Preventing Violence and Related Health-Risking Social Behaviors in Adolescents
National Institutes of Health State-of-the-Science Conference Statement Available free at http://consensus.nih.gov/ta/023/023youthviolenceHTMLstatement.htm.
“Scare tactics” aimed at preventing violent behavior among adolescents do not work and may make the problem worse, according to a new research-based consensus document put together by a panel at the National Institutes of Health (NIH). The panel convened Oct. 13-15 to review scientific research on youth violence prevention.
It concluded that “get tough” programs such as detention centers and boot camps create environments where more experienced delinquent adolescents teach the less experienced how to be delinquent. In addition, a research review by the U.S. Centers for Disease Control and Prevention suggests that putting juveniles in the adult judicial system is counterproductive, because it is more likely to result in kids learning to be more violent than it is to deter them.
The draft statement concludes: “Ineffective programs may not harm the participants directly (although some do) but they may have an important toxic effect nonetheless; namely the ‘opportunity cost’ of funds misspent on an unsuitable program that might have been spent on an effective one.”
The experts agreed that two programs aimed at reducing arrests for violent crimes or violence precursors are effective: Functional Family Therapy and Multisystemic Therapy. Functional Family Therapy is a short-term family-based prevention and intervention program to treat high-risk youth and their families. The youth and families attend at least 12 one-hour sessions over three months.
Multisystemic Therapy provides community-based clinical treatment for violent and chronic juvenile offenders who are at risk for out-of-home placement. The average treatment is 60 hours of therapist-family contact over four months. Both programs reduced re-arrest rates, violent crime arrests and out-of-home placements for a period of approximately four years.
Six programs were classified as “effective with reservation,” because they were not replicated adequately to draw conclusions. The programs and their effects were: Big Brothers Big Sisters (reduced hitting); Multi-dimensional Treatment Foster Care (reduced incarceration); Nurse Family Partnership (reduced arrests and crime); Project Towards No Drug Abuse (reduced weapon carrying); Promoting Alternative Thinking Strategies (reduced peer aggression); and Brief Strategic Family Therapy (reduced conduct disorder and socialized aggression).
Although get-tough programs have been criticized by experts before, the Consensus Panel report should be the last nail in the coffin, convincing youth workers, policy-makers and parents to seek more effective strategies. However, even though it was convened by NIH, the panel is independent and its report is not a policy statement of the federal government. The panel is part of the NIH Consensus Development Program, which was established in 1977 to judge controversial topics in medicine and public health.
Conference sponsors included the National Institute of Mental Health, the National Institute of Child Health and Human Development, the National Institute on Drug Abuse, the Centers for Disease Control and Prevention, the U.S. Substance Abuse and Mental Health Services Administration, the U.S. Department of Education and the U.S. Department of Justice. The 13 members of the panel included practitioners and researchers in medicine, nursing, behavioral health, economics, juvenile justice and outcomes research.
Why do Teens Become Violent?
Preventing Violence and Related Health-Risking Social Behaviors in Adolescents
Linda Chan, Michelle Kipke, A. Schneir and colleagues. Agency for Healthcare Research and Quality, Publication No. 04-EO32-1, September 2004Available free at www.ahrq.gov/clinic/epcsums/adolvisum.htm, or call (800) 358-9295 and ask for Technology Assessment No. 107.
Hundreds of studies have been conducted on youth violence, but the results vary greatly. The Agency for Healthcare Research and Quality is a government agency that reviews major research to determine best practices. It recently completed a comprehensive review of more than 1,000 articles on youth violence, then focused on 23 studies.
Being male was the only risk factor that was consistently associated with youth violence. Surprisingly, low family socioeconomic status was consistently not associated with youth violence when other risk factors were statistically controlled. Otherwise, there was little consistency in findings across studies, partly because the studies examined different factors.
The report criticizes the inconsistent research designs and lack of appropriate quality standards for evaluating research on youth violence programs.
One of the few consistent findings in studies of adolescent boys was the significant association between violence and anger, cigarette smoking and nonviolent delinquency. For adolescent girls, there was generally a significant association between violence and nonviolent delinquency.
For at-risk youth, Latinos tended to exhibit more repeated physical aggression than did youth from other racial or ethnic groups. What clusters of risk factors may lead to youth violence? Individual studies showed the following:
• Prenatal risk exposure combined with disadvantaged family environment at age 7 increased the chances of criminal behavior during the late teens in a high-risk, inner-city group.
• Boys and girls who used more than one drug tended to be more violent, but this was not true when examining boys’ and girls’ use of specific drugs.
• Boys and girls who reported parent-family connectedness, school connectedness and parental presence, and higher grade point averages were significantly less likely to engage in violence.
In one study, repeated youth violence was associated with living in a low socioeconomic neighborhood, combined with lack of guilt, sexual activity, carrying a hidden weapon and poor communication at home. Youth violence was also associated with living in a high socioeconomic neighborhood combined with displaying a lot of physical aggression.
Overall, the researchers found no differences in the effectiveness of anti-violence programs linked to specific settings or to single or multimodal programs. However, all four of the secondary interventions – aimed at youth at “enhanced risk” for violence – that lasted a year or longer were effective, and all five secondary interventions that lasted less than six months were ineffective. Unfortunately, the studies used many different definitions to measure youth violence, and risk and protective factors were measured, analyzed and reported differently as well. As a result, the findings showed little consistency across studies, making it impossible to draw overall conclusions.
What Happens When the Tiniest Babies Become Teens?
Behavioral Outcomes and Evidence of Psychopathology Among Very Low Birth Weight Infants at Age 20 Years Maureen Hack, M.D., Eric Youngstrom, Ph.D., Lydia Cartar, M.A., and colleagues. Pediatrics, Vol. 114, October 2004, pages 932-940 Available free from Dr. Hack at Rainbow Babies and Children’s Hospital of University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, OH 44106, or mxh7@cwru.edu.
Very small babies face myriad health challenges that have implications for their life-long development, and this study indicates that very low birth weight babies are more likely to have several developmental problems throughout adolescence.
In this study of 490 very low birth weight babies born between 1977 and 1979, almost two-thirds (312) lived to be 20 years old, and 241 agreed to participate in this research about their experiences as children and teens. Those who participated were born at an average of 30 weeks gestation and weighed an average of 2 pounds, 9 ounces at birth. In this study, they were compared with other children born during the same years that were of normal weight.
The good news is that, in their first 20 years of life, the boys and girls born at very low weights were less likely to participate in delinquent behaviors. There was no difference in ADHD or behavior problems.
The bad news is that the very low birth weight babies had lower IQs at age 20 than did the comparison children. Parents reported that the baby boys grew up to have more thought problems, and that the girls grew up to be more anxious, withdrawn and depressed and had attention problems. These mental health and attention problems were still significant when IQ was statistically controlled.
It is important to note that teen mothers and low-income parents are more likely to have low birth weight babies, but in this study there were no statistically significant differences in parents’ education, race, marital status or social class.
The findings have important implications for youth workers, because at-risk children are more likely to have a history of low birth weight, and because teen mothers are more likely to give birth to children with low birth weights.
Knowing the long-term implications of very low birth weight can help inform youth workers about the need for additional stimulation and services for such children when they are young. Youth workers should also provide such information to pregnant teens to motivate them to seek early prenatal care in order to avoid giving birth to very low birth weight babies.
Diana Zuckerman, Ph.D., is president of the National Research Center for Women & Families. Contact: dz@center4research.org.
