There is some evidence that socio-cultural factors can influence both the prevalence and nature of symptoms. There are also differences in how symptoms are described and the explanatory models tend to vary across cultures, with attribution of symptoms to medical illness, family, work, environmental stress or culture-specific phenomena [ 19 ]. The present study builds on one of the few studies on community violence with a cross-cultural perspective [ 10 ] however using a larger, culturally different sample and adding a gender perspective.
The present study hypothesized that increased severity of exposure from no exposure to witnessing to victimization is associated with an increase in substance abuse, even when controlling for own perpetration of violence and for emotional problems. We further hypothesized that these relationships may be gender-specific, with higher levels of substance use in relation to community violence exposure among boys. The primary aim of this study was to determine the factors associated with adolescent health and well-being. The study sites were the following: Russia [the city of Arkhangelsk population , ]; the US [the city of New Haven, Connecticut population , ]; and the Czech Republic [the capital Prague population 1.
Details of the survey and its methodology have been previously published elsewhere [ 20 , 21 ].
In brief, in New Haven, all students aged 12—17 who were in the public school system were included In Arkhangelsk and the Czech study locations, data were collected from a representative sample of students aged 12—17 and 12—18, respectively, in all public schools. Students were recruited from within classes that were randomly selected from within schools that had themselves been randomly selected excepting New Haven, where all students were included.
In all countries, students completed the survey in their classrooms during a normal school day. All administrators were trained in a standardized procedure for administering the survey. Each student received a survey booklet, which contained all of the questions and response options.
Students followed along the survey, reading questions to themselves and circling responses in the booklet. Written informed consent was obtained from all participants prior to the survey administration, and both parents for their children and children had the right to refuse to participate. All students were surveyed unless their parents requested that they not be involved, the students said that their parents had objections, or the students said that they themselves wished not to participate.
Response rates for these surveys were high with only 3. All instruments, described below, were used as parts of the survey, and included both new scales developed specifically for the survey and scales available from the literature that has been used with similar populations. Witnessing and victimization Items assessing witnessing and victimization were derived from the Screening Survey of Exposure to Community Violence, developed by Richters and Martinez [ 24 ].
Three groups were formed according to the reported types of exposure.
Those who did not report any witnessing and victimization episodes were considered as the non - exposed group. Those, who reported at least one episode of witnessing, but no episodes of victimization were considered as the witnessing group. Finally, those, who reported at least one episode of victimization were considered the victimization group.
Substance use Items on alcohol use were derived from the Monitoring the Future Scale [ 25 ] and for cigarette use, marijuana use, and hard drug use from the School Health Study [ 26 ]. Each item had a 4-point response scale, and all 3 were summed to obtain a total smoking score. Three items addressed the use of 3 different alcoholic beverages [How many times if any have you had a drink of… beer, wine, hard liquor ] on a 4-point scale 0, 1—2, 3—5, 6 or more times , and 1 item assessed the frequency of binge drinking [On how many days if any did you have five or more drinks of alcohol in a row, that is, within a couple of hours?
The items scores were summed in order to obtain a marijuana use index. Problems related to substance use lifetime were assessed by five items [ 27 ] asking whether the respondent ever had problems related to the use of drugs, such as getting into an argument, feeling sick, getting arrested, or having money problems. These six items were selected from a larger pool of conduct problems and antisocial behavior items to reflect the types of violence also assessed by the witnessing and victimization measures.
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The selection of these 6 items was further supported by factor analysis. Responses were tallied on a 4-point scale, producing a total score range from 0 to Proxy for Socioeconomic Status SES was based on the student reports of coming from a single-parent family 1 vs. A proxy for SES was calculated as a sum of the above variables single-parent family status and parental employment status , hence producing a variable potentially ranging from 0 to 5. Although direct between-country comparisons of the prevalence of violence exposure may seem unjustified, due to differences in culture, ethnicity, socioeconomic status, size of the city and other parameters, we nevertheless provide the basic rates of exposure to violence both by the type of exposure and a summary table for each study group, as we hypothesized that in spite of expected differences in the levels of exposure and substance use, there would be specific patterns of relationships, potentially generalizable across the three contexts.
Multivariate analyses of covariance MANCOVA were performed in order to assess differences in the levels of alcohol and substance use in boys and girls, who had experienced violence exposure of different severity no violence exposure, witnessing and victimization. Similar to the previous studies, students from all three countries reported relatively high prevalence of exposure to community violence. Within each study group, more boys were exposed to episodes of violence than girls. The proportion of boys and girls in Russia and Czech Republic who witnessed at least one episode of violence was similar within country, but in the US a higher proportion of girls than boys reported witnessing violent events.
Violence in Schools
The results obtained have been largely similar. This cross-sectional, cross-cultural study found a significant relation between exposure to community violence on the one side, and alcohol and substance use on the other side, and this association seems to be robust across culture and gender.
Across all three countries boys were more often victimized by violence than girls. After controlling for the subjects own level of violent behavior and for emotional problems, levels of alcohol and substance use increased along with increased level of violence exposure. Although, this association seems in some ways to be gender-specific i.
The relation between violence and emotional problems on the one side and violence exposure and substance use on the other side is intricate and seems to be suggestive rather than conclusive, as they all represent risk factors for one another and may often co-occur [ 30 , 31 ]. Some theories suggest that engagement in high-risk behaviors, like substance use, may represent a way of coping with negative effects following violence exposure for adolescents [ 32 ].
This hypothesis is further supported by a prospective study of young adults that concluded that individuals with PTSD had four times higher risk of developing substance use disorder than those without the diagnosis [ 33 ]. At the same time, youth who use drugs tend to spend more time in risky environments and hence, are at greater risk for victimization by community violence [ 28 ].
Furthermore, substance use is connected to violent behavior either directly though disinhibition, or indirectly through association with aggressive peers, reduced coping skills, and increased life stressors [ 34 ]. In addition, those youth who perpetrate violence themselves are also more likely to witness or become victims of violence [ 35 ]. Hence, controlling for own violent behavior and emotional problems is essential when examining the relationship between violence exposure and substance abuse.
The present study found that in all three countries substance use increases along with the degree of violence exposure from no exposure, to witnessing to victimization. Previous studies have found a strong association between witnessing community violence and substance use [ 9 ] and one longitudinal study even found that this association was stronger with witnessing compared to victimization [ 36 ]. Assuming that the patterns of psychopathology in perpetrators and innocent bystanders tend to differ, one explanation for this discrepancy might be that the later study did not control for the subjects own violent acts.
Although, the research on gender differences with regard to the prevalence and consequences of community violence exposure has been rather inconclusive, several American studies have reported higher levels of exposure to community violence among boys than girls [ 5 , 37 ] with more pronounced differences for victimization rates, as compared to witnessing.
Our findings of boys reporting more episodes of victimization, as compared to girls, support the previous research and seem to hold across different countries, except for the high number of girls in the US sample reporting witnessing violence, as compared to boys. There have been only a handful of studies regarding gender differences in the association between violence exposure and substance use and the findings tend to be inconclusive. One longitudinal study, Pinchevsky et al. However, Kilpatrick et al. The interaction effects for all other substance use variables were non-significant, suggesting that although the rates of victimization and substance use varied by gender, the general patterns of increase in other types of substance use along with the levels of exposure were not gender-specific.
The role of culture in the development of adverse effects as a result of community violence exposure also remains unclear. Others argue that trauma response knows no cultural boundaries [ 18 ].
Violence in schools : cross-national and cross-cultural perspectives
Although the present study found significant differences between the three countries both with regard to the prevalence of violence exposure, and to the levels of substance and alcohol use, we refrain from making any direct comparisons between the study groups, as the groups differ substantially with regard to the background factors and the findings in the present study groups may not necessarily be generalizable to the respective countries as a whole.
The important finding, however, was that in line with some previous studies on community violence exposure and substance and alcohol use e. Hence, despite substantial between-county differences in levels of substance use and violence exposure, the pattern of response was similar cross-culturally. The use of a cross-sectional design prevents us from determining causality and prospective studies are needed. The reliance of self-report on sensitive issues like violence exposure and substance use can produce recall-bias, however prior studies have indicated that self-reports on sensitive behavior by adolescents tend to be valid and reliable [ 40 ].
In fact when it comes to reporting exposure to violence adolescents themselves are the best informants, as parents often tend to underestimate the extent of violence exposure [ 24 ]. Finally, the data collected in the study are over one decade old.
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The prevalence of the exposure to violence and of the substance use during this time could have changed, thus potentially changing the picture. However, the same pattern of associations observed in all three countries, despite the different levels of problems reported at each site, suggests that the associations would probably hold in spite the time has passed. It is evident that community violence exposure, violence and substance abuse are interlinked.
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This study underline that an increase in violence exposure is associated with an increase in alcohol and substance use and that this pattern of association is neither gender nor culture bound. Hence, globally clinicians working with youth exposed to violence should assess substance use, and prevention programs aimed to reduce alcohol and substance use should address the issues of violence exposure. Finally practitioners working with delinquent youths need to take into account the effects of alcohol and substance abuse when intervening with youth at risk of violence exposure.
Mimmie Willebrand, Email: es. Mary Schwab-Stone, Email: ude.
National Center for Biotechnology Information , U. Eur Child Adolesc Psychiatry. Published online Dec Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Oct 21; Accepted Dec 8. This article has been cited by other articles in PMC. Abstract 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.
Keywords: Community violence exposure, Substance use, Gender, Adolescents. Open in a separate window. The values presented are not adjusted for the list of covariates. Alcohol use Binge drinking Cigarette use Marijuana use Substance-use-related problems Violence exposure 0. Discussion This cross-sectional, cross-cultural study found a significant relation between exposure to community violence on the one side, and alcohol and substance use on the other side, and this association seems to be robust across culture and gender. Compliance with ethical standards Conflict of interest The authors declare that they have no competing interest.
Austin, The Annals of the American Academy. It will be an invaluable resource for macro research on social change and crime. Also of Interest. The Culture of Punishment in America. Anne-Marie Cusac. David E. Brandt, Ph. Russia's Super Mafia. Mark Galeotti. How to Transform Punishment in America. Robert A. John Bennett. Keramet Reiter. In-depth conversations with experts on topics that matter.
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