Cognitive Coping Moderates the Association between Violent
Victimization by Peers and Substance Use among Adolescents
Sonya S. Brady,1PHD, Jeanne M. Tschann,2PHD, Lauri A. Pasch,2PHD, Elena Flores,3PHD,
and Emily J. Ozer,4PHD
1Division of Epidemiology & Community Health, University of Minnesota School of Public Health,
2Department of Psychiatry, University of California, San Francisco,3School of Education, University of
San Francisco, and4School of Public Health, University of California, Berkeley
and tobacco use among adolescents, and whether adaptive coping styles moderated associations.
MethodsA total of 247 urban Mexican-American and European-American adolescents aged 16–20 years
were interviewed.ResultsIndependent of demographics and violent perpetration, adolescents victimized
by violence reported greater alcohol and tobacco use. Adolescents who engaged in higher levels of behavioral
coping (e.g., problem solving) reported less substance use, independent of violence variables. Interaction effects
showed that violent victimization was associated with greater substance use only among adolescents who
engaged in lower levels of cognitive coping (e.g., focusing on positive aspects of life). Substance use was
relatively low among adolescents who engaged in higher levels of cognitive coping, regardless of whether
they had been victimized.Conclusions Enhancement of cognitive coping skills may prevent engagement
in substance use as a stress response to violent victimization.
This study tested whether violent victimization by peers was associated with alcohol
Key wordsadolescence; coping; substance use; stress; violence.
National estimates suggest that 20–30% of youth experi-
ence violent victimization by peers, such as physical assault
or attack with a weapon (Slovak & Singer, 2002; Stein,
Jaycox, Kataoka, Rhodes, & Vestal, 2003). Although
much of the literature has focused on peer violence
within impoverished, inner-city communities, these rates
are typical of urban, suburban, and rural communities
(Slovak & Singer, 2002; Stein et al., 2003). Violent victi-
mization may have consequences other than physical
injury among youth, including posttraumatic stress and
depression (Gorman-Smith & Tolan, 1998; Ozer &
Weinstein, 2004). Adolescents who have been victimized
by violence are also more likely to engage in alcohol and
tobacco use, initiate substance use early, engage in more
frequent use, and become substance use dependent
(Ellickson, Saner, & McGuigan, 1997; Schwab-Stone et
al., 1995). Studies on peer violence and substance use
have included nationally representative (Kilpatrick et al.,
2000) and predominantly African-American urban samples
of youth (Albus, Weist, & Perez-Smith, 2004; Sullivan,
Farrell, & Kliewer, 2006), as well as relatively understudied
ethnic minority subgroups such as Central-American
(Kliewer et al., 2006) and Mexican-American youth
Associations between substance use and both violent vic-
timization (Brady, Tschann, Pasch, Flores, & Ozer, in
press) and violent perpetration (Brady et al., in press;
White, Loeber, Stouthamer-Loeber, & Farrington, 1999)
are bidirectional, suggesting that substance use may both
be a response to violence involvement and place adoles-
cents at risk for further violence involvement.
According to stress-coping theory, a stressor will not
negatively impact individuals who possess resources to
adequately cope (Lazarus & Folkman, 1984). To our
knowledge, no studies have examined coping as a modera-
tor of the association between violent victimization and
substance use among adolescents. Some studies suggest
that adaptive coping may protect youth from broadly
All correspondence concerning this article should be addressed to Sonya S. Brady, PhD, Assistant Professor, Division of
Epidemiology & Community Health, University of Minnesota School of Public Health, 1300 South Second Street,
Suite 300, Minneapolis, MN 55454, USA. E-mail: email@example.com.
Journal of Pediatric Psychology 34(3) pp. 304–310, 2009
Advance Access publication July 31, 2008
Journal of Pediatric Psychology vol. 34 no. 3 ? The Author 2008. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.
All rights reserved. For permissions, please e-mail: firstname.lastname@example.org
defined behavioral problems in response to violence expo-
sure. In one prospective study of urban African American
and Latino male adolescents, community violence expo-
sure was associated with increases in violent behavior
only among adolescents who did not engage in adaptive
coping (e.g., focusing on positive aspects of life) during the
time of violence exposure (Brady, Gorman-Smith, Henry,
& Tolan, 2008). Cross-sectional studies of adolescents
and young adults show that coping similarly moderates
associations between community violence exposure and
delinquency (Rosario, Salzinger, Feldman, & Ng-Mak,
2003), externalizing behavior (McGee, 2003), and aggres-
sive behavior (Scarpa & Haden, 2006). Cross-sectional
(Wills, 1986) and prospective (Wills, Sandy, Yaeger,
Cleary, & Shinar, 2001) studies among ethnically diverse
adolescents show that associations between general stres-
sors and substance use are not as strong among adoles-
cents who engage in high levels of behavioral coping
(e.g., problem solving) or cognitive coping (e.g., positive
reappraisal of stress).
The present cross-sectional study tests whether coping
moderates the association between violent victimization by
peers and substance use among urban Mexican-American
and European-American adolescents. We address two
issues of conceptual significance. First, we examine
whether engagement in cognitive and behavioral coping
both moderate associations between violent victimization
and substance use, or whether only cognitive coping acts
as a moderator. When stressors are relatively uncontrolla-
ble, attempting to change negative thoughts and feelings
(i.e., cognitive coping) may be more effective in reducing
distress than attempting to change one’s situation (i.e.,
behavioral coping; Lazarus & Folkman, 1984; Zeidner,
2005). Second, we adjust for violent perpetration in ana-
lyses to conduct a more direct test of stress-coping theory.
The cooccurrence of different health risk behaviors among
youth has been described as a problem behavior syndrome
(Jessor, Donovan, & Costa, 1996). Although a problem
behavior syndrome may explain the clustering of violent
perpetration with other forms of health risk behavior, it
may not provide the best explanation of why violent victim-
ization is associated with substance use, particularly after
adjustment for perpetration.
We hypothesize that violent victimization will be asso-
ciated with greater levels of alcohol and tobacco use, inde-
pendent of age, gender, ethnicity, socioeconomic status,
and violent perpetration. We further hypothesize that the
association between violent victimization and substance
use will be stronger in magnitude among adolescents who
engage in low rather than high levels of cognitive coping.
We do not expect behavioral coping to act as a modera-
tor. Our sample composition allows us to test for poten-
tial interactions involving ethnicity and gender.
Participants were part of a larger study examining parental
conflict and adolescent functioning (Tschann, Flores,
Pasch, & Marin, 1999; Tschann et al., 2002). The present
study’s data were obtained 4 years after initial recruitment.
At initial recruitment, families were randomly selected
from membership lists of a large health maintenance orga-
nization (HMO) serving an urban, Northern California
community. One adolescent from each family and parents
were eligible if the adolescent was aged 12–15, biological
parents were residing together, all three family members
were either Mexican American or US born European
American, and the adolescent had no severe learning
disability. Seventy-three percent of eligible families partici-
pated (N¼302). Four years after initial recruitment,
families were contacted and asked to participate in an
additional interview that included all of the present
study’s constructs (N¼247; retention rate¼82%; inter-
views completed in October, 1999). The Institutional
Review Board and HMO approved the study. Informed
consent was obtained from parents and adolescents aged
18 years and older; informed assent was obtained from
One hundred and twenty-six Mexican-American and 121
European-American adolescents completed interviews for
the present study (total N¼247; 54% male; aged 16–20).
Mexican-American parents reported an average 8 years of
education (SD¼4), while European-American parents
reported 16 years (SD¼2). The average Hollingshead
European-American parents, corresponding to small busi-
ness owners and managers, while the average score was 3.3
(SD¼1.8) for Mexican-American parents, corresponding
to semiskilled workers. Family socioeconomic status was
calculated by averaging across four standardized variables:
years of education and occupation score for each parent.
Participants reported their victimization by and perpetra-
tion of 10 peer-based violent acts during the previous
12 months. Items were developed based on focus groups
Violence, Coping, and Substance Use
and existing measures of violence exposure (CDC, 1992).
The percentages of adolescents reporting victimization by
and perpetration of the following acts, respectively, were as
follows: starting a fight (18%, 19%), getting hurt in a fight
(14%, 5%), attacking (17%, 23%), beating up (10%, 18%),
pulling a knife (10%, 4%), pulling a gun (6%, 2%), threat-
ening with a club/bottle/screwdriver (13%, 7%), hurting
with a club/bottle/screwdriver (6%, 4%), stabbing with a
knife (1%, 0.5%), and firing a gun (3%, 1%). Dichotomous
victimization and perpetration groups were created for ana-
lyses; 29 and 28% of participants reported any violent
victimization and perpetration, respectively, while 23%
reported both types of violence.
Alcohol and tobacco use during the previous 6 months was
assessed. Participants completed five items from the
Roehling, & Goldman, 1989), including ever using alco-
hol, drinking frequency, quantity typically consumed,
drunkenness frequency, and maximum amount consumed
in one drinking episode. A quarter of adolescents reported
not drinking during the past 6 months. Among adolescents
who reported drinking, median responses indicated that
half of adolescents drank at least once per month, usually
consumed at least two drinks per occasion, became drunk
at least twice during the previous 6 months, and consumed
a maximum of six or more drinks in one drinking episode.
We standardized and averaged across items within all
adolescents to create a composite score [M (SD)¼0.08
(0.82); range, ?1.39 to 1.45; a¼.91]; higher scores indi-
cate higher levels of alcohol use. Frequency of tobacco
use was assessed by a single item [M (SD)¼2.32 (2.61);
0—have never smoked, 1—have smoked, but not during
the past 6 months, through 8-A pack a day or more].
Thirty-five percent of adolescents reported never smoking
and 23% reported smoking, but not during the past
6 months. Among adolescents who smoked during the
past 6 months, two modal responses emerged: 3—once
in a while, and 6—one to five cigarettes a day.
Cognitive and behavioral coping were assessed using Wills’
Coping Inventory (Wills, 1986), which does not restrict
responses to a specific time frame. Six cognitive coping
items measured the extent to which adolescents selectively
focused on positive aspects of their situation and made
positive comparisons between their situation and that of
others (e.g., ‘‘I try to notice only the good things in life;’’
M (SD)¼2.45 (0.48); range, 1.33–4.00; a¼.58). Seven
behavioral coping items measured the extent to which
adolescents adopted an active approach to information
gathering, decision making, and problem solving (e.g.,
‘‘I think about the choices that exist before I take
a¼.80). Question stems were modified to begin, ‘‘When
I am having a problem at home....’’ By assessing how
adolescents coped with family problems rather than violent
victimization by peers, we ensured that we would have data
on coping styles in response to conflict.
(Pearson r’s¼.14–.29 in magnitude, p’s<.05). Age was
associated with greater alcohol use and behavioral coping,
male gender was associated with violence involvement, and
Mexican-American ethnicity was associated with perpetra-
tion and lower levels of substance use and cognitive
coping. Low socioeconomic status was associated with
violence involvement, lower levels of alcohol use and
behavioral coping, and greater levels of cognitive coping.
Violent victimization and perpetration (r¼.70), alcohol
and tobacco use (r¼.51), and cognitive and behavioral
coping (r¼.22) were correlated at p<.01. All violence
involvement and substance use variables were correlated
with one another (r’s¼.17–.28; p’s<.01). Low levels of
behavioral coping were associated with violence involve-
ment and greater substance use (r’s¼.16–.24; p’s<.05),
while cognitive coping was not associated with violence
involvement or substance use.
Linear Regression of Substance use on Violent
Table 1 (see Base Model) shows results from regression
analyses of individual substance use variables on violent
victimization, adjusting for demographic variables and vio-
lent perpetration. Violent victimization was associated with
greater levels of alcohol and tobacco use.
Main Effects and Interaction Effects Involving
Behavioral coping was associated with lower alcohol and
tobacco use, while cognitive coping had no main effects
(see Table I, Step 1 of Models 1 and 2). Cognitive, but not
behavioral coping, modified associations between violent
victimization and substance use (see Step 2 of Models 1
and 2). Violent victimization was not associated with sub-
stance use among adolescents who engaged in high levels
of cognitive coping, but was associated with greater alcohol
Brady et al.
and tobacco use among adolescents who engaged in low
levels of cognitive coping (Fig. 1). Interaction tests between
violent victimization, coping, and ethnicity or gender were
not significant (data not shown in table).
As hypothesized, violent victimization was associated with
greater alcohol and tobacco use among adolescents, and
cognitive coping moderated these associations. Results are
consistent with the idea that cognitive coping may protect
adolescents from engaging in substance use as a stress
response to violent victimization. Cognitive coping is
focused on changing negative thoughts and feelings
rather than changing the situation (Wills, 1986). In some
situations, behavioral coping might decrease the likelihood
of violent victimization. However, cognitive coping may
still be necessary to reduce distress and the likelihood
that adolescents choose potentially harmful activities as
a means of escaping from distress.
Although behavioral coping did not moderate associa-
tions between violent victimization and substance use in
the present study, other research suggests that behavioral
coping protects adolescents from engaging in substance
use as a response to general stressors (Wills, 1986; Wills
et al., 2001). In the present study, adolescents who
engaged in higher levels of behavioral coping engaged in
less substance use, independent of victimization history.
Results suggest that both cognitive and behavioral coping
strategies may contribute to long-term positive outcomes
among adolescents. Interestingly, lower levels of behavioral
coping were reported by adolescents who had been
involved with violence and by adolescents of lower socio-
economic status. It may be that environments character-
ized by less control provide fewer opportunities to learn
behavioral coping strategies. Behavioral coping strategies
may also be less effective in environments that are dis-
empowering. Because behavioral coping may result in
more positive outcomes than engagement in cognitive
coping alone when stressors are controllable (Lazarus &
Folkman, 1984), disadvantaged adolescents may benefit
from targeted interventions to strengthen both cognitive
and behavioral coping skills.
Table 1. Linear Regressions of Substance Use Variables on Violent Victimization and Copinga
Alcohol use (N¼247)
Tobacco use (N¼247)
Mexican American ethnicity
Model 1Step 1
Model 2Step 1
aModels 1 and 2 include Base Model variables as covariates. Adjusted (Adj.) R2estimates the proportion of variation in the dependent variable that is collectively explained by
independent variables in the model, while adjusting for the tendency for R2to inflate as the number of independent variables in a model increases.
*p<.05; **p<.01; ***p<.001.
Alcohol Use, by Violent Victimization Group and
No Violent VictimizationViolent Victimization
Low Cognitive Coping (M + 1 SD)
High Cognitive Coping (M + 1 SD)
Tobacco Use, by Violent Victimization Group and
No Violent VictimizationViolent Victimization
Low Cognitive Coping (M + 1 SD)
High Cognitive Coping (M + 1 SD)
Figure 1. Interaction effects between violent victimization and
Violence, Coping, and Substance Use
Limitations of the present study include its cross-
sectional design. Coping was not assessed at each time
point of the larger study from which present data were
drawn. Although adolescents’ self-report of sensitive beha-
viors approximates actual behavior (Harrison, 1995), our
reliance on self-report introduces the possibility of method
and informant bias. Relatedly, bivariate analysis indicated
that half of the variance in violent victimization could be
explained by perpetration. However, examination of toler-
ance values suggested that potential multicollinearity was
not a problem in statistical models. Additional limitations
are that coping was assessed in relation to family conflict
and the internal consistency for cognitive coping was
somewhat low. However, hypothesized interactions involv-
ing cognitive coping were found, and research suggests
that adolescents’ coping strategies are moderately stable
across family and peer-based stressors (Griffith, Dubow,
& Ippolito, 2000; Jaser et al., 2007). Although our data
were collected in 1999, results are consistent with related
studies conducted at different time periods (Wills, 1986;
Zeidner, 2005). Thus, we have no reason to expect that
findings would not generalize to the present day. Results
may not generalize to families in which biological parents
are not residing together or to families that cannot obtain
Our sample of European-American and Mexican-
American adolescents with health insurance extends exist-
ing literature. Observed lower levels of substance use and
higher levels of violence involvement among Mexican-
American adolescents are consistent with national data
(CDC, 2006). Lack of significant interactions involving
ethnicity may reflect adjustment for socioeconomic status
or inadequate power to detect ethnic differences in the
strength of associations. Further studies examining poten-
tial ethnic differences should be conducted.
A stress-coping framework has implications for the
manner in which clinical and health professionals, parents,
and other key adults address youth violence and substance
use. Substance use may appear to be an attractive means of
coping with distress among youth who have been victim-
ized. Our findings highlight the importance of existing
prevention and intervention programs that identify sub-
stance use as a maladaptive method of coping with stress
and attempt to build adolescents’ coping skills (Botvin &
Griffin, 2004; Sussman, Dent, & Stacy, 2002). Enhance-
ment of adolescents’ cognitive coping skills may reduce the
likelihood that they cope with violent victimization and
other stressors through substance use. Enhancement of
behavioral coping skills may also reduce substance use
among adolescents, although this process may occur
independently from the experience of violent victimization.
Health promotion programs should help adolescents to
build a broad repertoire of coping skills and to select the
most adaptive strategies for specific situations.
We thank the UCSF Health Psychology Postdoctoral
Fellows Research Group for feedback on an early version
of this article. We are also grateful to Lilia Cardenas, Martha
Castrillo, Jorge Palacios, Philip Pantoja, and Stephanie
Whitzell for assistance with data collection, and to Seth
Duncan and Philip Pantoja for data management. This
research was supported by grants MNCJ-060623 and
R40MC00118 from the Maternal and Child Health
Bureau (Title V, Social Security Act), Health Resources
and Services Administration, Department of Health
and Human Services, awarded to Dr Tschann. Part of
Dr Brady’s work was funded by a Ruth L. Kirschstein
National Research Service Award (T32 MH019391) while
she was a postdoctoral fellow at UCSF. We would like to
thank the families who participated in the Adolescent
Health Research Project. We also thank the Kaiser
Foundation Research Institute, E. Marco Baisch, and
Charles J. Wibbelsman for providing access to members
of Kaiser Permanente.
Conflicts of interest: None declared.
Received February 6, 2008; revisions received June 26,
2008; accepted June 27, 2008
Albus, K. E., Weist, M. D., & Perez-Smith, A. M. (2004).
Associations between youth risk behavior and expo-
sure to violence: Implications for the provision of
mental health services in urban schools. Behavior
Modification, 28, 548–564.
Botvin, G. J., & Griffin, K. W. (2004). Life skills training:
Empirical findings and future directions. The Journal of
Primary Prevention, 25, 211–232.
(2008). Proactive coping reduces the impact of com-
munity violence exposure on violent behavior among
African American and Latino male adolescents. Journal
of Abnormal Psychology, 36, 105–115.
Brady, S. S., Tschann, J. M., Pasch, L. A., Flores, E., &
Ozer, E. J. (in press). Violence involvement, substance
use, and sexual activity among Mexican American and
Brady et al.
European American adolescents. Journal of Adolescent
Centers for Disease Control and Prevention. (1992).
Behaviors related to unintentional and intentional
injuries among high school students—United States,
1991. Morbidity and Mortality Weekly Report, 41,
Centers for Disease Control and Prevention (2006). Youth
risk behavior surveillance—United States, 2005.
Morbidity and Mortality Weekly Report, 55, 1–108.
Christensen, B. A., Smith, G. T., Roehling, P. V.,
& Goldman, M. S. (1989). Using alcohol expectancies
to predict adolescent drinking behavior after one year.
Journal of Consulting and Clinical Psychology, 57,
Ellickson, P., Saner, H., & McGuigan, K. A. (1997).
Profiles of violent youth: Substance use and other
concurrent problems. American Journal of Public
Health, 87, 985–991.
Gorman-Smith, D., & Tolan, P. H. (1998). The role of
exposure to community violence and developmental
problems among inner-city youth. Developmental
Psychopathology, 10, 101–116.
Griffith, M. A., Dubow, E. F., & Ippolito, M. F. (2000).
Developmental and cross-situational differences in
adolescents’ coping strategies. Journal of Youth and
Adolescence, 29, 183–204.
Harrison, L. D. (1995). The validity of self-reported data on
drug use. Journal of Drug Issues, 25, 91–111.
Hollingshead, A. B. (1975). Four-factor index of social
status. New Haven, CT: Department of Sociology:
Jaser, S. S., Champion, J. E., Reeslund, K. L., Keller, G.,
Merchant, M. J., Benson, M., et al. (2007). Cross-
situational coping with peer and family stressors in
adolescent offspring of depressed parents. Journal of
Adolescence, 30, 917–932.
Jessor, R., Donovan, J. E., & Costa, F. (1996). Personality,
perceived life chances, and adolescent behavior.
In K. Hurrelmann, & S. F. Hamilton (Eds.), Social
problems and social contexts in adolescence: Perspectives
across boundaries (pp. 219–233). New York: Aldine de
Best, C. L., & Schnurr, P. P. (2000). Risk factors
for adolescent substance abuse and dependence:
Data from a national sample. Journal of Consulting
and Clinical Psychology, 68, 19–30.
Kliewer, W., Murrelle, L., Prom, E., Ramirez, M.,
Obando, P., Sandi, L., et al. (2006). Violence exposure
and drug use in Central America youth: Family cohe-
sion and parental monitoring as protective factors.
Journal of Research on Adolescence, 16, 455–478.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and
coping. New York: Springer Publishing Company.
McGee, Z. (2003). Community violence and adolescent
development: An examination of risk and protective
factors among African American youth. Journal of
Contemporary Criminal Justice, 19, 293–314.
Ozer, E. J., & Weinstein, R. S. (2004). Urban adolescents’
exposure to community violence: The role of support,
school safety, and social constraints in a school-based
sample of boys and girls. Journal of Clinical Child and
Adolescent Psychology, 33, 463–476.
Ramos-Lira, L., Gonzalez-Forteza, C., & Wagner, F. A.
(2006). Violent victimization and drug involvement
among Mexican middle school students. Addiction,
Rosario, M., Salzinger, S., Feldman, R. S., & Ng-Mak, D. S.
(2003). Community violence exposure and
delinquent behaviors among youth: The moderating
role of coping. Journal of Community Psychology, 31,
Scarpa, A., & Haden, S. C. (2006). Community violence
victimization and aggressive behavior: The moderating
effects of coping and social support. Aggressive
Behavior, 32, 502–515.
Schwab-Stone, M. E., Ayers, T. S., Kasprow, W., Voyce, C.,
Barone, C., Shriver, T., et al. (1995). No safe haven:
A study of violence exposure in an urban community.
Journal of the American Academy of Child & Adolescent
Psychiatry, 34, 1343–1352.
Slovak, K., & Singer, M. I. (2002). Children and violence:
Findings and implications from a rural community.
Children and Adolescent Social Work Journal, 19, 35–56.
Stein, B. D., Jaycox, L. H., Kataoka, S., Rhodes, H. J.,
& Vestal, K. D. (2003). Prevalence of child
and adolescent exposure to community violence.
Clinical Child and Family Psychology Review, 6,
Sullivan, T. N., Farrell, A. D., & Kliewer, W. (2006). Peer
victimization in early adolescence: Association
between physical and relational victimization and drug
use, aggression, and delinquent behaviors among
urban middle school students. Development and
Psychopathology, 18, 119–137.
Sussman, S., Dent, C. W., & Stacy, A. W. (2002). Project
towards no drug abuse: A review of findings and future
directions. American Journal of Health Behavior, 26,
Violence, Coping, and Substance Use
Tschann, J. M., Flores, E., Marin, B. V., Pasch, L. A., Download full-text
Baisch, E. M., & Wibbelsman, C. J. (2002).
Interparental conflict and risk behaviors among
Mexican American adolescents: A cognitive-emotional
model. Journal of Abnormal Child Psychology, 30,
Tschann, J. M., Flores, E., Pasch, L. A., & Marin, B. V.
(1999). Assessing interparental conflict: Reports of
parents and adolescents in European American and
Mexican American families. Journal of Marriage and the
Family, 61, 269–283.
White, H. R., Loeber, R., Stouthamer-Loeber, M.,
& Farrington, D. P. (1999). Developmental
associations between substance use and violence.
Development and Psychopathology, 11, 785–803.
Wills, T. A. (1986). Stress and coping in early adolescence:
Relationships to substance use in urban school
samples. Health Psychology, 5, 503–529.
Wills, T. A., Sandy, J. M., Yaeger, A. M., Cleary, S. D.,
& Shinar, O. (2001). Coping dimensions, life stress,
and adolescent substance use: A latent growth analy-
sis. Journal of Abnormal Psychology, 110, 309–323.
Zeidner, M. (2005). Contextual and personal predictors of
adaptive outcomes under terror attack: The case of
Israeli adolescents. Journal of Youth and Adolescence,
Brady et al.