Iris W. Borowsky

Adolescent violence perpetration: associations with multiple types of adverse childhood experiences.

OBJECTIVE: Adverse childhood experiences are associated with significant functional impairment and life lost in adolescence and adulthood. This study identified relationships between multiple types of adverse events and distinct categories of adolescent violence perpetration. METHODS: Data are from 136 549 students in the 6th, 9th, and 12th grades who responded to the 2007 Minnesota Student Survey, an anonymous, self-report survey examining youth health behaviors and perceptions, characteristics of primary socializing domains, and youth engagement. Linear and logistic regression models were used to determine if 6 types of adverse experiences including physical abuse, sexual abuse by family and/or other persons, witnessing abuse, and household dysfunction caused by family alcohol and/or drug use were significantly associated with risk of adolescent violence perpetration after adjustment for demographic covariates. An adverse-events score was entered into regression models to test for a dose-response relationship between the event score and violence outcomes. All analyses were stratified according to gender. RESULTS: More than 1 in 4 youth (28.9%) reported at least 1 adverse childhood experience. The most commonly reported adverse experience was alcohol abuse by a household family member that caused problems. Each type of adverse childhood experience was significantly associated with adolescent interpersonal violence perpetration (delinquency, bullying, physical fighting, dating violence, weapon-carrying on school property) and self-directed violence (self-mutilatory behavior, suicidal ideation, and suicide attempt). For each additional type of adverse event reported by youth, the risk of violence perpetration increased 35% to 144%. CONCLUSIONS: Multiple types of adverse childhood experiences should be considered as risk factors for a spectrum of violence-related outcomes during adolescence. Providers and advocates should be aware of the interrelatedness and cumulative impact of adverse-event types. Study findings support broadening the current discourse on types of adverse events when considering pathways from child maltreatment to adolescent perpetration of delinquent and violent outcomes.

From adolescent connections to social capital: predictors of civic engagement in young adulthood

PURPOSE This study examined the ability of adolescent connection in family and community contexts to promote an aspect of healthy youth development and transition into adulthood, civic engagement. METHODS Data are from Wave 1 (1995) and Wave 3 (2001-2002) of the in-home interviews from the National Longitudinal Study of Adolescent Health. The sample for this study included 9130 young adults aged 18-26 years. Linear and logistic regression models were used to measure the influence of connection in family and community contexts (Wave 1) on outcomes of civic engagement in young adulthood (Wave 3). RESULTS Stronger connection in all family and community contexts during adolescence predicted greater likelihood of voting, community volunteer service, involvement in social action/solidarity groups, education groups, and/or conservation groups, and endorsement of civic trust in young adulthood. Select connections in family and community contexts were also significant predictors of political voice/involvement and blood product donation. In a final multivariate model, frequency of shared activities with parent(s) and school connection during adolescence emerged as unique predictors of young adult civic engagement. CONCLUSIONS Connections in family and community contexts during adolescence promote healthy youth development through facilitation of multiple aspects of civic engagement in young adulthood. The importance of these connections in fostering youth capacity to bond to a broader community construct is discussed.

Medical Homes for Children With Autism: A Physician Survey

BACKGROUND. Primary care physicians can enhance the health and quality of life of children with autism by providing high-quality and comprehensive primary care. OBJECTIVE. To explore physicians’ perspectives on primary care for children with autism. METHODS. National mail and e-mail surveys were sent to a random sample of 2325 general pediatricians and 775 family physicians from April 2007 to October 2007. RESULTS. The response rate was 19%. Physicians reported significantly lower overall self-perceived competency, a greater need for primary care improvement, and a greater desire for education for children with autism compared with both children with other neurodevelopmental conditions and those with chronic/complex medical conditions. The following barriers to providing primary care were endorsed as greater for children with autism: lack of care coordination, reimbursement and physician education, family skeptical of traditional medicine and vaccines, and patients using complementary alternative medicine. Adjusting for key demographic variables, predictors of both higher perceived autism competency and encouraging an empirically supported therapy, applied behavior analysis, included having a greater number of autism patient visits, having a friend or relative with autism, and previous training about autism. CONCLUSIONS. Primary care physicians report a lack of self-perceived competency, a desire for education, and a need for improvement in primary care for children with autism. Physician education is needed to improve primary care for children with autism. Practice parameters and models of care should address physician-reported barriers to care.

Smoking among American adolescents: a risk and protective factor analysis.

Cigarette smoking remains a substantial threat to the current and future health of Americas youth. The purpose of this study was to identify the risk and protective factors for cigarette smoking among US adolescents. Data from the National Longitudinal Study of Adolescent Health was used, comparing the responses of all non-smokers at Time 1 for their ability to predict the likelihood of smoking at Time 2, one year later. Data was stratified into four gender by grade group cohorts. Cross-cutting risk factors for smoking among all four cohorts were: using alcohol, marijuana, and other illicit drugs; violence involvement; having had sex; having friends who smoke and learning problems. Having a higher grade point average and family connectedness were protective across all cohorts. Other gender and grade group specific risk and protective factors were identified. The estimated probability of initiating smoking decreased by 19.2% to 54.1% both in situations of high and low risk as the number of protective factors present increased. Of the factors that predict or protect against smoking some are influential across all gender and grade group cohorts studied, while others are specific to gender and developmental stage. Prevention efforts that target both the reduction of risk factors and enhancement of protective factors at the individual, family, peer group and community are likely to reduce the likelihood of smoking initiation.

Suicidal Thinking and Behavior Among Youth Involved in Verbal and Social Bullying: Risk and Protective Factors

PURPOSE To identify risk and protective factors associated with thinking about or attempting suicide among youth involved in verbal and social bullying. METHODS We analyzed data on 130,908 students in the sixth, ninth, and twelfth grades responding to the 2010 Minnesota Student Survey. Among students involved in frequent bullying (once a week or more during the past 30 days), we compared those who did and did not report suicidal ideation or a suicide attempt during the past year. Separate analyses were conducted for perpetrators only, victims only, and bully-victims. RESULTS Overall, 6.1% of students reported frequent perpetration only, 9.6% frequent victimization only, and 3.1% both. Suicidal thinking or a suicide attempt was reported by 22% of perpetrators only, 29% of victims only, and 38% of bully-victims. In logistic regression models controlling for demographic and other risk and protective factors, a history of self-injury and emotional distress were risk factors that cross-cut the three bullying involvement groups. Physical abuse, sexual abuse, a mental health problem, and running away from home were additional risk factors for perpetrators only and victims only. Parent connectedness was a cross-cutting protective factor, whereas stronger perceived caring by friends and by nonparental adults were additional protective factors for some groups. CONCLUSIONS A range of risk and protective factors were associated with suicidal ideation and a suicide attempt among youth involved in verbal and social bullying. Findings may assist in identifying youth at increased risk for suicidal thinking and behavior and in promoting key protective factors.

Factors Distinguishing Youth Who Report Self-Injurious Behavior: A Population-Based Sample

OBJECTIVE To identify factors distinguishing adolescents across 3 groups: no self-harm, nonsuicidal self-injury (NSSI) only, and NSSI and suicide attempt (NSSI + SA). METHODS Data were from the 2007 Minnesota Student Survey. The sample included 61,330 students in grades 9 and 12. Logistic regression analysis determined factors that best distinguished adolescents who reported NSSI from those who reported no self-harm, and adolescents who reported NSSI + SA. Final models were developed over 3 stages of analysis that tested the importance of variables within risk factor, protective factor, and co-occurring health-risk behavior domains. RESULTS For male and female subjects, factors that consistently distinguished youth who reported NSSI from those who reported no self-harm included depressive symptoms, hopelessness, physical abuse, less parent connectedness, running away from home, and maladaptive dieting behavior. Factors that distinguished the NSSI + SA group from the NSSI only group for both sexes were a mental health problem, depressive symptoms, hopelessness, physical abuse, and running away from home. Other factors, such as sexual abuse, were significant in models for males or females only. Hopelessness constituted the leading factor to increase the likelihood that youth who self-injured also attempted suicide. CONCLUSIONS Youth engaging in NSSI experience diverse psychosocial stressors and significant distress. Clinicians and school personnel are well-positioned to offer support to these youth. Furthermore, they can help address NSSI among youth by identifying those who self-injure early, assessing for hopelessness and suicidality, facilitating connections to prosocial adults, addressing maladaptive dieting behavior, and supporting runaway youth.

Violence risk and protective factors among youth held back in school

OBJECTIVE To identify risk and protective factors for violence perpetration among youth with a history of grade retention. DESIGN Longitudinal analysis of in-home interviews of 13,781 adolescents in grades 7 through 12 conducted in 1995 and 1996. METHODS AND MEASURES Serious interpersonal violence perpetration at time 2 by time 1 independent variables including measures of community and school context, family context, and individual characteristics. RESULTS The 20% of girls and 28% of boys who had repeated 1 or more grades were more likely than those who had not to be in the top quintile of violence perpetration at time 2 (P <.001). For both girls and boys with a history of grade repetition, predictive risk factors with an odds ratio of 3 or greater (P <.001) included time 1 violence perpetration, violence victimization, weapon carrying, school problems, and alcohol and marijuana use. Although a high grade point average was a significant protective factor against violence perpetration for both girls (odds ratio, 0.36; P <.05) and boys (odds ratio, 0.23; P <.001), performance on a validated measure of verbal knowledge was not associated with violence perpetration over the study period. School connectedness, parent-family connectedness, and emotional well-being were also significant universal protectors against violence perpetration. CONCLUSIONS Youth who are held back in school are at heightened risk for violence perpetration. Violence-related behaviors and substance use considerably increase the likelihood of this outcome. The findings suggest that schools can participate in violence prevention by providing youth with a positive community and academic experience.

Correlation Between Different Experiences of Intrafamilial Physical Violence and Violent Adolescent Behavior

This research examined the relationship between different experiences of family physical violence and the violent behaviors of attempted suicide, fighting, and gun-carrying at school among 133,794 adolescents in Minnesota public schools. Levels of violence against self and others were compared for male and female youth reporting the following family histories: (a) both direct victim of physical violence and witnessing physical violence, (b) only direct victim of physical violence, (c) only witnessing physical violence, and (d) neither direct victim of physical violence nor witnessing physical violence. Any experience of familial physical violence was significantly associated with increased levels of violence toward self and others

Associations between frequency of bullying involvement and adjustment in adolescence.

OBJECTIVE To examine whether infrequent bullying perpetration and victimization (once or twice a month) are associated with elevated levels of internalizing and externalizing problems and to assess evidence for a minimum frequency threshold for bullying involvement. METHODS The analytic sample included 128,681 6th, 9th, and 12th graders who completed the 2010 Minnesota Student Survey. Logistic regression and general linear models examined the association between bullying frequency and adjustment correlates including emotional distress, self-harm, physical fighting, and substance use while controlling for demographic characteristics. Gender and grade were included as moderators. RESULTS Infrequent bullying perpetration and victimization were associated with increased levels of all adjustment problems relative to those who did not engage in bullying in the past 30 days. Grade moderated many of these findings, with perpetration frequency being more strongly related to substance use, self-harm, and suicidal ideation for 6th graders than 12th graders, whereas victimization frequency was associated with self-harm more strongly for 12th graders than 6th graders. Evidence for minimum thresholds for bullying involvement across all outcomes, grades, and bullying roles was inconsistent. CONCLUSIONS Infrequent bullying involvement may pose risks to adolescent adjustment; thus, clinicians and school personnel should address even isolated instances of bullying behavior. Researchers should reexamine the use of cut points in bullying research in order to more fully understand the nature of bullying in adolescence. These data indicate the need for prevention and intervention programs that target diverse internalizing and externalizing problems for bullies and victims, regardless of bullying frequency.

Examining Youth Hopelessness as an Independent Risk Correlate for Adolescent Delinquency and Violence

Prior research has identified a relationship between youth hopelessness and violence perpetration within specific groups of young people. The purpose of this study was to evaluate the relationship between youth hopelessness and violence perpetration in a population-based sample of adolescents. This study is a cross-sectional analysis of data from 136,549 students in the 6th, 9th, and 12th grades responding to the 2007 Minnesota Student Survey. Logistic regression models were used to evaluate the relationship between hopelessness and youth violence perpetration, including comparison analyses for gender and race/ethnic subgroups as well as adjustment for a measure of poor-low affect. One in four youth (25.1%) reported levels of hopelessness at least enough to bother them in the previous month. Moderate-high levels of hopelessness exhibited a statistically significant independent relationship with a range of violence-related outcomes for youth subgroups: delinquent behavior, weapon carrying on school property, and all forms of self-directed violence. Relationships between hopelessness and interpersonal and intimate partner violence suggest a greater contribution by poor affective functioning for some groups. Interventions designed to reduce youth violence perpetration may benefit from increased strategies to address youth hopelessness as well as youth mental health in general.