Cumulative Violence Exposure and Self-Rated Health: Longitudinal Study of Adolescents in the United States

Division of General Pediatrics, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
PEDIATRICS (Impact Factor: 5.47). 11/2008; 122(5):961-70. DOI: 10.1542/peds.2007-3063
Source: PubMed


The goal was to determine whether cumulative exposure to violence in childhood and adolescence contributes to disparities in self-rated health among a nationally representative sample of US adolescents.
The National Longitudinal Survey of Youth 1997 is an ongoing, 8-year (1997-2004), longitudinal, cohort study of youths who were 12 to 18 years of age at baseline (N = 8224). Generalized estimating equations were constructed to investigate the relationship between cumulative exposure to violence and risk for poor health.
At baseline, 75% of subjects reported excellent or very good health, 21.5% reported good health, and 4.5% reported fair or poor health. Cumulative violence exposures (witnessed gun violence, threat of violence, repeated bullying, perceived safety, and criminal victimization) were associated with a graded increase in risk for poor health and reduced the strength of the relationship between household income and poor health. In comparison with subjects with no violence exposure, risk for poor self-rated health was 4.6 times greater among subjects who reported >or=5 forms of cumulative exposure to violence, controlling for demographic features and household income. Trend analysis revealed that, for each additional violence exposure, the risk of poor health increased by 38%. Adjustment for alcohol use, drug use, smoking, depressive symptoms, and family and neighborhood environment reduced the strength of the relationships between household income and cumulative exposure to violence scores and poor self-rated health, which suggests partial mediation of the effects of socioeconomic status and cumulative exposure to violence by these factors.
In this nationally representative sample, social inequality in risk for poor self-rated health during the transition from adolescence to adulthood was partially attributable to disparities in cumulative exposure to violence. A strong graded association was noted between cumulative exposure to violence and poor self-rated health in adolescence and young adulthood.

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    • "More recently, it is estimated that armed violence resulted in nearly 350,000 deaths and injuries between 2003 and 2010 (Hicks et al., 2011) and that the unemployment rate was as high as 28% in 2004 (Trading Economics, 2013). Given the widely recognized associations between violence exposure, unemployment, and adverse mental and physical health outcomes (Boynton-Jarrett et al., 2008; McKee- Ryan et al., 2005; Linn et al., 1985; Murthy, 2007; Murthy and Lakshminarayana, 2006; Shaw and Krause, 2002), researchers have recently started examining the prevalence and correlates of mental and physical disorders in Iraq. In the Iraqi Mental Health Survey, for example, Alhasnawi et al. (2009) found that anxiety disorders were the most common class of disorder and major depression was the most common individual disorder. "
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    ABSTRACT: In an effort to support mental health policy planning efforts in conjunction with the reconstruction of Iraq, a nationally representative face-to-face household survey was carried out that assessed the prevalence and correlates of common mental disorders in the Iraqi population. A total of 4,332 adult (ages 18+) respondents were interviewed (95.2% response rate). The current report presents data on the role impairments (number of days out-of-role in the past 30 days) associated with the nine mental disorders assessed in the survey in comparison to the impairments associated with ten chronic physical disorders also assessed in the survey. These disorders were all assessed with the WHO Composite International Diagnostic Interview. Days out-of-role was assessed with the WHO Disability Assessment Schedule. Both individual-level and societal-level effects of the disorders were estimated. Strongest individual-level predictors were bipolar and drug abuse disorders (176-95 days per year), with mental disorders making up five of the seven strongest predictors. The strongest population-level predictors were headache/migraine and arthritis (22-12% population proportions). Overall population proportions were 57% of days out-of-role due to the chronic physical disorders considered here and 18% for the mental disorders. Despite commonly-occurring mental disorders accounting for more individual-level days out-of-role than the physical disorders, mental disorders are much less likely to receive treatment in Iraq (e.g., due to stigma). These results highlight the need for culturally tailored mental health prevention and treatment programs in Iraq.
    Journal of Psychiatric Research 06/2014; 53(1). DOI:10.1016/j.jpsychires.2014.02.006 · 3.96 Impact Factor
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    • "Overall, it has been found that exposure to family conflict has the potential to affect a large range of negative outcomes, but internalising problems are most consistently represented (Harold and Conger 1997; Herrenkohl et al. 2009; Neighbors et al. 1997; Rice et al. 2006; Sheeber et al. 1996; Shelton and Harold 2008), particularly in adolescent depression (Garnefski and Doets 2000; Patton et al. 2008; Sallinen et al. 2004). Even though many studies have measured children and adolescent's exposure to conflict, one is unique in that it has addressed and reported on the specific levels of cumulative violence exposure necessary for negative health outcomes (Boynton-Jarrett et al. 2008). The finding that exposure to ≥5 types of violence leads to a 4.6-fold increase in the likelihood of poor health is a well-defined starting point that further research can use to establish a minimum level of perceived conflict that could induce harm in children or adolescents (Boynton-Jarrett et al. 2008). "
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    Prevention Science 06/2013; 15(5). DOI:10.1007/s11121-013-0416-4 · 2.63 Impact Factor
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    • "Indeed, global surveillance efforts estimate that an average of 565 youth between the ages of 10 and 29 years old are victims of homicide each day, with an additional 20–40 youth violence-related injuries occurring for each homicide [1]. Apart from the potential for death or serious injury, youth experiencing violence, namely, physical fighting, are more likely than their nonviolent counterparts to engage in further risk and violence-related behaviors and to suffer from a myriad of negative physical and emotional health outcomes [1, 4–6]. Considering the magnitude and severity of these consequences, a growing body of the literature has sought to better understand the prevalence and risk factors for youth involvement in physical fighting both in the USA and internationally [1, 2, 7–12]. "
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    ABSTRACT: Objective: Using nationally representative data, this study examined the prevalence of very frequent physical fighting (≥12 times per year) among youth in 27 countries and cities. Frequent physical fighting has rarely been reported in the previous literature despite the implications for research and practice. Methods: Analyses were based on the Global School-based Student Health Survey (2003-2008) and the 2009 US Youth Risk Behavior Survey. Multinomial regression analyses were conducted to determine gender differences in frequent fighting. Countries were categorized into five regions (Sub-Saharan Africa, Central and South America, Asia, Eastern Mediterranean, and the United States), and one-way ANOVA tests were used to determine regional differences. Results: The prevalence of frequent fighting was highest in Zambia (7.7%) and lowest in Myanmar (0.5%). Gender differences were found in 20 countries, with boys being more likely to report frequent fighting than girls. The prevalence of frequent fighting varied by region (F(3,22) = 4.78, P = .01), with the Eastern Mediterranean having a significantly higher prevalence of frequent fighting than Asia (P < .01). Conclusion: The prevalence of frequent fighting varies by gender in many countries and varies across world regions. More cross-national research is needed to better understand the sociocultural context of frequent fighting and to inform youth violence prevention efforts.
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