and youth delinquency. Analyses were conducted using N = 2,980 sixth to eighth graders (M age = 12.48; 41.1% males) from a racially, ethnically, and socioeconomically diverse sample. After controlling for demographic factors, delinquency was positively associated with community violence exposure and inversely associated with each of the promotive factors. When interaction effects between all promotive factors and community violence exposure were examined simultaneously, only future expectations moderated the relationship between community violence exposure and delinquency. Specifically, community violence exposure had a weaker association with delinquency for youth reporting high versus low levels of future expectations. Results indicate that while promotive factors from family, school, and neighborhood domains are related to lower rates of delinquency, only future expectations served as a protective factor that specifically buffered youth from the risk effects of community violence exposure.

Anxiety sensitivity among Black youth: A cross-sectional analysis of the direct and indirect effects of community violence exposure, neighborhood risk, parenting practices, and peer effects.

Youth exposed to community violence and neighborhood stressors report devastating mental health consequences. Black youth are at greater risk and experience community violence at rates higher than other youth populations. An underexplored mental health consequence is anxiety sensitivity, the fear of experiencing anxiety-related symptoms, which contributes to maladaptive coping strategies and the development and severity of other mental health problems. This study utilized structural equation modeling (SEM) to examine socio-ecological risk and protective factors associated with community violence exposure and anxiety sensitivity among low-income Black youth. Survey data are from a sample of 320 Black youth residing in public and subsidized housing in a Northeastern city in the United States. Results indicated that neighborhood risk, parenting behaviors, and exposure to delinquent peers were indirectly associated with anxiety sensitivity, which occurred through community violence exposure. Additionally, neighborhood risks had direct effects on anxiety sensitivity. Results point to the need to incorporate social and environmental factors in interventions addressing anxiety sensitivity among Black youth in urban communities.

Coping with Community Violence: Perspectives of African American Young Adult Men and Hispanic/Latino Young Adult Men.

Further study is needed regarding the intersection of community violence exposure, coping strategies, and health behaviors among young adult African American men and Hispanic/Latino men. This study did so in Lake County, Indiana, which contains multiple areas with disproportionate prevalence of violence relative to population size. Approximately 22 miles from Chicago, Lake County includes noteworthy mid-sized cities such as Gary, Hammond, and East Chicago. This study explored the perceptions of African American men and Hispanic/Latino men ages 18 to 25 regarding coping strategies and both healthy and health risk behaviors after directly witnessing or indirectly experiencing a violent act or event. We used aspects of social cognitive theory to design this community-based participatory research study. Thirteen males who self-identified as African American, Hispanic/Latino, or both, completed 34- to 80-minute, audio-recorded phone interviews. Audio recordings were transcribed, and NVivo 12 Windows was used by the research team (primary researchers and two coders) to complete transcript analysis. Findings from this study provided insight around African American men and Hispanic/Latino men regarding (a) witnessing violence directly or indirectly experiencing violence; (b) changes in everyday life experiences; (c) coping strategies that involved socio-emotional health, spiritual health, social health, and risky health behaviors; (d) rationales for not asking for help; (e) observations of significant others' coping; (f) what to do differently in the future; (g) beliefs about mentors; and (h) beliefs about mental health providers. Delving into participants' experiences revealed that African American men and Hispanic/Latino men in Lake County, Indiana chose to adopt a range of health risk and health positive strategies after directly witnessing or indirectly experiencing violence. Becoming knowledgeable about African American men's and Hispanic/Latino men's diverse coping strategies and health behaviors may help inform the community about how best to cocreate spaces that aim to alleviate the traumatic experience of having directly or indirectly experienced community violence.

A Four-Wave Cross-Lagged Study of Exposure to Violent Contexts, Cognitive Distortions, and School Bullying during Adolescence.

School bullying represents a widespread expression of violence in the peer context. Guided by the social-ecological model, this study investigated the longitudinal and transactional pathways linking domestic and neighborhood/community violence exposure (through direct victimization and witnessing), self-serving cognitive distortions (CDs), and school bullying perpetration. Furthermore, consistent with the previous literature, we tested the cognitive desensitization process that could develop in response to chronically violent contexts. Two four-wave cross-lagged panel mediation models were tested in a sample of 778 high school students (28.1% males; Mage [Time 1; T1] = 14.20, SD = 0.58). The results showed differential effects of multiple contexts and forms of violence exposure, with domestic violence victimization and community violence witnessing being associated with self-serving CDs and bullying perpetration over time. Moreover, significant associations between CDs and bullying perpetration over time were found, with bidirectional effects for each of these longitudinal patterns. Finally, self-serving CDs significantly mediated the relationships between both domestic violence victimization and community violence witnessing and school bullying perpetration. These findings highlight the need to consider school bullying as a social phenomenon stemming from a complex and bidirectional interplay between individuals and the environments they inhabit, confirming a basic postulate that "violence breeds violence".

Longitudinal Associations Between Community Violence Exposure and Mental Health Problems in Inner-City Youth: Ethnicity and Gender Perspectives.

There is a lack of agreement on whether children and adolescents with different cultural/ethnic backgrounds react to trauma in a similar fashion. This study adds to the existing literature by providing ethnicity and gender perspectives on the longitudinal associations between the degree of community violence exposure (CVE) and mental health problems in U.S. inner-city youth. The study was conducted on a representative sample of predominantly ethnic minority youth (N = 2,794; 54.1% female; age 11-16 years old (M [SD] = 12.77 [1.29]); 60.0% African-American, 26.1% Hispanic American, 13.9% White). Self-reported information was obtained on CVE in year 1 and on mental health problems (depressive symptoms, posttraumatic stress, alcohol use, and conduct problems) in year 1 and year 2. Multivariate analyses of covariance (MANCOVA) were used to compare mental health problems in youth from the three ethnic groups in relation to the different degrees of CVE experienced one year prior, while controlling for their baseline mental health problem levels, age, and socio-economic status. Mental health problems in year 2 increased in a similar fashion in relation to the degree of severity of CVE in year 1 in all three ethnic groups. The interaction effects suggested a gender-specific response to CVE, where girls in the three ethnic groups reported higher levels of depression and posttraumatic stress in relation to the same degree of CVE, as compared to boys. Adolescents from different ethnic backgrounds respond similarly to differing degrees of CVE with an increase in mental health problems over time. In response to a similar degree of exposure, girls tend to experience greater levels of internalizing problems than boys. Timely recognition of traumatic exposure and associated mental health problems is important for early prevention and intervention strategies.

Physical and Mental Health Outcomes of Black Emerging Adults with Community Violence Exposure: An Integrative Review.

Community violence exposure (CVE) and its health impact is a public health crisis. Violent crime has steadily increased over recent years and has disproportionately affected Black communities. Emerging adulthood (18-29 years old) is a vulnerable period of development and Black emerging adults may be at increased risk for negative physical and mental health consequences from CVE. This integrative review was conducted to evaluate available evidence on health outcomes in Black emerging adults exposed to CVE. This review appraised published studies (2012-2022) addressing physical and mental health outcomes of Black emerging adults with CVE. Articles were identified using structured search terms in several databases (CINAHL, PubMed, PsycInfo, and Web of Science), a gray literature search, and citation mining. A total of 177 studies were identified for screening and 19 studies met inclusion criteria and were included in the review. The majority of studies found a significant positive association between CVE and adverse mental (n = 12) and physical (n = 7) health outcomes. CVE appears to have both mental and physical health consequences for Black emerging adults. Given that violent crime disproportionately increased in Black communities and Black people are more likely to develop chronic health conditions at younger ages, more work is needed to elucidate the relationship between CVE and health outcomes.

The Impact of Adverse Childhood Experiences and Community Violence Exposure on a Sample of Anxious, Treatment-Seeking Children.

Screening for adverse childhood experiences (ACEs) can help prevent and reduce adverse outcomes on child development, including increased risk for anxiety disorders. Emerging studies strongly support the inclusion of community-level adversities in ACE screeners to consider diverse contexts and populations. Recent studies suggest that community violence exposure (CVE) may have a distinct impact on youth mental health. Although recent studies have examined the association between ACEs, CVE, and mental health in primary care settings, this association has not been examined on treatment-seeking children in urban mental health settings. The present study employs a mediation model using the PROCESS macro to examine community violence exposure mediating the effect on the association between ACEs and somatic symptoms (SS) on a sample of anxious treatment-seeking children. A total of 98 participants (Mage = 11.7, SD = 3.79, 51.6% males, 54.1% ethnic minority children) who sought services at a specialized anxiety clinic completed self-report measures. Results indicated that exposure to ACEs is associated with endorsement of somatic symptoms as a result of reporting hearing, witnessing, or experiencing CVE. Evidence of mediation was found in a statistically significant indirect effect of ACEs on SS through CREV (Effect = .17, 95% CI = .069-.294). These findings support recent evidence that CVE is a distinct ACE as it contributes to toxic stress similar to individual-level ACEs. The use of a comprehensive ACE screening that includes CVE is warranted, particularly when working with culturally and socioeconomically diverse populations, as it would better capture a broader range of adversities across demographic groups.

Child Community Violence Exposure in an at-Risk Sample: Developmental Trajectories, Caregiving Risks, and the Role of Child Temperament.

Objective: To better understand early etiological pathways to trajectories of child exposure to community violence (CECV), we used person-centered latent class growth analysis (LCGA) to examine chronicity of CECV from early school age through early adolescence, and examined early risks of the identified CECV trajectories (i.e., prenatal cocaine exposure, harsh parenting and caregiving instability across infancy and early childhood, and child activity level and inhibitory control at kindergarten age). Method: An at-risk sample (N = 216; 110 girls) of primarily low-income participants (76% on Temporary Assistance for Needy Families) with high rates of prenatal substance exposure was used. The majority of the mothers were African American (72%), had high school or below education (70%), and were single (86%). Postnatal assessments occurred at eight time points during infancy and toddlerhood, early childhood through early school age, and early adolescence. Results: We identified two distinct linearly increasing CECV trajectories (high-exposure and low-exposure). An interaction between child activity level and maternal harshness emerged, such that children with high activity levels and experiencing high harshness had the highest probabilities of being in the high exposure-increasing trajectory, in addition to early caregiving instability (conditional effect). Conclusion: The current findings not only have important theoretical implications but also provide insights into early intervention.

Is Delinquency Associated With Subsequent Victimization by Community Violence in Adolescents? A Test of the Risky Behavior Model in a Primarily African American Sample.

OBJECTIVE: Victimization is common in adolescence and is associated with negative outcomes, including school failure, and poor emotional, behavioral, and physical health. A deeper understanding of the risk of victimization can inform prevention and intervention efforts. This study tests the risky behavior model in adolescents, examining prospective associations between mean levels of and changes in delinquency and risk for victimization over four annual data collections. METHOD: Low-income adolescent (53.6% female; M age = 12.13 years, SD = 1.62 years; 91.9% African American) and maternal caregiver dyads (N = 358) residing in urban neighborhoods in the mid-Atlantic region of the United States that had moderate-to-high levels of violence and/or poverty completed separate annual home interviews for 4 years. Maternal caregivers reported on adolescents' delinquent behavior; adolescents reported on their victimization by community violence experiences. RESULTS: Using a latent difference score model, results supported the risky behavior model for the first 2 years, but not the final data collection period. That is, levels of and changes in delinquent behavior were associated with more victimization by community violence at the subsequent time point for the first 2 study years. In contrast, there was no evidence for the opposite, specifically that victimization by community violence predicted delinquency. CONCLUSION: Knowing that both levels of delinquency and increases in delinquency place youth at heightened risk for victimization by community violence provides impetus to intervene. Screening for increases in delinquency among youth may be one way to target youth at high risk for victimization by community violence for fast-tracked intervention.