Youth violence prevention

Background

From a social, public health and emotional perspective, violence/homicide has long had a devastating effect on individual, families and communities. And more disturbingly there are increasing trend of events of mass unprovoked violence/homicide of innocent people at various places across the globe, which are claimed to be perpetuated by mentally disturbed youth. Law enforcement agencies, social scientists and community leaders have long struggled to find a solution to such a seemingly intractable problem.[Jenkins and Bell 1992] However there are many different effective interventions at our disposal. This article reviews violence data, noting the different tracks youth take toward violence, risk factors that lead toward a violent lifestyle and the protective factors that shield them from it; various principles of prevention of violent behaviour such as homicide are also discussed.

Official statistics

Since 1929, when the Federal Bureau of Investigation (FBI) began the uniform crime reporting programme, homicide has been one of the leading causes of death among youth in USA. Most recent data also show that firearm was the leading mechanism for homicide/violence.

Recent data from National Crime Records Bureau,[2012] shows that in 2001 total number of juvenile crime was 16509 and the rate of crime by juvenile was 1.6% whereas in 2011 the total number of crime was 25125 and the rate of crime was 2.1% respectively. Research on adolescence violence is limited. Fifteen hundred high school students were investigated to study the prevalence and demographic characteristics of witnesses, victims and perpetrators of violence and to see the impact of violence exposure on their psychosocial adjustments.[Munni and Malhi 2006] Sixty nine percent of students had witnessed violence in real life and 28% were of serious nature. Media violence exposure was universal. The prevalence of victims and perpetrators was 27% and 13% respectively. Bullying was prevalent. Male sex was the most important predictive risk factor for witnessing and perpetrating violence (P < or = 0.001). Victims were predominantly females. Those having exposure to violence had poorer school performance and adjustment scores (P < or = 0.05).

Developmental dynamics

It is apparent that youth tend to follow different paths to violent behaviour, depending on the age of onset of the behavior.[Department of Health and Human Services 2001] Youths who are violent before the age 13 years tend to show different characteristics than those who become violent afterward. Violent youths with a history of early onset tend to commit more crimes, and tend to commit more serious crimes. They also tend to commit crimes for a longer period of their lives than the late onset counterparts. In contrast the late onset type does not show violent behaviour until they reach adolescence and they tend to show few signs of violent behaviour into early adulthood.

In addition, another dynamic of youth violence is the prevalence of psychiatric disorders in delinquents. At least one third of juvenile delinquents have a mental illness, which often have been adequately treated.[Teplin et al. 2002] Common disorders include attention-deficit/hyperactivity disorder (ADHD), depressive disorders and substance abuse. These considerations are important as many of the potentially violent youth can be prevented from actually doing the crime.

Neurodevelopment

The violent youth’s transition to adulthood is usually marked by abrupt discontinuation of serious violent behaviour. Only roughly 20% of surveyed violent youth continued the behaviour into their 20s. The cause of this shift in behaviour is the ability to control emotion. Modern neuroscience indicates that the youth are at higher risk for violence due to their inability to control affect. The central nervous system (CNS) develops from bottom to top and from inside to out.[O’ Connell et al. 2009] The first part of the brain to develop is the limbic system, which regulates the survival system of the brain and engages the flight, fight and freeze behaviour in youth. The frontal lobes (judgement, deductive reasoning, discernment and wisdom etc) do not fully develop until about 25 years of age. Children, adolescents and young are neurodevelopmentally predisposed to be emotionally unstable, impulsive, adventurous and violent.

Risk factors

A risk factor is anything that increases the probability that an individual will become engaged in violent behaviour. A protective factor is any factor that buffers any risk factors to which an individual may be exposed. The influence a risk factor has on an individual depends on various factors like – the time it occurs in an individual’s life, social context in which it occurs, and also what protective factors are present at that time. The result is a dynamic interplay between risk and protective factors throughout one’s life. So it is useful to identify the risk and protective factors, determining how they interact and designing intervention programme incorporating this information into an effective one.

Biological risk factors are being male, having a low intelligence quotient (IQ), having a psychiatric diagnosis and having any other general medical condition. Behavioural risk factors include substance use, aggressive behaviour, problem behaviour, antisocial attitudes and excessive exposure to TV violence. Family related risk factors are lower socio-economic (SE) status, having antisocial parents, poor parent-child relationship, being from a broken home, and having abuse parents. Other risk factors include poor school performance, having antisocial peers, and having weak social ties. Other specific risk factors for serious violent behaviour (homicide) are gang membership, neighborhood crime, neighborhood drug use.

The strength of a risk factor is indicated by effect size; the larger the effect size, the more predictive value it has. For early onset trajectory violence, more powerful risk factors are substance use, being male, low SE status, antisocial parents and aggression. For late onset trajectory violence, more important risk factors are weak social ties, antisocial peers and gang membership. Race is a variable mistakenly assumed to be a risk factor. Race is a risk marker. Race is a proxy for other known risk factors such as poverty, single parent families, poor educational level, exposure to gangs etc.

Protective factors

Protective factors tend to be consistent in buffering the effects of risk factors for both early and late onset trajectories of violence. Individual protective factors include being female, having an intolerant attitude toward deviance, high IQ, having a positive social orientation. There is also some evidence that having sufficient amounts of omega-3 in the diet is a protective factor that decreases the likelihood of aggression and autonomic dysregulation.[ Hibbeln et al. 2006] Family protective factors include having warm supportive relationships with parents or other adults, parents having a positive evaluation of youth’s peers, and having sufficient parental monitoring. School protective factors include commitment to school and recognition for involvement in conventional activities.

Principles of prevention

Complex behaviour such as violence/homicide is multidetermined and prevention strategies must be equally complex. The principles of a successful prevention are those that address the risk factors and accentuate the protective factors linked to violent behaviour. The public health field principles that decrease risky/violent behaviour are:[Bell et al. 2008]

1. Rebuilding the village: Since the early 1900, the hypothesised cause for delinquency was a lack of social fabric surrounding the youth.[Shaw and McKay 1942] The social disorganisation theory of deviance, suggests that few job opportunities, poverty, single-headed households, isolation from neighbours, and weakened community networks lead to reduced informal and formal social control. As discussed earlier the youth lack emotional control and need grown adults to provide them with brakes, which can only be accomplished if social fabric or village surrounds the youth.

Rebuilding the village refers to the idea that institutions, organisations, businesses, families, and individuals within a given community work together in a way that use their individual strengths, perspectives, and resources in a way that is beneficial to the community as a whole. Dysfunctional communities are those in which each entity has different goals, has no common language, and overly guards resources instead of allowing for their exchange. A functional community has common goals, communicates effectively and collectively maximises its resources. An example of rebuilding the village is a church or police district helping to organise block clubs and encourage neighbors to monitor each other’s children’s behaviour.

2. Access to modern technology: A large number of youth involved with juvenile crime have psychiatric disorders.[Teplin et al. 2002] One hypothesis is that, if these youth were provided modern treatment, their subsequent violent behaviour could be prevented.

3. Connectedness: According to the attachment theory,[Bowlby 1973] a young child needs to develop a relationship with at least one primary caregiver in order for normal social and emotional development to occur. The nurse-family partnership is an effective intervention that targets the mother-infant bond, which directly affects the later affect regulation of the offspring. This intervention improved pregnancy outcomes, maternal care giving, and the maternal life course, preventing future antisocial behaviour.

4. Improving self-esteem: Much research has been done linking low self-esteem with violent behaviour such as bullying and domestic abuse. Self-esteem is defined as (1) a sense of power, (2) a sense of uniqueness, (3) a sense of models, and (4) a sense of connectedness. A sense of power refers to the perception that the individual has the ability do what they must. One of the key features of building self-esteem is transforming learned helplessness into learned helpfulness, also known as mastery or self-efficacy. A sense of uniqueness comes from acknowledging and respecting the qualities and characteristics about oneself that are special and different. A sense of models comes from observing individuals who have developed effective strategies for success. A sense of connectedness results in a feeling of satisfaction from being connected to people, places or things.

5. Increasing social and emotional skills: The enhancement of social and emotional skill helps the person to develop skills necessary to prevent and intervene in violence.[Bell and McBride 2010] Some useful programme are peer leader programs, teen court, mentoring, youth negotiators etc. In the classroom setting, few important programs are peer mediation, conflict resolution, anger management skills.

6. Minimising the effect of trauma: One way of describing the phenomenon of anger is as a sense of being hurt. Often attached to that hurt is the fear of being hurt again. Traumatic stress is also associated with a lack of affect regulation. One way of minimising the effect of trauma is to convert learned helplessness into learned helpfulness.

7. Role of media: Glorification of violence, risk taking behaviour and adventure sports should not be done by the media.

Summary

Youth violence is a growing problem worldwide. Violence exposure is prevalent even in the lives of Indian adolescents and gender differences exist. Its impact on their psychosocial adjustments is detrimental. Early identification and corrective interventions of these adolescents is vital. The science of violence prevention is clear but the political will to disseminate, adapt, and implement these programs waxes and wanes. It is hoped that the science of violence prevention will become so strong that to not provide such programs ubiquitously throughout the country will become unethical.

References

Bell CC, Bhana A, Petersen I, McKay MM, Gibbons R, Bannon W, et al. (2008) Building protective factors to offset sexually risky behaviors among black youths: a randomized control trial. J Natl Med Assoc. 100:936-44

Bell CC, McBride DF (2010) Affect regulation and prevention of risky behaviors. JAMA. 304:565-6.

Bowlby J (1973) Attachment and loss. Vol 2: Separation: anxiety and anger. New York: Basic Books

Department of Health and Human Services (2001) Youth violence: a report of the Surgeon General. Rockville (MD): Department of Health and Human Services

Hibbeln JR, Ferguson TA, Blasbalg TL (2006) Omega-3 fatty acid deficiencies in neurodevelopment, aggression and autonomic dysregulation: opportunities for intervention. Int Rev Psychiatry. 18:107-18.

Jenkins EJ, Bell CC (1992) Adolescent violence: can it be curbed? Adolesc Med. 3:71-86

Munni R, Malhi P (2006) Adolescent violence exposure, gender issues and impact. Indian Pediatr. 43:607-12

National Crime Records Bureau (2012) Crime in India: 2011 statistics. New Delhi: Government of India, Ministry of Home Affairs [Internet]. [cited 2012 Sep 1]. Available from: http://ncrb.nic.in/CD-CII2011/Statistics2011.pdf

O’ Connell ME, Boat T, Warner KE, editors (2009) Preventing mental, emotional and behavioral disorders among young people: progress and possibilities. Washington, DC: National Academies Press

Shaw CR, McKay H (1942) Juvenile delinquency and urban areas. Chicago: University of Chicago Press

Teplin LA, Abram KM, McClelland GM, Dulcan MK, Mericle AA (2002) Psychiatric disorders in youth in juvenile detention. Arch Gen Psychiatry. 59:1133-43