High-violence Communities Research Articles

A Qualitative Exploration of the Built Environment as a Key Mechanism of Safety and Social Cohesion for Youth in High-Violence Communities

The characteristics of a neighborhood’s built environment may influence health-promoting behaviors, interactions between neighbors, and perceptions of safety. Although some research has reported on how youth in high-violence communities navigate danger, less work has investigated how these youth perceive the built environment, their desires for these spaces, and how these desires relate to their conceptions of safety and perceptions of other residents. To fill this gap, this study used focus group data from 51 youth ages 13–24 living in New Orleans, Louisiana. Four themes were developed using reflexive thematic analysis: community violence is distressing and disruptive, youth use and want to enjoy their neighborhood, systemic failure contributes to negative outcomes, and resources and cooperation create safety. This analysis indicates that young people desire to interact with the built environment despite the threat of community violence. They further identified built environment assets that facilitate socialization and recreation, such as local parks, and social assets in the form of cooperation and neighbor-led civic engagement initiatives. In addition, the youth participants demonstrated awareness of structural inequities that influence neighborhood health and violence-related outcomes. This study contributes to efforts to understand how youth with high levels of community violence exposure understand and interact with the built and social environments.

An epidemiology of paediatric cervical spine injuries at the Red Cross War Memorial Children's Hospital over a ten-year period

Background: Paediatric cervical spine injury (CSI) is rare compared to adult CSI. Very little has been published regarding the epidemiology and outcome of CSI in children in South Africa. The objective of this retrospective study is to characterise the epidemiology and report on the outcome of CSI in children <13 years at a tertiary referral centre for paediatric trauma. Methods: We performed a retrospective study of CSI at our hospital over a ten-year period. The Picture Archiving and Communication System (PACS) of our institution was searched for patients with CSIs. Search terms included: cervical spine fracture, subluxation, dislocation, contusion, SCIWORA (spinal cord injury without radiographic abnormality) and retroclival haematoma. Demographic and clinical data were obtained from hospital records. Injury-related variables were compared for children ≤8 and >8 years due to anatomical and biomechanical differences observed. Outcome was assessed using the Frankel grading. Results: Sixty-six children were identified with a cumulative incidence of 0.1%. The median age was 7 years (inter-quartile range 4–8.8) and 65% were male. All injuries were caused by blunt trauma. Passenger motor vehicle injury (MVA) accounted for 52% of injuries. Injuries due to physical abuse, and recreational and sporting activities did not occur. Children ≤8 years of age incurred more injuries than those >8 years (74.2% vs 25.8%). Ninety-eight per cent of injuries occurred in the upper cervical spine (C1–C4) of children ≤8 years. Of the 13 (19.6%) children with neurologic injury, five (7.5%) had complete spinal cord injury, four (6%) had incomplete neurology, and three (4.5%) died. SCIWORA occurred in six (9%) children with variable outcome. Seven patients (10.6%) were operated for instability. An injury severity score (ISS) of 25 (13–34) was associated with poor outcome. The mortality rate was 4.5% and all children who died were ≤8 years with upper CSIs and closed head injuries (CHIs) related to MVA. Conclusion: CSI occurred in 0.1% of patients evaluated following trauma. MVAs, either pedestrian or passenger, were responsible for the majority of these injuries. Children ≤8 years were more frequently injured and sustained injuries to the upper cervical spine. The majority of paediatric CSIs are stable injuries that can be managed conservatively; however, urgent surgical stabilisation is indicated for unstable injuries. CSI with associated CHI caused by MVAs in young children is associated with death. Even though our patients are referred from high violence communities, no CSIs were attributed to physical abuse or penetrating injury. Level of evidence: Level 4

Is the introduction of violence and injury observatories associated with a reduction in violence-related injury in adult populations? A systematic review and meta-analysis

ObjectiveThe aim of this study was to summarise the results from existing studies reporting on the effectiveness of the introduction of violence and injury observatories (VIOs).DesignThis is a systematic review...

Exposure to Community Violence and Self-harm in California: A Multilevel, Population-based, Case-Control Study.

Self-harm is a leading cause of morbidity and mortality. Exposure to community violence is an important and potentially modifiable feature of the social environment that may affect self-harm, but studies to date are limited in the samples and outcomes examined. We conducted a population-based, nested case-control study. Cases were all deaths and hospital visits due to self-harm in California, 2006-2013. We frequency-matched California resident population-based controls from the American Community Survey to cases on age, gender, race/ethnicity, and year of survey/injury. We assessed past-year community violence using deaths and hospital visits due to interpersonal violence in the community of residence. We estimated risk difference parameters that were defined to avoid extrapolation and to capture associations between changes in the distribution of community violence and the population-level risk of self-harm. After adjustment for confounders, setting past-year community violence to the lowest monthly levels observed within each community over the study period was associated with a 30.1 (95% confidence interval = 29.6, 30.5) per 100,000 persons per year lower risk of nonfatal self-harm but no difference in the risk of fatal self-harm. Associations for a parameter corresponding to a hypothetical violence prevention intervention targeting high-violence communities indicated a 5% decrease in nonfatal self-harm at the population level. In sensitivity analyses, results were robust. This study strengthens evidence on the relationship between community violence and self-harm. Future research should investigate reasons for differential associations by age and gender and whether community violence prevention programs have meaningful impacts on self-harm.

Social support, violence exposure and mental health among young South African adolescents

Objective: Cumulative violence exposure has been associated with both internalising and externalising difficulties in youth. Therefore, it is important to identify protective factors that may ameliorate both exposure to and the impact of cumulative violence. This study aimed to identify sources of perceived social support amongst early adolescents in a low-income, high-violence community in South Africa, and to examine the association of perceived support with exposure to violence and with the severity of depression, aggression and conduct disorder symptoms.Method: A sample of 615 Grade 7 learners completed measures of perceived social support, different types of violence exposure and symptoms of depression, aggression and conduct disorder.Results: Maternal, paternal and overall family support were weakly associated with a reduced risk of domestic violence, but not with other forms of violence exposure, and were also weakly associated with a reduced risk of mental health difficulties. Peer support was associated with higher symptomatology across all mental health outcomes while teacher support was associated with greater severity of depression.Conclusions: The stress-buffering effects of social support may not be maintained in contexts of high exposure to violence. Implications for interventions to enhance youth safety and resilience in high-violence contexts are considered.

Pathways to violence propensity: Results from a two-wave study of young males in urban South Africa

The aim of this study was to model pathways to violence propensity and violent behaviour among boys and young men in a high-violence community in South Africa. To that end, 284 young males (11 to 23 years old) from Khayelitsha, Cape Town self-reported risk for engagement in interpersonal violence and criminality; including within family, peer, and school domains, over a 12 month period. In Structural Equation Modelling, a pathway emerged through which an unstable home environment, influenced by deprivation and violence, affects the quality of parenting. In turn, early deviant associations and attitudes toward violence and gangs are cultivated and may have a deleterious effect on schooling, resulting in greater future substance abuse, greater violence propensity, and offending. These findings support the life course perspective approach, emphasising turning points and human agency in the aetiology of violence.

How Exposure to Violence Affects Ethnic Voting

How does wartime exposure to ethnic violence affect the political preferences of ordinary citizens? Are high-violence communities more or less likely to reject the politicization of ethnicity post-war? We argue that community-level experience with wartime violence solidifies ethnic identities, fosters intra-ethnic cohesion and increases distrust toward non-co-ethnics, thereby making ethnic parties the most attractive channels of representation and contributing to the politicization of ethnicity. Employing data on wartime casualties at the community level and pre- as well as post-war election results in Bosnia, we find strong support for this argument. The findings hold across a number of robustness checks. Using post-war survey data, we also provide evidence that offers suggestive support for the proposed causal mechanism.

Community readiness for youth violence prevention: a comparative study in the US and Bolivia

ABSTRACTMuch attention in the field of community-based youth violence prevention has focused on the importance of evidence-based programs and practices – there are multiple lists of effective and promising programs (e.g. Blueprints, CrimeSolutions.gov), and reviews of best practices in the US and internationally are readily available (e.g. World Health Organization, 2010). Less attention has been directed toward community motivation and ‘readiness’ for action, although it is beginning to be recognized as an important component of implementation, scale-up and sustainability. Readiness refers to a community’s willingness to address a problem, access to resources and knowledge about empirically supported best practices. This paper presents findings from a qualitative study assessing community readiness for youth violence prevention in high-violence, low resource communities in three cities in two countries (El Alto and Santa Cruz, Bolivia and Wilmington, DE, USA). Based on the community readiness literature we developed a semi-structured interview to characterize and provide feedback to communities on strengths and challenges, and conducted 85 interviews with key leaders across the three communities. We also were interested in exploring whether communities with high youth violence problems, but different historical, cultural and economic characteristics shared common challenges that could provide broader guidance for community-based prevention and policies in high violence settings. Across the three settings, high violence communities were keenly aware of the problem and motivated to address it, but lacked resources and knowledge of evidence-based practices.

Managing Conflicts in Urban Communities: Youth Attitudes Regarding Gun Violence.

Gun violence remains a pressing public health concern, especially in high-risk urban environments. Community-level violence intervention efforts are being mounted in cities across the United States to prevent and reduce the most severe forms of violence. There is growing evidence to suggest the effectiveness of the Safe Streets Program/ Cure Violence as a community-based intervention to reduce homicides and shootings. The mechanism underlying the reductions in community violence is theorized to be linked with changes in attitudes toward violence as well as shifts in social norms related to violence and retaliation, but there are few tools to assess these domains. This preliminary investigation sought to establish the metric properties of the Survey on Attitudes About Guns and Shootings (SAGAS) with the goal of providing an empirical measure of attitudes and community-level norms. Males aged 18 to 24 were surveyed using the SAGAS in two high-violence communities in Baltimore, Maryland, using street intercept methodology. We found acceptable reliability and validity metrics for the SAGAS. Reliability and validity of the SAGAS were assessed using internal consistency and a latent class analysis with violent behavior outcomes. The internal consistency of the total scale was in the extensive range (α = .70-.79) and the internal consistency of the factors was in the exemplary range (α ≥ .80). In addition, latent classes of attitudes were predictive of being arrested or being shot. Future studies will examine if rates of violence decrease in neighborhoods targeted by the Safe Streets Program and the mediating role of attitudes toward gun violence using the SAGAS.

A qualitative inquiry investigating adolescents' sense of hope within a context of violence in a disadvantaged community in Cape Town

Violent crime has proven to have profound negative effects, especially on children and adolescents residing in high violence communities in South Africa. Many studies in the field have identified the need to focus on hope, one of the factors which can protect children and adolescents from the harmful effects of exposure to violence. The aim of the research study is to explore the sense of hope in adolescents, who are living in communities known to have high levels of exposure to violence. Data was collected by means of two focus groups comprising a total of 14 participants. This group of young people demonstrated a future-oriented understanding of hope, as well as illuminating the link between hope and faith.

Risk and protective factors for bullying victimization among AIDS-affected and vulnerable children in South Africa

Objectives To examine whether bullying is a risk factor for psychological distress among children in poor, urban South Africa. To determine risk and protective factors for bullying victimization. Method One thousand and fifty children were interviewed in deprived neighborhoods, including orphans, AIDS-affected children, streetchildren, and child-headed households. Using standardized scales, children reported on bullying victimization, psychological problems, and potential risk and protective factors at individual, peer, family, and community levels. Results 34% of children reported bullying victimization. Bullied children showed higher levels of anxiety, depression, suicidal ideation, and post-traumatic stress, as well as higher levels of clinical-level disorder. Risk factors for being bullied were being a victim of physical or sexual abuse or domestic violence at home, living in a high-violence community, and experiencing AIDS-related stigma (independent of sociodemographic cofactors and child psychological disorder). Protective factors were sibling support and support from friends, although findings suggest that friendship groups may also be sources of bullying for AIDS-affected children. Conclusions Bullying is an independent and important risk factor in child psychological distress in South Africa. Children victimized at home or in the community are more likely to be bullied, suggesting a cycle of violence. Practice implications Those working with children in Southern Africa should be alert to risk of bullying, especially among abused or AIDS-affected children. Interventions combating community violence and AIDS-related stigma may have additional positive impacts on bullying, and promotion of peer and sibling support may reduce bullying victimization among high-risk children.

Examining Risk and Protective Factors in Head Start Populations Located in High- and Low-Violence Communities

This study examined parental reports of children attending Head Start programs in high(N = 200) and low(N = 188) violence communities to determine whether differences existed in the level of risk and protective factors as measured by the Devereux Early Childhood Assessment (P. A. LeBuffe & J. A. Naglieri, 1999). Previous research has indicated that children exposed to community violence are at risk for the development of social and emotional problems (S. Overstreet, 2000). Results from this study contrast with expected results as children in lowviolence communities exhibited greater parent-reported behavior concerns than children in highviolence communities and no significant differences were found on levels of protective factors. This is the first study to demonstrate that protective factors are similar in an at-risk preschool population despite significant differences in the level of community violence.

School Violence and Theoretically Atypical Schools: The Principal’s Centrality in Orchestrating Safe Schools

Theories often assume that schools in communities with high violence also have high rates of school violence, yet there are schools with very low violence in high violence communities. Organizational variables within these schools may buffer community influences. Nine “atypical” schools are selected from a national database in Israel. Three years of intense qualitative and quantitative methods are employed at these schools. The most important variable found is the leadership of the principal. These schools emphasize a school reform approach rather than packaged school violence evidence-based programs. The schools demonstrate “outward” oriented ideologies, a schoolwide awareness of violence, consistent procedures, integrated use of cultural and religious symbols, visual manifestations of student care, and the beautification of school grounds.

Adolescents' Views of Guns in a High-Violence Community

Firearms account for the majority of deaths among young Black men in America. This article presents a qualitative investigation of youth temptations, emotional reactions, and subsequent behavior with respect to guns. Twenty-three youth enrolled in a community-based firearm reduction program have participated in interviews on retrospective experiences with guns. Common temptations for gun carrying are protection during drug dealing, protection from disrespect, and protection from repeated aggression and bullying. Gun handling produces two diverse responses, fear and excitement. Interviews reveal a dangerous form of gunplay known as flossing and cognitive distortions of peer attitudes toward carriers. Results suggest the need to promote normal adolescent development through increased social opportunities, reduced exposure to guns, and empowering bystanders to prevent escalation of conflict.

Violence and Asthma: A Review.

Recent research shows that exposure to community violence is, directly and indirectly, associated with asthma. This article reviews the findings on the impact of violence on asthma, and the pathways for the association of violence and asthma are suggested: 1) exposure to violence is directly associated with asthma, mainly through dysregulation of sympathetic-adrenal-medullary (SAM) and hypothalamic-pituitary-adrenal (HPA) axis, 2) exposure to violence is associated with the change of susceptibility of outdoor air pollution on asthma, probably through the change of an immune response, and 3) behavioral change due to exposure to violence (e.g. keeping children indoors) leads to more exposure to indoor pollutants. The suggested framework may be useful to develop health policy on asthma in high-violence communities.

Factors Affecting Resilience in Children Exposed to Violence

Exposure to violence puts children at risk for developing a variety of problems, including depression, anxiety, and conduct problems. The extent to which children's individual, family, school, and peer group characteristics influence resilient responses to violence exposure was investigated amongst Grade 6 students living in a high-violence community in Cape Town. The majority (68.44%) reported both witnessing and being a victim of violence. Both witnessing and victimisation by violence were found to be positively associated with anxiety and depression, but only victimisation was positively associated with conduct problems. Peer delinquency was positively associated with both depression and conduct problems. Involvement in conventional after-school activities was negatively associated with anxiety, and school support was negatively associated with both depression and conduct problems. No association was identified between parent support and any of anxiety, depression, or conduct problems. However, this latter finding may be related to measurement problems, or to participants' reports that they were most likely to be victimised in their homes (rather than at school or in the neighbourhood). While this study is limited by its cross-sectional nature, it implies that key sites for intervention are after-school activities, school support, peer delinquency, and home life.

PROSOCIAL AND ANTISOCIAL TENDENCIES IN CHILDREN EXPOSED TO COMMUNITY VIOLENCE

The objective of the study was to explore the relationship between exposure to community violence and antisocial and prosocial behaviours. Data was collected from a sample comprising 78 Grade 7 children (mean age 12.8 years) living in a high violence community in Cape Town. The children completed a shortened version of the Survey of Exposure to Community Violence (Richters & Saltzman, 1990). They were rated by their teachers on four sub-scales of the South African Child Assessment Scales (Barbarin, 1998): opposition/defiance, aggression, self-regulation, and affability (prosocial behaviour). The results indicate a moderate correlation between direct exposure to violence and levels of aggression, opposition/defiance and deficits in self-regulation. Additionally, direct exposure was found to be less predictive of aggression than gender. The sample was most likely to be exposed to violent incidents in the vicinity of the home or in the wider community, rather than in school or in the home. This finding has implications for safety and violence prevention initiatives.