Protective Factors for Youth Exposed to Violence in Their Communities: A Review of Family, School, and Community Moderators.

Journal of Clinical Child & Adolescent Psychology

ISSN: 1537-4416 (Print) 1537-4424 (Online) Journal homepage: http://www.tandfonline.com/loi/hcap20

Protective Factors for Youth Exposed to Violence in Their Communities: A Review of Family, School, and Community Moderators Emily J. Ozer, Iris Lavi, Laura Douglas & Jennifer Price Wolf To cite this article: Emily J. Ozer, Iris Lavi, Laura Douglas & Jennifer Price Wolf (2015): Protective Factors for Youth Exposed to Violence in Their Communities: A Review of Family, School, and Community Moderators, Journal of Clinical Child & Adolescent Psychology, DOI: 10.1080/15374416.2015.1046178 To link to this article: http://dx.doi.org/10.1080/15374416.2015.1046178

Published online: 26 Jun 2015.

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Date: 05 November 2015, At: 13:23

Journal of Clinical Child & Adolescent Psychology, 0(0), 1–26, 2015 Copyright # Taylor & Francis Group, LLC ISSN: 1537-4416 print=1537-4424 online DOI: 10.1080/15374416.2015.1046178

Protective Factors for Youth Exposed to Violence in Their Communities: A Review of Family, School, and Community Moderators Downloaded by [Chinese University of Hong Kong] at 13:23 05 November 2015

Emily J. Ozer, Iris Lavi, and Laura Douglas School of Public Health, University of California Berkeley

Jennifer Price Wolf Prevention Research Center

This review provides a comprehensive investigation of the pattern and strength of findings in the literature regarding the environmental moderators of the relationship between exposure to community violence and mental health among children and adolescents. Twenty-nine studies met criteria for inclusion in our analysis of family, school, and community variables as moderators. Dependent variables included internalizing (e.g., anxiety, depression, posttraumatic stress disorder) and externalizing symptoms (e.g., aggression, substance use). Effect sizes for the interactions of exposure to violence and potential moderators were summarized by their patterns of protective processes. The majority of studies in the literature examined family characteristics as moderators of the exposure to violence–symptom relationship, rather than school- or communitylevel factors. Our results indicated more consistent patterns for (a) close family relationships and social support for internalizing symptoms and (b) close family relationships for externalizing symptoms. Overall, the most common type of protective pattern was protective-stabilizing, in which youth with higher levels of the environmental attribute demonstrate relative stability in mental health despite exposure to violence. We found no consistent evidence that parental monitoring—a dimension inversely associated with exposure to violence in prior studies—moderated the relationship between exposure to violence and symptoms. The study emphasizes the importance of strengthening family support for young people’s exposure to community violence; more research is needed to provide a solid evidence base for the role of school and community-level protective factors for youth exposed to violence.

Violence—experienced both directly and indirectly—is unfortunately an environmental reality for many children and adolescents in the United States and the world. Violence that affects youth development takes the form of highly publicized mass shootings as well as the regular occurrences of murder and injury in high-crime neighborhoods that often garner little media attention. A large body of research provides compelling evidence that violence is a major problem in numerous U.S. Correspondence should be addressed to Emily J. Ozer, School of Public Health, University of California Berkeley, 529 University Hall, Berkeley, CA 94720-7360. E-mail: [email protected]

communities, particularly urban ones (Dubrow & Garbarino, 1989; Finkelhor, Turner, Ormrod, Hamby, & Kracke, 2009; Osofsky, Wewers, Hann, & Fick, 1993). Despite recent decreases in homicide rates (Cooper & Smith, 2011), U.S. residents are approximately 4 times more likely to die as victims of violent crime than residents of other high-income countries such as Canada and Australia (Woolf & Aron, 2013). Adolescents and residents of urban areas are the most likely to experience violence (Truman & Planty, 2011). Exposure to violence has major consequences for mental health, academic achievement, and other aspects of development for exposed youth. Exposure leads to

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OZER, LAVI, DOUGLAS, WOLF

various forms of distress, such as depression (Schwartz, Gorman, Nakamoto, & Toblin, 2005; Zinzow et al., 2009), anxiety (Gorman-Smith & Tolan, 1998; Rosenthal, 2000), aggression (Fowler, Tompsett, Braciszewski, Jacques-Tiura, & Baltes, 2009; Margolin & Gordis, 2003; Rosario, Salzinger, Feldman, & Ng-Mak, 2003), and intrusive symptoms (McCart et al., 2007; Ozer & Weinstein, 2004). Psychological distress resulting from exposure to community violence has been found to persist over time (Gorman-Smith & Tolan, 1998; Hammack, Richards, Luo, Edlynn, & Roy, 2004; Ozer, 2005; Schwab-Stone et al., 1999). Youth exposed to community violence also show impairments in academics (Schwartz et al., 2005) even years after exposure (Henrich, Schwab-Stone, Fanti, Jones, & Ruchkin, 2004). Depressive symptoms can impair adolescents’ ability to function well academically (Hysenbegasi, Hass, & Rowland, 2005), as do anxiety and elevated arousal, which narrow attention and impair concentration (Parks-Stamm, Gollwitzer, & Oettingen, 2010; Wood, 2006). Posttraumatic aggressive symptoms can lead to problems in school in terms of fights and disciplinary actions (Basch, 2011). Of importance, exposed youth may also anticipate shorter lives for themselves and have lower expectations to achieve due to a sense of foreshortened future (Cauce, Cruz, Corona, & Conger, 2011; Fitzpatrick & Boldizar, 1993).

VARIABILITY IN RESPONSES TO VIOLENCE Many studies conducted over the past two decades have demonstrated variability in adaptation among youth who have been exposed to violence and sought to explain this variability by examining ‘‘protective’’ factors or resources that appear to buffer psychological functioning. This approach is consistent with an ecological framework that considers the interactive effects of factors across multiple contexts of youth’s lives that increase or decrease vulnerability to the effects of violence exposure (Bronfenbrenner, 1979; Cicchetti & Lynch, 1993). In light of extensive theory and research regarding the role of parenting and family functioning on youth development, particular emphasis has been placed on the study of family-level protective factors in the community violence literature (Gorman-Smith & Tolan, 1998; Hammack et al., 2004; Kliewer et al., 2004). Paralleling the broad developmental literature, the family factors of greatest interest in the community violence literature have included parenting dimensions of affective warmth, social support, and monitoring (Steinberg, 2001). Less research has examined characteristics of schools and neighborhoods (Copeland-Linder, Lambert, & Ialongo, 2010; Li, Nussbaum, & Richards, 2007; Ozer, 2005; Ozer & Weinstein, 2004).

Thus, sparked by findings of differential adaptation and drawing on developmental psychopathology constructs of resilience, risk factors, and protective factors, a growing literature has focused on identifying the factors that influence the impact of exposure to violence on adolescents. This research is important for both theoretical and practical reasons, addressing basic research questions about adolescent development in stressful environments while providing empirical evidence to help target interventions to support youth as they negotiate these stressors. The literature on factors that help protect adolescents from the negative psychological sequelae of exposure to community violence is highly diverse with respect to outcomes, protective factors, and samples. Two early qualitative reviews summarized patterns regarding family moderators of exposure to community violence in the literature up to the turn of the last century. Mazza and Overstreet’s (2000) review of several studies suggested that the influence of family moderators differed by outcome, in that family characteristics such as mother’s presence in the home or maternal education were protective for depression and anxiety but not posttraumatic stress disorder (PTSD), whereas family support showed stronger evidence as a moderator for PTSD. Findings highlighting the importance of social support in the etiology of PTSD is consistent with research across the lifespan that identifies social support immediately following traumatic events as a key protective factor for PTSD (Brewin, Andrews, & Valentine, 2000; Ozer, Best, Lipsey, & Weiss, 2003). Another early review (Buka, Stichick, Birdthistle, & Earls, 2001) summarized the small literature regarding how family structure and support moderated the relationship between exposure to community violence and mental health, reporting no clear patterns at that time. A decade ago, a special section of this journal focused on this question of protective factors for exposure to community violence among youth, presenting five studies conducted with a range of urban and rural populations. The set of studies provided further evidence that exposure to violence was high among diverse populations and was linked to clinically significant mental health problems among youth, as well as demonstrating that youth appeared to benefit from protective factors in the home and school despite the limits of those salutary effects at high levels of exposure (Luthar & Goldstein, 2004; Ozer, Richards, & Kliewer, 2004). The 2004 special issue also identified multiple areas for growth in the literature, including differentiation between ‘‘promotive’’ main effects versus interactive protective effects and the use of multiple methods. In the subsequent decade since the special issue and the prior qualitative reviews, this literature has grown significantly, providing the opportunity for further in-depth examination to

COMMUNITY VIOLENCE PROTECTIVE FACTORS

clarify the role of protective factors in youth’s exposure to community violence.


FOCUS OF PRESENT REVIEW There are three main goals for the present study. First, we provide an updated systematic review focused on integrating the disparate findings on family characteristics that may moderate mental health for adolescents exposed to community violence. Consistent with the literature, the mental health domains examined here are organized with respect to internalizing (i.e., anxiety, depression, PTSD) and externalizing symptoms (i.e., aggression, antisocial behavior, substance use). We also characterize the sample and methods used, which is important in light of a recent review demonstrating that methodological variation in community violence studies was associated with the strength of effects found for the relationship between exposure to violence and symptomatology (Fowler et al., 2009). Second, we consider the smaller body of literature for nonfamily environmental attributes (i.e., school, community factors) as moderators of the exposure–outcome relationship. Third, we suggest next steps for research and intervention related to family, school, and community factors. Our approach to reviewing the literature was informed by both the ecological framework just discussed and conceptual work on the construct of resilience (Luthar, Cicchetti, & Becker, 2000). With respect to ecological framing, we sought to identify studies that examined the potential influence of any feature of a developmental setting on the relationship between exposure to violence and the functioning of youth. Theoretical work on resilience informed our specific characterization of moderating effects (Luthar et al., 2000). A basic protective relationship demonstrates a main effect in that a characteristic of the young person’s environment is associated with better functioning, regardless of the magnitude of exposure to violence. In a protective–stabilizing relationship, however, youth with higher levels of the environmental attribute do not demonstrate decrements in mental health despite increased exposure to violence, whereas youth with lower levels of the attribute show worse outcomes in the context of exposure to violence. A protective– enhancing relationship suggests that those who experience high levels of the environmental attribute actually demonstrate stronger mental health in the face of higher exposure to violence, whereas youth who experience low levels of the attribute show worsening with higher exposure. Protective–enhancing patterns are exemplified in research on posttraumatic growth in which some people are able to engage in stressful life experiences in a manner that promotes positive development (e.g.,

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Park, 2010). In a protective–reactive relationship, the attribute is generally associated with better mental health, but less so when exposure to violence is high. Further, vulnerability patterns characterize moderation relationships in which the presence of an attribute leads to increased maladjustment. In a vulnerable–stable relationship, the negative impacts of the attribute are stable despite level of exposure to violence, whereas in a vulnerable–reactive relationship the degree of disadvantage associated with the attribute is worse at higher levels of exposure to violence.

METHOD Review of Literature What is the strength of evidence that family, school, or community characteristics moderate the influence of exposure to community violence on adverse mental health outcomes for young people? To address this question, an extensive search of the community violence literature was conducted using the following strategies. PsycNET and PubMed electronic databases were searched through November 2014, and all published papers providing quantitative data were reviewed. The search conducted was as follows: (‘‘community violence’’) and (‘‘effect modifier’’ OR ‘‘effect moderator’’ OR ‘‘positive adaptation’’ OR ‘‘resilience’’ OR ‘‘protective’’ OR ‘‘buffer’’ OR ‘‘anxiety’’ OR ‘‘depression’’ OR ‘‘post traumatic’’ OR ‘‘posttraumatic’’ OR ‘‘posttraumatic’’ OR ‘‘post-trauma’’ OR ‘‘post trauma’’ OR ‘‘substance abuse’’ OR ‘‘aggression’’ OR ‘‘internalizing’’ OR ‘‘externalizing’’). The search strategy excluded studies that are not empirical and quantitative, such as qualitative studies, book reviews, commentaries, or reviews. Literature reviews on community violence, reference lists of empirical articles, and author searches were all utilized to identify additional articles for inclusion. Criteria for selection of papers included those that (a) examined the extent to which any factor strengthened or weakened the relationship of exposure to community violence to any kind of symptom or indicator of positive adaptation; (b) had a sample size of 20 or more, as this was a reasonable minimum threshold for quantitative analysis; (c) studied youth ages 9 to 19; (d) were published in English; and (e) included community- or school-based samples, rather than hospital or clinicbased samples. Our rationale for (c) was our focus on a broad adolescent range and to exclude young children who are developmentally different in salient ways, including the expression of trauma symptoms and the nature of family and school experiences; adolescence is typically defined from ages 10 to 19, although recent


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evidence suggests that many—especially low-income and ethnic minority children—enter puberty earlier (Greenspan & Deardorff, 2014; World Health Organization, 2014). The rationale for criterion (e) for sample selection was our goal of summarizing the pattern of protective and risk factors for nonreferred youth rather than youth already referred for treatment, who would likely display more severe symptoms and=or may differ from general populations of youth in other ways. Community violence was defined broadly as violence occurring outside of the home in order to cast a wide net and ensure coverage of the literature. We did not include studies of the effects of acts of war and terrorism on the mental health of youth, because the political context for these events was distinctive from the construct of community violence that generally characterizes this literature. The most common reasons for excluding papers included the following: (a) the study did not investigate a statistical interaction between exposure to violence and the environmental attribute; (b) the authors provided no specific data regarding youth in the 9–19 age range; (c) the same sample was used in multiple studies; (d) the study considered moderators that were not family, school, or community variables (e.g., self-reliance, self-worth); and (e) the study reported a protective relationship but did not report data or description sufficient for interpreting the pattern. Papers included in the review appear in Appendix A. Using our search criteria listed previously, we identified 209 published papers for full review on the basis of the abstract. Of these, 31 studies met the criteria for inclusion in our analysis of family, school, or community variables as moderators. Coding Studies Papers were thoroughly reviewed by the authors to identify any quantitative effect size (ES) that represented the statistical interaction between exposure to community violence and a potential protective factor in analyses seeking to explain variability in internalizing symptoms, externalizing symptoms, or positive functioning. The relevant characteristics and statistics of each paper were coded and entered into a Microsoft Excel database to document the authors, study design, demographics of the study sample, covariates included in the analysis, type of protective factor and measure used, outcome variable and measure used, degrees of freedom, ES (standardized beta coefficient), and type of protective relationship reported. To reduce the possibility of errors, a coauthor entered the codes, and then a second coauthor rechecked them. Selection and Summary of ES Estimates Selection of ES estimates. We established decision rules consistent with standard practice (Cooper &

Hedges, 1994; Rosenthal, 1994) to present a parsimonious summary of the literature. First, articles were reviewed closely to ensure that the same data published in more than one article would be counted as one study. Second, for longitudinal studies that presented multiple assessments over time, we selected the ES that represented the longest available follow-up. After selecting the appropriate ES from each study, we initially summarized the exposure to Violence Potential protective factor relationships. We categorized the magnitude of each ES consistent with Cohen’s (1988) classic guidelines: An ES of between .20 and .30 is considered small, between .30 and .50 is considered medium, and above .50 is considered large.

Coding and summary of ES estimates. We note that our substantive focus on moderating relationships necessitated the selection of ESs that represented interaction terms (Exposure to Violence Possible Protective Factors) rather than main effects. These interaction terms are the products of multivariate analyses; our ESs of interest were typically calculated in the last step in a hierarchical regression with sets of control variables or covariates that differed across studies. For example, the ES for the interaction of family support might be analyzed while controlling for age, sex, and life events in one study while another study tested a similar question while controlling for a different set of covariates. Of the 31 papers in this review, no two papers included the exact same set of covariates. Thus, approaches using averaging across ESs were not appropriate for synthesis. A meta-analytic approach to ES synthesis was not conducted. In light of the constraints on numeric averaging of ESs, we employed several strategies to analyze patterns in the literature. First, we characterized each ES consistent with Luthar et al.’s (2000) conceptualization of the five resilience patterns discussed earlier; coding was conducted by one coauthor with review by a second coauthor and was based on close review of the published articles. We deemed that it was neither conceptually consistent nor informative to combine ESs if they represented patterns of protective effects with different meanings, such as protective–stabilizing versus protective–reactive. Thus, we did not combine ESs even within the same study but instead noted all ESs in our appendixes. Because of space limitations, we used footnotes as needed to summarize the results of studies that generated large numbers of relevant ESs. Our approach of summarizing internalizing and externalizing outcomes by family variable without statistically combining ESs enabled us to highlight the nuanced protective relationships uncovered in the literature while retaining the meaning of the interaction effect. We then assigned a sign to each ES; a positive sign



indicates a protective relationship regardless of the sign of the ES in the original study (see Appendix A). Our analytic approach enabled a review of the literature that characterizes the strength, direction, and patterns of the ESs. Categorization of findings. Based on the factors identified in the literature, we organized our findings regarding family moderators in terms of the following categories: support, close=warm relationship, parental monitoring, and parental structure. Each of these categories comprised at least two studies that examined the variable. Although the constructs of family support and warm parent–adolescent relationships both reflect affective dimensions of these relationships, we separated these in our review because they are conceptually and operationally distinct and could potentially reflect different protective processes. Our category of family support is operationalized in terms of measures that assess parents’ responses to the adolescent in the context of a stressor, for example, mothers’ helpfulness when the adolescent experienced a personal problem. In contrast, close and warm relationships with the parent were operationalized by more global items such as the child’s report of sharing her inner feelings with the parent or feeling satisfied with the relationship. Due to the small number of studies that investigated characteristics of nonfamily settings, we did not create any subcategories of moderators for school or community settings.

RESULTS We first report the characteristics of the studies in terms of sample and methods. We then present our observed patterns in relationships for internalizing and externalizing symptoms, considering these dimensions separately and then examining patterns across both dimensions. As outlined earlier, we characterized the effects found in the literature in terms of patterns conceptualized by Luthar et al.’s (2000) prior theoretical work: protective–stabilizing, protective–enhancing, protective– reactive, vulnerable–stable, and vulnerable–reactive. Overview of Literature The studies included in our review focused primarily on testing moderators of exposure to violence for adolescents living in U.S. urban areas (24 of 31). Characteristics of the family were studied with much greater frequency than characteristics of the school or community. Although we included studies analyzing outcomes for youth ages 9 to 19 years, the overwhelming majority of the literature focused on young adolescents

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attending middle school to early high school in the United States. Sample sizes ranged greatly, from 75 to more than 5,700 participants. Of the 31 studies, approximately 40% utilized a longitudinal (k ¼ 12 for longitudinal design, k ¼ 19 for cross-sectional design). Investigators used a range of scales to measure family characteristics and mental health outcomes. The most commonly used outcome measures included the Children’s Depression Inventory (Kovacs, 1992) and the Children’s Behavior Checklist (Achenbach, 1991). PTSD was assessed using multiple measures, with the Trauma Symptom Checklist for Children (Briere, 1995) the only scale that was used in several studies. In the studies included here, exposure to community violence was assessed in multiple ways. The most common approach was to assess both the young person’s direct victimization and witnessing of violence, which were then either analyzed separately or as a composite (k ¼ 14), followed by studies that used a composite of direct victimization, witnessing and hearing about community violence (k ¼ 5), victimization only (k ¼ 3), and witnessing violence only (k ¼ 7). Two studies used general parental reports of their adolescents’ exposure to violence. All but six of the studies reported using validated scales of exposure to community violence (see Appendix A); the others used scales that were specifically developed for the study.

Internalizing Symptoms: Pattern of Findings Appendix B displays a schematic view of the strength of the evidence for each family variable found in the literature by type of mental health outcome examined. We identified 126 ESs that examined potential moderators of the relationship of exposure to violence to internalizing symptoms. Fifty six of these ESs were statistically significant. Next we provide detailed information about the patterns of findings for each category of moderator. Close and warm relationship. Eleven studies investigated close and warm relationships in the family as possible protective factors (see Appendix B). These studies reported 16 ESs, 11 of which were statistically significant. Six of the ESs represented small, protective–stabilizing effects with absolute values ranging from .15 to .241 (Dinizulu, Grant, & McIntosh, 2014; Gorman-Smith & Tolan, 1998; Hammack et al., 2004; Kliewer et al., 2004; Kliewer, Murrelle, Mejia, Torres de G., & Angold, 2001; McKelvey et al., 2011), providing evidence that adolescents who experienced high 1 We report absolute values for the effects throughout this article, as the differences in the sign of the original ES are not substantive but rather due to differences in the measurement strategies used by the studies.


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exposure to violence who also reported strong parental support did not show the expected decrements in mental health associated with exposure to violence. Five of these effects were generated by studies of U.S. youth, and the sixth was conducted with Colombian adolescents. One protective–enhancing effect was reported— for girls only—in a large Colombian sample (Kliewer et al., 2001). This pattern indicated that girls who reported high levels of disclosure with their mothers showed lower levels of distress despite higher exposure to violence. Three additional effects found for U.S.based studies were protective–reactive, small to moderate in magnitude (Hammack et al., 2004; Kliewer et al., 2004; McKelvey et al., 2011). These protective–reactive relationships indicate that the protective effect of close relationships with parents was not sustained at high levels of exposure to violence. One additional study reported parental involvement as a significant factor but did not describe the protective pattern (O’Donnell, Roberts, & Schwab-Stone, 2011). Support. Ten studies examined familial support as a moderator, generating 22 ESs, 11 of which were statistically significant. All of the significant ESs, which ranged from .11 to .54, were from U.S. samples. Six of the effects were protective–stabilizing: two large effects (Kaynak, Lepore, & Kliewer, 2011; Kuther & Fisher, 1998) and four small effects (Ozer & Weinstein, 2004). Two protective– enhancing effects were found (Kaynak et al., 2011; Rosario, Salzinger, Feldman, & Ng-Mak, 2008), ranging in magnitude from small to large. Two protective–reactive effects were identified (LeBlanc, Self-Brown, Shepard, & Kelley, 2011; Salzinger, Feldman, Rosario, & Ng-Mak, 2010). One study reported a small effect suggesting that support from parents and family members served as a vulnerable-reactive factor in that those with high levels of family support demonstrated higher symptoms at higher levels of exposure to violence (Li et al., 2007). Parental monitoring. Two studies investigated parental monitoring as a moderator of the relationship between exposure to violence and internalizing symptoms, generating four ESs (Bacchini, Miranda, & Affuso, 2011; Gorman-Smith & Tolan, 1998). Only one small statistically significant effect was identified: In a study of Italian teens (Bacchini et al., 2011), parental monitoring showed a protective–enhancing effect for anxiety=depressive symptoms for those who had witnessed a violent event but not those who had been directly victimized. Other family factors. Five U.S.-based studies examined additional family characteristics as possible protective factors (Fitzpatrick & Boldizar, 1993;

Gorman-Smith & Tolan, 1998; Overstreet & Dempsey, 1999; Self-Brown et al., 2006, 2012), presenting 11 ESs. Four protective-stabilizing effects were found, two for family structure as a moderator (e.g., mother present in the home) and two for parental mental health as a moderator (specifically, parental trauma exposure and parental PTSD). The size of these effects was small to medium. School factors. Four studies examined characteristics of schools as possible buffers, generating 12 ESs; six were statistically significant. Among U.S. urban teens, teacher support demonstrated a strong protective–stabilizing effect for students’ self-reported hope (Ludwig & Warren, 2009). Also among U.S. urban teens, small protective–enhancing effects for teacher helpfulness and school safety were reported for students’ adaptive functioning (Ozer & Weinstein, 2004); teacher helpfulness or school safety, however, did not demonstrate statistically significant protective patterns for depression or PTSD. A study in Gambia found that for PTSD school climate showed a protective–enhancing effect for adolescents who were witnesses of community violence and a protective–reactive effect for victims of community violence (O’Donnell et al., 2011). Other factors. Two U.S. studies of young urban adolescents examined characteristics of youths’ friendships as potential moderators of exposure to violence and internalizing symptoms; only one out of four effects tested was found to be statistically significant. Friend attachment demonstrated a small protective–stabilizing effect (Salzinger et al., 2010), whereas friends’ helpfulness showed no statistically significant pattern with respect to PTSD, depression, or adaptive functioning (Ozer & Weinstein, 2004). Gender-specific effects for internalizing symptoms. Four of the studies that reported protective relationships for internalizing symptoms demonstrated differential patterns for boys versus girls. Three reported protective effects for female participants only; one reported a protective relationship for male participants only. First, for girls, exposure to violence was moderated by family cohesion for anxiety and by disclosure of thoughts and feelings for hopelessness (Kliewer et al., 2001). Second, time spent with family was a protective–stabilizing factor for anxiety for female participants only (Hammack et al., 2004). Third, social support was a protective–enhancing factor for depression for girls only (Rosario et al., 2008). In contrast, one study found that lower family conflict was a protective factor for male adolescents only (McKelvey et al., 2011).



Externalizing Symptoms: Pattern of Findings Close and warm relationship. Seven studies examined close and warm relationships in the family as possible moderators of the relationship between exposure to violence and externalizing symptoms (Barr et al., 2012; Gorman-Smith & Tolan, 1998; Hardaway, McLoyd, & Wood, 2012; Kliewer et al., 2004; Kliewer, Murrelle, et al., 2006; Lee, 2012; McKelvey et al., 2011). These studies generated 17 ESs; nine were statistically significant. All moderation patterns found were small protective–stabilizing effects (.03–.19) and were found for samples from the United States, Panama, and Costa Rica. Adolescents who reported closer and warmer relationships within their families demonstrated stable levels of externalizing behavior despite high levels of exposure to violence, in comparison to increased levels of externalizing behavior associated with higher exposure to violence found for youth with less warm and close family relationships. Support. Five studies investigated parental support as a moderator in U.S. samples with 13 effects reported (LeBlanc et al., 2011; Li et al., 2007; Ozer, 2005; Salzinger et al., 2010; Sullivan, Kung, & Farrell, 2004). Of these, three ESs were found to be statistically significant (Ozer, 2005; Sullivan et al., 2004). These ESs indicated a small protective–stabilizing pattern: Only adolescents with high familial support showed stable levels of externalizing symptoms, whereas adolescents with low support reported higher externalizing symptoms in the context of violence exposure. Two effects indicated a protective–reactive pattern (Sullivan et al., 2004): Adolescents with high family support showed lower use of substances when community violence was low but showed a larger relative increase at higher levels of exposure to violence. Parental monitoring. Six studies examined parental monitoring as a moderator (Bacchini et al., 2011; Gorman-Smith & Tolan, 1998; Kliewer, Murrelle, et al., 2006; Lee, 2012; Low & Espelage, 2014; Sullivan et al., 2004). Nineteen ESs were reported; seven were statistically significant. Five ESs showed protective–stabilizing patterns for alcohol and drug use and for deviancy that were small in magnitude (.06–.14; Kliewer, Murrelle, et al., 2006). Two studies reported a protective–reactive pattern for antisocial behavior (Bacchini et al., 2011) and for advanced alcohol use (Sullivan et al., 2004). Other family factors. Two studies examined additional family factors (e.g., parental beliefs, mental health) generating three ESs (Gorman-Smith & Tolan,

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1998; Self-Brown et al., 2012). Of these, only one ES was statistically significant: A vulnerable-reactive pattern of small magnitude suggested that families’ composite score of organization, support, and intolerance of antisocial behavior did not serve as a buffer at higher levels of exposure to violence (Gorman-Smith & Tolan, 1998). School factors. Two U.S. studies (Hardaway et al., 2012; Ozer, 2005) examined the protective effects of school factors on the relation between exposure to community violence and externalizing symptoms. A small protective–stabilizing effect for extracurricular activities in the relationship between exposure to community violence and externalizing symptoms (Hardaway et al., 2012) was the only statistically significant ES. Community factors. Only one U.S. study (Li et al., 2007) examined community characteristics as a moderator, finding a small protective–stabilizing effect for positive neighborhood characteristics (e.g., neighborhood cohesion) on externalizing symptoms. Gender-specific effects for externalizing symptoms. Only one study reported gender-specific effects for a family factor as a moderator of externalizing symptoms (McKelvey et al., 2011). Boys in families displaying low family conflict indicated a stable level of antisocial and risk-taking behaviors. In contrast, in families displaying high family conflict, levels of antisocial and risk-taking behaviors were elevated with exposure to community violence. This protective–stabilizing pattern was not found for girls. Design-Related Patterns in Findings The studies included in this review utilized a range of methodological approaches, as shown in Appendix A. We examined our findings to identify potential evidence that the design characteristics of the studies were linked to our pattern of results. Due to the limited sample size of studies and ESs, we did not conduct significance tests; instead, we next present relevant patterns with respect to the distribution and pattern of ESs. Cross-sectional versus longitudinal. The study design—cross-sectional or longitudinal—did not appear to be associated with whether the study found statistically significant moderation effects; slightly less than half of the ESs generated from both cross-sectional and longitudinal data were found to be significant (37 of 86 ESs for cross-sectional studies, 20 of 40 ESs for longitudinal). In both designs, most of the statistically significant

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ESs indicated protective–stabilizing patterns. However, whereas in the longitudinal designs protective–stabilizing patterns constituted about 45% of significant effects, protective–stabilizing effects constituted 70% of the ESs generated from cross-sectional designs. Approach to assessing exposure to violence. Studies that analyzed exposure to violence using a composite variable that combined victimization and witnessing generated 69 ESs, 36% of which were statistically significant. Studies that examined exposure to violence using separate variables of witnessing of violence or direct victimization yielded ESs that were statistically significant in 50%–75% of the cases, respectively. We further explored if different types of exposure to violence, such as direct victimization or witnessing, were associated with varying patterns in the protective relationships found. In all of the types of exposure studied as the independent variable, protective–stabilizing was the most frequently found type of effect. Measures utilized. As noted earlier and as demonstrated in Appendix A, investigators used a wide range of measures to assess exposure to violence, possible familial protective factors, and mental health outcomes. The measurement of exposure to violence was conducted using 18 different scales, some of which were constructed for the specific study. The most commonly used measure was the Survey of Exposure to Community Violence (Richters & Saltzman, 1990), utilized in five studies. Six of the eight ESs that were based on this measure were statistically significant. The Screen for Adolescent Violence Exposure was used in four papers, with five significant effects of a total of 14 reported effects (Hastings & Kelley, 1997). The Children’s Report of Exposure to Community Violence (Cooley-Quille, Turner, & Beidel, 1995) was utilized in three papers, with 15 significant effects found of a total of 39. With respect to mental health outcomes, the most commonly utilized measures were the Children’s Behavior Checklist, Youth Self Report, and Teacher Report Form clinical scales (Achenbach, 1991). These normed scales were used in eight papers representing independent studies; these generated 39 ESs, 16 of which were significant. The Children’s Depression Inventory was used in seven studies, generating 18 ESs of which seven were statistically significant. Sample characteristics. The samples represented in this review were highly ethnically diverse, with the majority from African American and U.S. Latino groups, with a small proportion of participants from South America, Africa, and Europe. Although all samples would be expected to have experienced some

exposure to violence given the topic of the research, investigators differed in their sampling strategies and in their characterization of their samples as ‘‘high risk’’ for exposure to violence. For example, 42% of studies explicitly characterized their samples as ‘‘high risk,’’ by virtue of targeting recruitment to groups such as adolescents considered high risk for antisocial behavior or, more commonly, adolescents residing in neighborhoods with high levels of crime or violence. Other studies (k ¼ 18) instead sought to recruit a representative sample of the community or school population. Using the description of the sample and recruitment approach from the published studies, we found no differences in the proportion of significant effects for high-risk versus low-risk samples (42% vs. 46%). Further, studies with both types of samples were found to have a similarly high proportion of protective–stabilizing effects found relative to other patterns of protective effects (i.e., 65% for high risk vs. 60% for representative samples). Multiple versus single reporter. In the majority of studies (23), only one respondent reported on exposure to violence, the moderator, and symptoms. This was typically the adolescent. A smaller number of studies (six) engaged parents or teachers in providing their own reports of the young person’s symptomatology. We found a roughly similar pattern in the moderation patterns or proportion of statistically significant ESs yielded by either approach: 11 of 30 ESs (37%) from the multiple-reporter approach were found to significant, compared to 44 of 94 ESs for the single reporter approach (47%). DISCUSSION This review investigated the pattern and strength of findings in the literature for potential environmental moderators of the relationship between exposure to community violence and mental health among adolescents. Our interpretation of this literature was informed by prior theory and research in developmental psychopathology that distinguish between internalizing and externalizing spectra, as well as by conceptual work in the field of psychological resilience that suggest the importance of identifying specific patterns of protective and vulnerability processes (Bronfenbrenner, 1979; Cicchetti & Lynch, 1993; Luthar et al., 2000). The overwhelming majority of moderators investigated in the literature were family-level factors. This was not surprising in light of the strong focus on the family in developmental science. We also searched the literature, however, for moderators that represented characteristics of other key developmental settings such as schools or neighborhoods; relatively few were identified.



Internalizing Symptoms We found that moderating relationships have been studied more extensively for internalizing symptom outcomes (anxiety, depression, PTSD symptoms) than for externalizing outcomes (aggression, substance use) or domains of adaptive functioning such as social competence. Further, ESs for internalizing symptoms showed a more consistent pattern of evidence that family factors moderate the relationship between exposure to violence and mental health outcomes. Although protective–stabilizing patterns were most frequently found (k ¼ 26), protective–enhancing (k ¼ 5), protective– reactive (k ¼ 6), and vulnerable–reactive (k ¼ 2) relationships were also found. The moderation findings were most consistent for close and warm relationships with parents and for family members’ provision of social support when the youth experienced a problem. Although both parental warmth and family support are constructs that reflect the affective quality of family life, we examined these separately because of the possibility that the provision of social support in the context of stressors could be more directly implicated in the response to exposure to violence and to the etiology of traumarelated symptomatology. We did not, however, observe any differential patterns. Further, we found no consistent evidence that parental monitoring served as a protective factor with respect to internalizing outcomes. We found some evidence that family structure and parental mental health were protective factors, acting in a protective–stabilizing manner for outcomes of PTSD, depression, and other emotional symptoms) with elevated level of exposure to community violence. We note that, overall, half of the ESs tested were not significant, indicating variability in the pattern of moderation relationships for internalizing symptoms within and across study samples. Turning to moderators outside the family setting, our analysis based on a small number of studies suggested that supportive relationships with teachers can provide protective effects for positive functioning, but there was no evidence that teacher relationships were protective for depression or PTSD. No study was identified that examined community-level characteristics as a moderator, and no consistent effects were found for the supportiveness of young people’s friendships as a potential moderator of exposure to violence and internalizing symptoms.

Externalizing Symptoms With respect to externalizing symptoms, the only factor that demonstrated a consistent pattern of moderation was close and warm parenting relationships. Approximately half of the ESs generated by the seven studies

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that examined this factor reported a small protective– stabilizing relationship. That is, adolescents who reported more close and accepting relationships with their parents did not show increased levels of externalizing problems such as substance use and aggression at higher levels of exposure to community violence. In contrast to the findings for internalizing symptoms, only one study reported that parental social support when adolescents experienced a problem played a protective role. It should be noted, however, that family support was investigated less frequently (four studies) as a moderator for externalizing symptoms than for internalizing (nine studies). Parental monitoring showed only weak evidence of moderation. Few three studies examined nonfamily factors as potential moderators of exposure to violence and externalizing symptoms; no consistent pattern of effects was observed. Methodological Variation Early qualitative reviews of moderators of the relationship between exposure to violence and symptoms suggested that the influence of family moderators differed by outcome. Further, a recent review of the main effects of exposure to violence on a range of symptoms among youth identified a stronger relationship between exposure to violence and PTSD for lower risk samples and for studies in which the same person reported on exposure and outcomes (Fowler et al., 2009). In the present study, however, we did not find evidence for these differential patterns. We did find that designs that utilized a composite variable to analyze exposure to violence showed fewer statistically significant moderation effects than those that examined dimensions of violence in terms of more discrete categories of witnessing or direct victimization. These findings are consistent with the interpretation that combining across discrete dimensions of exposure to violence could create more error in the analyses. However, it could also be reasonable to expect the contrary—that a composite variable might better reflect the cumulative impact of exposure to violence and therefore be linked with stronger effects. We further found that, although there were no differences in the proportion of significant moderation effects yielded from cross-sectional versus longitudinal analyses, there was a difference in the pattern of findings. Protectivestabilizing effects were found in 75% of the significant moderating effects found for cross-sectional designs but only 50% of those in longitudinal designs. Given the small number of longitudinal studies, we exercise caution in interpreting this and other comparisons. This may suggest, however, that it is more difficult to find evidence for such sustained protective effects over time. Last, we did not identify any consistent patterns in

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findings according to the specific measures used. Well-established measures did not tend to demonstrate stronger patterns of findings than other measures, with the exception of the Survey of Children’s Exposure to Community Violence (Richters & Saltzman, 1990). This was the first published measure of exposure to violence and the longest measure used by studies in this review.


Parental Monitoring As just noted, parental monitoring showed limited evidence as a moderator for externalizing but not for internalizing symptoms. In prior research on adolescent development, parental monitoring has been identified as a key protective factor with respect to externalizing problems such as substance use and delinquency (Coombs & Landsverk, 1988; Flannery, Vazsonyi, & Rowe, 1996; Mogro-Wilson, 2008; Shakib et al., 2003). In the community violence literature, parental monitoring has been associated with less exposure to violence (Gorman-Smith, Henry, & Tolan, 2004; Matjasko et al., 2013). These findings make intuitive sense because parents’ supervision of their children’s whereabouts and interactions would likely result in less time in unsupervised places where they might be exposed to or engage in violence. It is important to note, however, that many shootings also occur near schools, stores, or homes— spaces that are part of young people’s necessary daily routes. The results of the present study complement the findings of the prior research, suggesting that parental monitoring may serve as a key main effect type of protective factor but not as a moderator that influences the relationship between exposure to violence and symptomatology once exposure to violence has occurred. Pathways for Moderation Effects It is important to consider the psychological processes by which these protective factors might operate, that is, to focus on the mechanisms indicated by protective factors rather than the variables themselves (Kraemer et al., 1997; Rutter, 1979). Along these lines, we submit that our results are generally consistent with pathways by which family factors, especially parenting behaviors, may moderate adolescents’ internalizing and externalizing symptoms in the context of exposure to community violence. First, consistent with cognitive theories of stress and coping (Lazarus & Folkman, 1984), parental warmth or support can serve a key stress-buffering role. Adolescents who perceive that their parents or other key adults are open to hearing about their experiences of violence or their accompanying distress would be expected to be more likely to disclose and receive instrumental or emotional support. This support could aid in

helping to process and integrate the experience, as well as in promoting healthier coping strategies to manage distress and reduce (or even prevent) symptomatology. This interpretation is consistent with literature reviewed here regarding the cognitive and emotional processing of exposure to violence (Kliewer et al., 2004; Kliewer et al., 2001; Ozer, 2005; Ozer & Weinstein, 2004). These same psychological processes could also moderate aspects of externalizing behavior, because some adolescents may engage in substance use and aggression as a means of responding to and coping with emotional distress (Tschann et al., 2002). Further, adolescents whose parents provide less monitoring would likely have more opportunities to engage in externalizing behavior as a coping strategy (Steinberg, Fletcher, & Darling, 1994; Wills & Yaeger, 2003). Limitations First, despite more than two decades of theory and research on protective factors for youth exposed to community violence, the quantity of studies that actually test moderators of exposure to violence and mental health is relatively small. Although we reviewed more than 200 published, peer-reviewed papers for possible inclusion in our review, less than 20% of these studies met inclusion criteria. Next, as noted earlier, the evidence we present here regarding moderation effects is not based on the meta-analytic strategy of averaging effects estimates, owing to the fact that the literature under review is based on interaction effects that are not appropriate to combine statistically. Instead, we reviewed the strength of the evidence by examining the patterns and direction of the moderation effects found. There was not sufficient statistical power to test for differences in our patterns of findings by methodological characteristics of studies. We note, however, that any claims made regarding the equivalence appear to be reasonable given that the percentages of significant findings were nearly identical for several of our comparisons. Third, a broad comment regarding the research literature reviewed here is that the outcomes examined represent symptom levels but do not represent a diagnosis of a disorder or the level of impairment in the young people’s daily lives. Our findings, like those of the literature we reviewed, do not directly speak to the clinical significance of the symptoms and how they interfere with young people’s developmental competencies, engagement with school and peers, sense of hope for the future, or other aspects of meaning and purpose for these young people. For example, research in other areas of the trauma literature has emphasized the importance of religious and spiritual beliefs in particular societal contexts as a more culturally salient indicator than symptom levels (Miller et al., 2006; Rasco & Miller, 2004).



The ESs considered in this review were the product of statistical moderator analyses that focused on how the characteristic of one microsystem such as the family or school influenced the relationship between exposure to violence and mental health. We acknowledge that the developmental-ecological theories that inform the field, however, also highlight the interactive and nested effects of microsystem influences on development, such as the joint effects of qualities of families and neighborhoods and schools. These more complex relationships are more methodologically challenging to study and the literature is not yet developed enough to summarize in this type of review. We note this topic as one to be pursued in future reviews. Several other methodological limitations should be considered. First, as detailed in the Results section, many of the moderation findings reported in the literature were of modest magnitude; thus, although meaningful patterns were noted, we are cautious in not overstating the strength of their effects. Second, because a single study could contribute multiple ESs that represented distinctive analyses, we are mindful that a small number of studies could be overrepresented in our patterns of results. Third, all comprehensive reviews must consider the ‘‘file drawer problem’’ with respect to potential bias in the publication of positive results (Rosenthal, 1979, 1991); the published literature may overestimate the strength of the relationships found here. Last, we note that this investigation did not examine questions regarding protective factors for interpersonal violence more broadly due to our focus on exposure to violence operationalized as ‘‘in the neighborhood’’ or ‘‘in the community’’; the measures used in the community violence literature typically do not specify contextual aspects of the violence beyond whether the person was known to the respondent versus a stranger, or the location of the violence exposure (e.g., near the home). Summary and Implications In general, the high degree of variability in the protective relationships found in the present review is consistent with and extends qualitative reviews conducted more than a decade ago with a much smaller empirical literature. Our findings advance the existing knowledge base by demonstrating more consistent patterns for (a) close family relationships and social support for internalizing symptoms, and (b) close family relationships for externalizing symptoms. The extant literature regarding nonfamily factors such as characteristics of schools and communities is still scant; the only suggestive pattern found here was that perceived teacher support and school safety demonstrated protective effects for students’ positive adaptation.

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Our findings regarding the role of protective factors within the family emphasizes the potential importance of interventions to strengthen family support and communication in the context of exposure to violence. Prior research indicates that some young people may feel constrained from discussing experiences of violence with family members or other adults and that perceived constraints are linked with higher levels of symptoms (Kliewer et al., 2001; Ozer & Weinstein, 2004). Although parental modeling and suggestions for coping with violence have been found to be influential in youth’s coping strategies (Kliewer, Parrish, et al., 2006), parents and caregivers may feel too distressed themselves to directly discuss violent incidents in the community, or may believe that their efforts will not help. Caregiver–youth interventions such as the Child and Family Traumatic Stress Intervention could help promote capacity for constructive parent–adolescent discussions regarding exposure to violence by boosting familial support and enhancing coping skills (Berkowitz, Stover, & Marans, 2011). Recent community-based efforts to identify coping responses to violence suggest that active discussions may not feel safe or productive for the youth or their caregivers (RYSE=Watson, 2013). Youth may fear that discussing violent events will reactivate painful memories and feelings and that adults will limit their freedom if they know the extent of their exposure to violence. There are also safety concerns for teens who know the identity of a perpetrator of crime. Thus, interventions to assist youth in coping with violence should engage the expertise of young people and parents to understand how to promote psychological and physical safety in the local context. In addition to family-based interventions, schools are targeted for secondary prevention efforts aimed at communities with high levels of exposure to violence. School-based expressive writing interventions provide opportunities to process and reappraise emotions related to violence and have shown promise for reducing externalizing and internalizing symptoms (Kliewer et al., 2011; Reynolds, Brewin, & Saxton, 2000; Soliday, Garofalo, & Rogers, 2004), although evidence is mixed (Giannotta, Settanni, Kliewer, & Ciairano, 2009). Expressive-writing interventions may be more effective for youth with higher levels of violence exposure (Kliewer et al., 2011), although little is known about the factors related to intervention effectiveness. It is likely that a combination of family and school-based interventions with flexible options for youth could be most successful. Although stronger policy efforts must be initiated to help prevent exposure to violence in the lives of so many young people, the current review provides insight into how to support adolescents’ development as they respond to violence in their environment.

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FUNDING This research was supported by the European Commission Marie Curie International Outgoing Fellowship awarded to the second author. REFERENCES


References marked with an asterisk indicate studies included in the review. Achenbach, T. M. (1991). Manual for the child behavior checklist=4–18 and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry. Bacchini, D., Miranda, M. C., & Affuso, G. (2011). Effects of parental monitoring and exposure to community violence on antisocial behavior and anxiety=depression among adolescents. Journal of Interpersonal Violence, 26, 269–292. doi:10.1177=0886260510362879 Barr, S. C., Hanson, R., Begle, A. M., Kilpatrick, D. G., Saunders, B., Resnick, H., & Amstadter, A. (2012). Examining the moderating role of family cohesion on the relationship between witnessed community violence and delinquency in a national sample of adolescents. Journal of Interpersonal Violence, 27, 239–262. doi:10.1177=0886260511416477 Basch, C. E. (2011). Aggression and violence and the achievement gap among urban minority youth. Journal of School Health, 81, 619–625. doi:10.1111=j.1746-1561.2011.00636.x Berkowitz, S. J., Stover, C. S., & Marans, S. R. (2011). The child and family traumatic stress intervention: Secondary prevention for youth at risk of developing PTSD. Journal of Child Psychology and Psychiatry, 52, 676–685. doi:10.1111=j.1469-7610.2010.02321.x Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting & Clinical Psychology, 68, 748–766. doi:10.1037=0022-006X.68.5.748 Briere, J. (1995). The trauma symptom checklist for children: Professional manual. Odessa, FL: Psychological Assessment Resources. Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University. Buka, S. L., Selner-O’Hagan, M. B., Kindlon, D. J., & Earls, F. J. (1997). The ‘‘My Exposure to Violence Interview’’ administration and scoring manual, Version 3. Boston, MA: Harvard School of Public Health. Buka, S. L., Stichick, T. L., Birdthistle, I., & Earls, F. J. (2001). Youth exposure to violence: Prevalence, risks, and consequences. American Journal of Orthopsychiatry, 71, 298–310. doi:10.1037==00029432.71.3.298 Cauce, A. M., Cruz, R., Corona, M., & Conger, R. (2011). The face of the future: Risk and resilience in minority youth. Health Disparities in Youth and Families: Nebraska Symposium on Motivation, 57, 13–32. doi:10.1007=978-1-4419-7092-3_2 Chen, W.-Y. (2010). Exposure to community violence and adolescents’ internalizing behaviors among African American and Asian American adolescents. Journal of Youth and Adolescence, 39, 403–413. doi:10.1007=s10964-009-9427-7 Cicchetti, D., & Lynch, M. (1993). Toward an ecological=transactional model of community violence and child maltreatment: Consequences for children’s development. Psychiatry: Interpersonal and Biological Processes, 56, 96–118. Cohen, L. H. (1988). Measurement of life events. In L. H. Cohen (Ed.), Life events and psychological functioning: Theoretical and methodological issues (pp. 11–30). Thousand Oaks, CA: Sage. Cooley, M. R., Turner, S. M., & Beidel, D. C. (1995). Assessing community violence: The children’s report of exposure to violence.

Journal of the American Academy of Child & Adolescent Psychiatry, 34, 201–208. doi:10.1097=00004583-199502000-00015 Cooley-Quille, M. R., Turner, S. M., & Beidel, D. C. (1995). Emotional impact of children’s exposure to community violence: A preliminary study. Journal of the American Academy of Child & Adolescent Psychiatry, 34, 1362–1368. doi:10.1097=00004583199510000-00022 Coombs, R. H., & Landsverk, J. (1988). Parenting styles and substance use during childhood and adolescence. Journal of Marriage and the Family, 50, 473–482. doi:10.2307=352012 Cooper, A., & Smith, E. L. (2011). Homicide trends in the United States, 1980–2008. Washington, DC: Bureau of Justice Statistics. Retrieved from http://bjs.gov/content/pub/pdf/htus8008.pdf Cooper, H., & Hedges, L. V. (Eds.). (1994). The handbook of research synthesis. New York, NY: Russell Sage Foundation. Copeland-Linder, N., Lambert, S. F., & Ialongo, N. S. (2010). Community violence, protective factors, and adolescent mental health: A profile analysis. Journal of Clinical Child & Adolescent Psychology, 39, 176–186. doi:10.1080=15374410903532601 Dinizulu, S. M., Grant, K. E., & McIntosh, J. M. (2014). The influence of nondisclosure on the mental health of urban AfricanAmerican adolescents exposed to community violence. Journal of Prevention & Intervention in the Community, 42, 208–220. doi:10.1080=10852352.2014.916583 Dubrow, N. F., & Garbarino, J. (1989). Living in the war zone: Mothers and young children in a public housing development. Child Welfare, 68, 3–20. Finkelhor, D., Turner, H., Ormrod, R., Hamby, S., & Kracke, K. (2009). Children’s exposure to violence: A comprehensive national survey. Juvenile Justice Bulletin. Retrieved from https://www.ncjrs. gov/pdffiles1/ojjdp/227744.pdf Fitzpatrick, K. M., & Boldizar, J. P. (1993). The prevalence and consequences of exposure to violence among African-American youth. Journal of the American Academy of Child & Adolescent Psychiatry, 32, 424–430. doi:10.1097=00004583-199303000-00026 Flannery, D. J., Vazsonyi, A. T., & Rowe, D. C. (1996). Caucasian and hispanic early adolescent substance use parenting, personality, and school adjustment. The Journal of Early Adolescence, 16, 71–89. doi:10.1177=0272431696016001005 Fowler, P. J., Tompsett, C. J., Braciszewski, J. M., Jacques-Tiura, A. J., & Baltes, B. B. (2009). Community violence: A meta-analysis on the effect of exposure and mental health outcomes of children and adolescents. Development and Psychopathology, 21, 227–259. doi:10.1017=S0954579409000145 Giannotta, F., Settanni, M., Kliewer, W., & Ciairano, S. (2009). Results of an Italian school-based expressive writing intervention trial focused on peer problems. Journal of Adolescence, 32, 1377–1389. doi:10.1016=j.adolescence.2009.07.001 Gorman-Smith, D., Henry, D. B., & Tolan, P. H. (2004). Exposure to community violence and violence perpetration: The protective effects of family functioning. Journal of Clinical Child & Adolescent Psychology, 33, 439–449. doi:10.1207=s15374424jccp3303_2 Gorman-Smith, D., & Tolan, P. (1998). The role of exposure to community violence and developmental problems among inner-city youth. Development and Psychopathology, 100, 101–116. doi:10.1017=s0954579498001539 Greenspan, L., & Deardorff, J. (2014). The new puberty: How to navigate early development in today’s girls. New York, NY: Rodale. Hammack, P. L., Richards, M. H., Luo, Z., Edlynn, E. S., & Roy, K. (2004). Social support factors as moderators of community violence exposure among inner-city African American young adolescents. Journal of Clinical Child & Adolescent Psychology, 33, 450–462. doi:10.1207=s15374424jccp3303_3 Hardaway, C. R., McLoyd, V. C., & Wood, D. (2012). Exposure to violence and socioemotional adjustment in low-income youth: An


COMMUNITY VIOLENCE PROTECTIVE FACTORS examination of protective factors. American Journal of Community Psychology, 49, 112–126. doi:10.1007=s10464-011-9440-3 Hastings, T. L., & Kelley, M. L. (1997). Development and validation of the Screen for Adolescent Violence Exposure (SAVE). Journal of Abnormal Child Psychology, 25, 511–520. Henrich, C. C., Schwab-Stone, M., Fanti, K., Jones, S. M., & Ruchkin, V. (2004). The association of community violence exposure with middle-school achievement: A prospective study. Journal of Applied Developmental Psychology, 25, 327–348. doi:10.1016=j.appdev.2004.04.004 Hysenbegasi, A., Hass, S. L., & Rowland, C. R. (2005). The impact of depression on the academic productivity of university students. Journal of Mental Health Policy and Economics, 8, 145–151. ¨ ., Lepore, S. J., & Kliewer, W. L. (2011). Social support Kaynak, O and social constraints moderate the relation between community violence exposure and depressive symptoms in an urban adolescent sample. Journal of Social and Clinical Psychology, 30, 250–269. doi:10.1521=jscp.2011.30.3.250 Kliewer, W., Cunningham, J. N., Diehl, R., Parrish, K. A., Walker, J. M., Atiyeh, C., . . . Mejia, R. (2004). Violence exposure and adjustment in inner-city youth: Child and caregiver emotion regulation skill, caregiver–child relationship quality, and neighborhood cohesion as protective factor. Journal of Clinical Child & Adolescent Psychology, 33, 477–487. doi:10.1207=s15374424jccp3303_5 Kliewer, W., Lepore, S. J., Farrell, A. D., Allison, K. W., Meyer, A. L., Sullivan, T. N., & Greene, A. Y. (2011). A school-based expressive writing intervention for at-risk urban adolescents’ aggressive behavior and emotional lability. Journal of Clinical Child & Adolescent Psychology, 40, 693–705. doi:10.1080=15374416.2011. 597092 Kliewer, W., Murrelle, L., Mejia, R., Torres de, G. Y., & Angold, A. (2001). Exposure to violence against a family member and internalizing symptoms in Colombian adolescents: The protective effects of family support. Journal of Consulting and Clinical Psychology, 69, 971–982. doi:10.1037=0022-006X.69.6.971 Kliewer, W., Murrelle, L., Prom, E., Ramirez, M., Obando, P., Sandi, L., & Karenkeris, M. D. C. (2006). Violence exposure and drug use in Central American youth: Family cohesion and parental monitoring as protective factors. Journal of Research on Adolescence, 16, 455–478. doi:10.1111=j.1532-7795.2006.00502.x Kliewer, W., Parrish, K. A., Taylor, K. W., Jackson, K., Walker, J. M., & Shivy, V. A. (2006). Socialization of coping with community violence: Influences of caregiver coaching, modeling, and family context. Child Development, 77, 605–623. doi:10.1111=j.1467-8624. 2006.00893.x Kovacs, M. (1992). Children’s depression inventory manual. North Tonawanda, NY: Multi Health Systems. Kraemer, H. C., Kazdin, A. E., Offord, D. R., Kessler, R. C., Jensen, P. S., & Kupfer, D. J. (1997). Coming to terms with the terms of risk. Archives of General Psychiatry, 54, 337–343. doi:10.1001= archpsyc.1997.01830160065009 Kuther, T. L., & Fisher, C. B. (1998). Victimization by community violence in young adolescents from a suburban city. The Journal of Early Adolescence, 18, 53–76. doi:10.1177=0272431698018001003 Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York, NY: Springer. LeBlanc, M., Self-Brown, S., Shepard, D., & Kelley, M. L. (2011). Buffering the effects of violence: Communication and problem-solving skills as protective factors for adolescents exposed to violence. Journal of Community Psychology, 39, 353–367. doi:10.1002=jcop.20438 Lee, R. (2012). Community violence exposure and adolescent substance use: Does monitoring and positive parenting moderate risk in urban communities? Journal of Community Psychology, 40, 406–421. doi:10.1002=jcop.20520

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Li, S. T., Nussbaum, K. M., & Richards, M. H. (2007). Risk and protective factors for urban African-American youth. American Journal of Community Psychology, 39, 21–35. doi:10.1007= s10464-007-9088-1 Low, S., & Espelage, D. (2014). Conduits from community violence exposure to peer aggression and victimization: Contributions of parental monitoring, impulsivity, and deviancy. Journal of Counseling Psychology, 61, 221–231. doi:10.1037=a0035207 Ludwig, K. A., & Warren, J. S. (2009). Community violence, school-related protective factors, and psychosocial outcomes in urban youth. Psychology in the Schools, 46, 1061–1073. doi:10.1002=Pits.20444 Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71, 543–562. doi:10.1111=1467-8624.00164 Luthar, S. S., & Goldstein, A. (2004). Children’s exposure to community violence: Implications for understanding risk and resilience. Journal of Clinical Child and Adolescent Psychology, 33, 499–505. doi:10.1207=s15374424jccp3303_7 Margolin, G., & Gordis, E. B. (2003). Co-occurrence between marital aggression and parents’ child abuse potential: The impact of cumulative stress. Violence and Victims, 18, 243–258. doi:10.1891= vivi.2003.18.3.243 Matjasko, J. L., Vivolo-Kantor, A. M., Henry, D. B., Gorman-Smith, D., Schoeny, M. E., & The Multisite Violence Prevention Project. (2013). The relationship between a family-focused preventive intervention, parenting practices, and exposure to violence during the transition to adolescence: Testing a mediational model. Journal of Aggression, Maltreatment & Trauma, 22, 45–66. doi:10.1080= 10926771.2013.743947 Mazza, J. J., & Overstreet, S. (2000). Children and adolescents exposed to community violence: A mental health perspective for school psychologists. School Psychology Review, 29, 86–101. McCart, M. R., Smith, D. W., Saunders, B. E., Kilpatrick, D. G., Resnick, H., & Ruggiero, K. J. (2007). Do urban adolescents become desensitized to community violence? Data from a national survey. American Journal of Orthopsychiatry, 77, 434–442. doi:10.1037=0002-9432.77.3.434 McKelvey, L. M., Whiteside-Mansell, L., Bradley, R. H., Casey, P. H., Conners-Burrow, N. A., & Barrett, K. W. (2011). Growing up in violent communities: Do family conflict and gender moderate impacts on adolescents’ psychosocial development? Journal of Abnormal Child Psychology, 39, 95–107. doi:10.1007=s10802010-9448-4 Miller, K. E., Omidian, P., Quraishy, A. S., Quraishy, N., Nasiry, M. N., Nasiry, S., . . . Yaqubi, A. Z. (2006). The Afghan symptom checklist: A culturally grounded approach to mental health assessment in a conflict zone. American Journal of Orthopsychiatry, 76, 423–433. doi:10.1037=0002-9432.76.4.423 Mogro-Wilson, C. (2008). The influence of parental warmth and control on Latino adolescent alcohol use. Hispanic Journal of Behavioral Sciences, 30, 89–105. doi:10.1177=0739986307310881 O’Donnell, D. A., Roberts, W. C., & Schwab-Stone, M. E. (2011). Community violence exposure and post-traumatic stress reactions among Gambian youth: The moderating role of positive school climate. Social Psychiatry and Psychiatric Epidemiology, 46, 59–67. doi:10.1007=s00127-009-0162-x Osofsky, J. D., Wewers, S., Hann, D. M., & Fick, A. C. (1993). Chronic community violence: What is happening to our children? Psychiatry: Interpersonal & Biological Processes, 56, 36–45. Overstreet, S., & Dempsey, M. (1999). Availability of family support as a moderator of exposure to community violence. Journal of Clinical Child Psychology, 28, 151–159. doi:10.1207=s15374424j ccp2802_3

14



Ozer, E. J. (2005). The impact of violence on urban adolescents: Longitudinal effects of perceived school connection and family support. Journal of Adolescent Research, 20, 167–192. doi:10.1177= 0743558404273072 Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129, 52–73. doi:10.1037= 0033-2909.129.1.52 Ozer, E. J., Richards, M. H., & Kliewer, W. (2004). Introduction to the special section on protective factors in the relation between community violence exposure and adjustment in youth. Journal of Clinical Child & Adolescent Psychology, 33, 434–438. doi:10.1207= s15374424jccp3303_1 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 & Adolescent Psychology, 33, 463–476. doi:10.1207= s15374424jccp3303_4 Park, C. L. (2010). Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events. Psychological Bulletin, 136, 257–301. doi:10.1037=a0018301 Parks-Stamm, E. J., Gollwitzer, P. M., & Oettingen, G. (2010). Implementation intentions and test anxiety: Shielding academic performance from distraction. Learning and Individual Differences, 20, 30–33. doi:10.1016=j.lindif.2009.09.001 Pearce, M. J., Jones, S. M., Schwab-stone, M. E., & Ruchkin, V. (2003). The protective effects of religiousness and parent involvement on the development of conduct problems among youth exposed to violence. Child Development, 74, 1682–1696. doi:10.1046=j.1467-8624.2003.00631.x Rasco, L. M., & Miller, K. E. (2004). Innovations, challenges, and critical issues in the development of ecological mental health interventions with refugees. In K. E. Miller & L. M. Rasco (Eds.), The mental health of refugees: Ecological approaches to healing and adaptation (pp. 375–414). Mahwah, NJ: Erlbaum. Reynolds, M., Brewin, C. R., & Saxton, M. (2000). Emotional disclosure in school children. Journal of Child Psychology and Psychiatry, 41, 151–159. doi:10.1017=S0021963099005223 Richters, J. E. (1990). Screening survey of exposure to violence: Self report version. Rockville, MD: National Institute of Mental Health. Richters, J. E., & Martinez, P. (1990). Things I have seen and heard: An interview for young children about exposure to violence. Rockville, MD: National Institute of Mental Health. Richters, J. E., & Martinez, P. (1993a). The NIMH community violence project: I. Children as victims of and witnesses to violence. Psychiatry: Interpersonal & Biological Processes, 56, 7–21. Richters, J. E., & Martinez, P. E. (1993b). Violent communities, family choices, and children’s chances: An algorithm for improving the odds. Development and Psychopathology, 5, 609–627. doi:10.1017= s0954579400006192 Richters, J. E., & Saltzman, W. (1990). Survey of children’s exposure to community violence: Self report version. Rockville, MD: National Institute of Health. 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, 489–512. doi:10.1002=Jcop.10066 Rosario, M., Salzinger, S., Feldman, R. S., & Ng-Mak, D. S. (2008). Intervening processes between youth’s exposure to community violence and internalizing symptoms over time: The roles of social support and coping. American Journal of Community Psychology, 41, 43–62. doi:10.1007=s10464-007-9147-7 Rosenthal, B. S. (2000). Exposure to community violence in adolescence: Trauma symptoms. Adolescence, 35, 271–284.

Rosenthal, B. S., & Wilson, W. C. (2001). Relationship between exposure to community violence and psychological distress: Linear or curvilinear? Psychological Reports, 88, 635–640. doi:10.2466= pr0.88.3.635-640 Rosenthal, B. S., & Wilson, W. C. (2008). Community violence and psychological distress: The protective effects of emotional social support and sense of personal control among older adolescents. Adolescence, 43, 693–712. Rosenthal, R. (1979). The file drawer problem and tolerance for null results. Psychological Bulletin, 86, 638–641. doi:10.1037==0033-2909.86.3.638 Rosenthal, R. (1991). Meta-analytic procedures for social research (Rev. ed.). Newbury Park, CA: Sage. Rosenthal, R. (1994). Parametric measures of effect size. In H. Cooper & L. V. Hedges (Eds.), The handbook of research synthesis (pp. 231–244). New York, NY: Russell Sage Foundation. Rutter, M. (1979). Protective factors in children’s reactions to stress and disadvantage. In M. W. Kent & J. E. Rolf (Eds.), Primary prevention of psychopathology (Vol. 3: Social competence in children) (pp. 49–74). Hillsdale, NJ: Erlbaum. RYSE=Watson, A. (2013, June). Distress and Healing from an Invisible War: Idioms of distress amongst youth exposed to prolonged, acute violence and ‘atmospheric’ terror. Paper presented at the Society for Community Research and Action, Miami, FL. Salzinger, S., Feldman, R. S., Rosario, M., & Ng-Mak, D. S. (2010). Role of parent and peer relationships and individual characteristics in middle school children’s behavioral outcomes in the face of community violence. Journal of Research on Adolescence, 21, 395–407. doi:10.1111=j.1532-7795.2010.00677.x Schwab-Stone, M., Chen, C., Greenberger, E., Silver, D., Lichtman, J., & Voyce, C. (1999). No safe haven II: The effects of violence exposure on urban youth. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 359–367. doi:10.1097=00004583-199904000-00007 Schwartz, D., Gorman, A. H., Nakamoto, J., & Toblin, R. L. (2005). Victimization in the peer group and children’s academic functioning. Journal of Educational Psychology, 97, 425–435. doi:10.1037= 0022-0663.97.3.425 Self-Brown, S., LeBlanc, M. M., David, K., Shepard, D., Ryan, K., & Kelley, M. L. (2012). The impact of parental trauma exposure on community violence exposed adolescents. Violence and Victims, 27, 512–526. doi:10.1891=0886-6708.27.4.512 Self-Brown, S. R., LeBlanc, M., Kelley, M. L., Hanson, R., Laslie, K., & Wingate, A. (2006). Effects of community violence exposure and parental mental health on the internalizing problems of urban adolescents. Violence and Victims, 21, 183–198. doi:10.1891= 088667006780644253 Shakib, S., Mouttapa, M., Johnson, C. A., Ritt-Olson, A., Trinidad, D. R., Gallaher, P. E., & Unger, J. B. (2003). Ethnic variation in parenting characteristics and adolescent smoking. Journal of Adolescent Health, 33, 88–97. doi:10.1016=S1054-139X(03)00140-X Soliday, E., Garofalo, J. P., & Rogers, D. (2004). Expressive writing intervention for adolescents’ somatic symptoms and mood. Journal of Clinical Child & Adolescent Psychology, 33, 792–801. doi:10. 1207=s15374424jccp3304_14 Steinberg, L. (2001). We know some things: Parent-adolescent relationships in retrospect and prospect. Journal of Research on Adolescence, 11, 1–19. doi:10.1111=1532-7795.00001 Steinberg, L., Fletcher, A., & Darling, N. (1994). Parental Monitoring and Peer Influences on Adolescent Substance Use Pediatrics, 93, 1060–1064. Sullivan, T. N., Kung, E. M., & Farrell, A. D. (2004). Relation between witnessing violence and drug use initiation among rural adolescents: Parental monitoring and family support as protective factors. Journal of Clinical Child & Adolescent Psychology, 33, 488–498. doi:10.1207=s15374424jccp3303_6 Tolan, P. H., & Gorman-Smith, D. (1991). Chicago stress and coping interview manual. Chicago, IL: Institute of Juvenile Research.



Truman, J. L., & Planty, M. (2011). Criminal Victimization, 2011. Bureau of Justice Statistics. http://bjs.gov/content/pub/pdf/ cv11.pdf Tschann, J. M., Flores, E., Martin, B. V., Pasch, L. A., 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, 373–385. Udry, J. R. (2003). The National Longitudinal Study of Adolescent Health (Add Health), Wave III, 2001–2002 [machine-readable data file and documentation]. Chapel Hill, NC: Carolina Population Center, UNC-Chapel Hill. White, K. S., Bruce, S. E., Farrell, A. D., & Kliewer, W. (1998). Impact of exposure to community violence on anxiety: A longitudinal study of family social support as a protective factor for urban children. Journal of Child and Family Studies, 7, 187–203. Wills, T. A., & Yaeger, A. M. (2003). Family factors and adolescent substance use: Models and mechanisms. Current Directions in

15

Psychological Science, 12, 222–226. doi:10.1046=j.0963-7214. 2003.01266.x Wood, J. (2006). Effect of anxiety reduction on children’s school performance and social adjustment. Developmental Psychology, 42, 345–349. doi:10.1037=0012-1649.42.2.345 Woolf, S. H., & Aron, L. (2013). US health in international perspective: Shorter lives, poorer health. Washington, DC: National Academies. World Health Organization. (2014). Adolescent development. Maternal, newborn, child and adolescent health. Retrieved from http://www.who.int/maternal_child_adolescent/topics/adolescence/ dev/en/ Zinzow, H. M., Ruggiero, K. J., Resnick, H., Hanson, R., Smith, D., Saunders, B., & Kilpatrick, D. (2009). Prevalence and mental health correlates of witnessed parental and community violence in a national sample of adolescents. Journal of Child Psychology and Psychiatry, 50, 441–450. doi:10.1111=j.1469-7610. 2008.02004.x

APPENDIX A TABLE A1 Papers Included in the Review

Authors Design

Location

Bacchini et al. (2011) CS Italy

Barr et al. (2012) L US

Chen (2010) L

US

Dinizulu et al. (2014) CS US

Sample

Urban youth, Grades 11 and 13

Representative sample of youth, age 12–17

Dependent Variable

Effect Size

516 Exposure to violence Parental monitoring Antisocial in the community behavior Anxiety= Depression

.17 ,V .01, nsW .05, nsV .13 W

N

Exposure Variable

2511 Trauma assessment for adults and witnessed community violence

Family Variable

Pattern

P-react ns ns P-enhan

Family cohesion

Delinquency

.16

P-stab

Urban youth, Grades 7–12 African and Asian American

901 Exposure to Community Violence

Mother=Adolescent connectedness

Depression

.021

ns

African-American urban, age 11–14H

152 EV - Experience of Violence scale (Richters & Martinez, 1993b)

Non-disclosure

Internalizing problems

.17

P-stab

PTSD

.44

Fitzpatrick and Boldizar (1993) CS US Urban youth, age 7–18 African AmericansH

221 NIMH-SSECV Males present at National Institute home of Mental Health Screening Survey of Exposure to Community Violence (Richters, 1990)

B

P-stab

(Continued )

16

OZER, LAVI, DOUGLAS, WOLF TABLE A1 Continued

Authors Design

Location

Sample

Gorman-Smith and Tolan (1998) L US Urban youth, age 11–15 male, African American and LatinoH

N

Exposure Variable

245 CYDS - Stress and Coping Interview (Tolan & Gorman-Smith, 1991)

Family Variable

Beliefs

Discipline

Family cohesion


Monitoring

Structure

Hammack et al. (2004) CS US

Hardaway et al. (2012) CS US

Kaynak et al. (2011) L US

Dependent Variable AggressionR Anxiety= DepressionR AggressionR Anxiety= DepressionR AggressionR Anxiety= DepressionR AggressionR Anxiety= DepressionR AggressionR Anxiety= DepressionR

Effect Size

Pattern

.17, ns .09, ns

ns ns

.08, ns .09, ns

ns ns

.05, ns .27

ns P-stab

.01, ns .17, ns

ns ns

.14 .08, ns

V-react ns

.15 .24 ,F .20

P-stab P-stab P-react

Urban youth, Grade 6 African AmericanH

196 MEVI - My Maternal closeness Exposure to Time with family Violence Interview (Buka, Selner-O’Hagan, Kindlon, & Earls, 1997)

Urban youth, age 13–17H

391 Add Health Extracurricular Externalizing National activities in school problems; Longitudinal delinquencyR Study of Internalizing Adolescent Health problems; (Udry, 2003) anxiety; lonelinessR Parent–child Externalizing relations problems; delinquencyR Internalizing problems; anxiety; lonelinessR School climate Externalizing problems; delinquency Internalizing problems; anxiety; lonelinessR

.15

P-stab

.02

ns

.19

P-stab

.01

ns

.01

ns

.07

ns

258 SCECV - Survey of Social constraints Depression Children’s discussing violence Exposure to with parent=other Community sig. adult Violence (Richters Social support from Depression parent=other sig. & Martinez, adult 1993a)

.41

P-enhan

.52

P-stab

Urban youth, Grade 7 African American

Kliewer, Murrelle et al. (2006) CS Costa Rica Representative sample of youth, age 12–21

5241 CRECV - Children’s Family cohesion Report of Exposure to Family cohesion Community

Anxiety Anxiety Depression

Lifetime .03 drunkenness Lifetime tobacco < .01 use

ns ns

(Continued )


17

TABLE A1 Continued

Authors Design

Location

Sample

N

Exposure Variable

Family Variable

Violence (Cooley, Turner, & Beidel, 1995)

No. of drugs other than alcohol or tobacco ever used Alcohol problems Drug problems


Monitoring

Panama


4599

Family cohesion

Monitoring

Kliewer et al. (2004) L US

Kliewer et al. (2001) CS Columbia

Urban youth, age 9–13 African AmericanH


Dependent Variable

Hopelessness Anxiety Anxiety Hopelessness Melancholia

Pattern

.08

P-stab

.03

ns

.12 .03 ,A .02

P-stabO

Lifetime drunkenness Lifetime tobacco .01 use No. of drugs .12 other than alcohol or tobacco ever used Alcohol .06 problems Drug problems .14 Lifetime .01 drunkenness Lifetime tobacco < .01 use No. of drugs .07 other than alcohol or tobacco ever used Alcohol .02 problems .04 ,A Drug problems .09 Lifetime .01 drunkenness Lifetime tobacco .01 use No. of drugs .04 other than alcohol or tobacco ever used Alcohol .02 problems Drug problems .06

101 SCECV - Survey of Felt acceptance from ExternalizingR Children’s InternalizingR caregiver Exposure to Community Violence (Richters & Martinez, 1993a) 5,775 Exposure to violence Disclosure with in the community mother Family cohesion Parental support

Effect Size

.03 .31

1.78

,B,F

.71 ,B,F .92B .61B .91B

ns ns P-stab

P-stab P-stab ns ns P-stab

P-stab P-stab ns ns ns

ns P-stab ns P-react

P-enhan P-stab ns ns ns

(Continued )

18


Authors Design

Location

Kuther and Fisher (1998) CS US


LeBlanc et al. (2011) CS US

Lee (2012) CS

US

Li et al. (2007) CS US

Low and Espelage (2014) L US

Sample

O’Donnell et al. (2011) CS Gambia

Exposure Variable

Family Variable

Dependent Variable

Urban youth, Grades 6–8

123 SCECV - Survey of Family support Children’s Exposure to Community Violence (Richters & Martinez, 1993a)

Anxiety and hopelessness

Urban youth, age 13–20 mostly African American females

114 SAVE - Screen for Communication and Adolescent problem-solving Violence Exposure skills adolescent (Hastings & report Communication and Kelley, 1997) problem-solving skills parent report

Adaptive skillsR Psychological distressR RisksR Adaptive skillsR Psychological distressR RisksR

Urban youth, Grades 7–12H

Urban youth, age 10–15 African American

Adolescents, M age ¼ 14

Ludwig and Warren (2009) CS US Urban youth, age 14–19

McKelvey et al. (2011) L US

N

Urban and rural youth, age 18

Youth, Grades 10–11

Effect Size .54

.32 .43

1,232 EV - Experience of Violence scale (Richters & Martinez, 1993b)

Perceived Support from parents and family members Positive neighborhood

.25

ns ns

ns

Externalizing Internalizing

ns .18

ns V-react

Externalizing

.15

P-stab

.09

P-stab

Parental monitoring Deviancy: delinquency, delinquent peers, & substance use Hope

.01

Hope

.60

728 Community violence Family conflict

Antisocial behaviorR Anxiety= DepressionR Anxiety= DepressionR Risk-taking behaviorR

Parental warmth School climate

ns P-react ns ns ns

175 SAVE - Screen for Identification with Adolescent school Violence Exposure Teacher support (Hastings & Kelley, 1997)

653 SCECV - Survey of Children’s Exposure to Community

P-stab

.03 .02 .37

2197 Community Parental monitoring Substance abuse ns Violence Exposure past year alcohol or drug use; binge drinking Positive parenting Substance abuse ns past year alcohol or drug use; binge drinking 263 EV - Experience of Violence scale (Richters & Martinez, 1993b)

Pattern

.01 ,B .01 ,B,G .01 ,B .03 ,B,G .01 B .03 ,B,G .08 ,B .15 ,B

Traumatic Stress ns Response ns Traumatic Stress .10 ,W .12 ,V Response

UniqueU P-stab

P-stab - boys girls: ns P-stab boys P-react girls P-stab - boys girls: ns ns ns P-enhan P-react

(Continued )


19

TABLE A1 Continued

Authors Design

Location

Sample

N

Exposure Variable

Family Variable

Dependent Variable

Effect Size

Pattern

Violence (Richters & Martinez, 1993a) Overstreet and Dempsey (1999) CS US Urban youth, age 10–15 African AmericanH


Ozer (2005) L

US


Ozer and Weinstein (2004) CS US Urban youth, Grade 7

75 TIHSH - Things I Family size Have Seen and Heard (Richters & Mother present at home Martinez, 1990)

Depression PTSD Depression PTSD

73 CRECV - Children’s Report of Exposure to Community Violence (Cooley et al., 1995)

Aggression Aggression Aggression

Father helplessness Mother helplessness Perceived School Connection Sibling helplessness

Aggression

349 CRECV - Children’s Father helpfulness Report of Exposure to Community Violence (Cooley Friend helpfulness et al., 1995)

Adaptive Function teacher report Depression PTSD Adaptive Function teacher report Depression PTSD Mother Helpfulness Adaptive Function teacher report Depression PTSD School safety Adaptive Function teacher report Depression PTSD Sibling helpfulness Adaptive Function teacher report Depression PTSD Teacher Helpfulness Adaptive Function teacher report Depression PTSD

Pearce, Jones, Schwab-stone, and Ruchkin (2003) 1794 EV - Experience of Parent involvement L US Urban youth, Violence scale Grades 6 and 8H (Richters & Martinez, 1993b) Rosario et al. (2008) 667 SCECV - Survey of Guardian social L US Urban youth, age Children’s 11–14 Hispanic support Exposure to and African Community AmericansH Violence (Richters & Martinez, 1993a)

Conduct problems

1.05B .09B 7.21 ,B .12 B .04 .24 < .01

ns ns P-stab ns ns P-stab ns

.94

ns

.09

ns

.04 .13 .09

ns P-stab ns

.05 .07 .06

ns ns ns

.14 .11 .12

P-stab P-stab P-enhan

.03 .08 .03

ns ns ns

.13 .04 .21

P-stab ns P-enhan

< .01 .04

ns ns

.04W .06 ,V

ns Pattern not displayed

Depression

.22

,F

P-enhan

(Continued )

20


Authors Design

Location

Sample

Rosenthal and Wilson (2008) CS US Urban youth, Grade 12


Salzinger et al. (2010) L US

Self-Brown et al. (2006) CS US

Self-Brown et al. (2012) CS US

Sullivan et al. (2004) L US

White et al. (1998) L US

Urban youth, age 11–14 Hispanic and African AmericansH


Urban youth, mean age of 15H

Rural youth, mean age of 11


N

Exposure Variable

Family Variable

947 Exposure to Emotional social community support violence during high (Rosenthal & Wilson, 2001)

Dependent Variable

Dysphoria

590 SCECV - Survey of Friend attachment Internalizing Children’s problems Exposure to Parental attachment Externalizing Community problems Violence (Richters Internalizing & Martinez, problems 1993a)

Effect Size 6.15F

Pattern

ns

.11

P-stab

.07

ns

.11

P-react

101 SAVE - Screen for Parental mental Adolescent health Violence Exposure Parental PTSD (Hastings & Kelley, 1997)

PTSD

.21

ns

Depression PTSD

.20 .32

ns P-stab

101 SAVE - Screen for Parent trauma Adolescent exposure Violence Exposure (Hastings & Kelley, 1997)

Emotional Symptoms IndexR Externalizing problemsR

.20

P-stab

1,282 CRECV - Children’s Family support Report of Exposure to Community Violence (Cooley et al., 1995)

Cigarettes use initiation Beer & wine use initiation Liquor initiation Advanced alcohol use Parental monitoring Cigarettes use initiation Beer & wine use initiation Liquor initiation Advanced alcohol use

285 TIHSH - Things I Family social Have Seen and support Heard (Richters & Martinez, 1990)

Anxiety

.03

1.2

,OR

ns

P-react

1.1OR

ns

1.1OR 1.2 ,OR

ns P-react

1.2

,OR

Prot

1.1OR

ns

1.0OR 1.4 ,OR

ns P-react

< .01B

ns

Note. Negative effects represent effects that are protective-reactive or vulnerable-stable. For consistency, all nonsignificant effects are noted as positive. Prot ¼ protective; P-stab ¼ protective-stabilizing; P-react ¼ protective-reactive; P-enhan ¼ protective-enhancing; V-react ¼ vulnerablereactive; H ¼ high risk; R ¼ multireporters of exposure and symptoms; B ¼ figure represents B (nonstandardized coefficients); F ¼ result for female; M ¼ result for male; W ¼ result for witnessing; V ¼ result for victims; O ¼ figure represents old adolescents; OR ¼ odds ratio; A ¼ with age; U ¼ unique pattern; G ¼ with gender; 1 ¼ AfAm: .01, ns, AsAm: .02, ns; PTSD ¼ posttraumatic stress disorder.


21

APPENDIX B

TABLE B1 Main Results According to Moderation Factors

Authors

Design


Internalizing symptoms Close and warm relationship Kliewer et al. CS (2001) Dinizulu et al. (2014) Gorman-Smith and Tolan (1998)

Location

Sample

N

Colombia

Representative sample of youth, age 12–18 African-American urban, age 11–14H Urban youth, age 11–15 male, African American and LatinoH Urban youth, Grade 6 African AmericanH Urban youth, Grade 6 African AmericanH Representative sample of youth, age 12–18 Urban and rural youth, age 18 Urban youth, Grade 6 African AmericanH Youth ages 9–13 African AmericanH Urban and rural youth, age 18 Urban youth, Grades 6 and 8H Urban youth, age 13–17H

5,775

CS

US

L

US

Hammack et al. (2004)

CS

US

Hammack et al. (2004)

CS

US

Kliewer et al. (2001)

CS

Colombia

McKelvey et al. (2011) Hammack et al. (2004)

L

US

CS

US


L

US

McKelvey et al. (2011) Pearce et al. (2003)

L

US

L

US

Hardaway et al. (2012)

CS

US

Chen (2010)

L

US

O’Donnell et al. (2011)

CS

Gambia

O’Donnell et al. (2011)

CS

Pearce et al. (2003)

Family Variable

ES

,B

P-enhanF

Hopelessness

152

Nondisclosure

.17

P-stab

245

Family cohesion

Internalizing problems Anxiety= DepressionR

.27

P-stab

196

Maternal closeness

Anxiety

.15

P-stab

196

Time with family

Anxiety

.24

P-stabF

Family cohesion

Anxiety

.71

P-stabF

728

Family conflict

.01

196

Time with family

Anxiety= DepressionR Depression

.20

P-react

101

Felt acceptance from caregiver

InternalizingR

.31

P-react

728

Family conflict

Anxiety= DepressionR Conduct problems Internalizing problems; anxiety; lonelinessR Depression

.01

5,775

1794

Parent involvement Parent-child relations

Urban youth, Grades 7–12 African and Asian American Youth, Grades 10–11

901

Mother=adolescent connectedness

653

Parental warmth

Gambia


653

Parental warmth

L

US

Urban youth, Grades 6 and 8H

1,794

L

US

258

Social constraints for discussing violence

Rosario et al. (2008)

L

US

667

Kuther and Fisher (1998)

CS

US

Urban youth, Grade 7 African American Urban youth, ages 11–14 African American and HispanicH Urban youth, Grades 6–8

123

Parent involvement

Traumatic Stress Response Traumatic Stress Response Conduct problems

1.78

Pattern

Disclosure with mother

391

Support Kaynak et al. (2011)

Dependent Variable

B

B

B

.06

P-stabM

P-reactF

.01, ns

Pattern not displayed ns

.02

ns

nsW

ns

nsV

ns

.04

ns

Depression

.41

P-enhan

Social support from parent=other sig adult

Depression

.22

P-enhanF

Family support

Anxiety and hopelessness

.54

P-stab

(Continued )

22

OZER, LAVI, DOUGLAS, WOLF TABLE B1 Continued


Authors

Design

Location

Sample

N

Family Variable

Dependent Variable

ES

Pattern

Depression

.52

P-stab

349

Social support from parent=other sig adult Mother Helpfulness

Depression

.14

P-stab

349

Mother Helpfulness

PTSD

.11

P-stab

349

Father helpfulness

PTSD

.13

P-stab

349

Sibling helpfulness

Depression

.13

P-stab

590

Parental attachment


.11

P-react

114

Family communication and adolescent problem solving skills Perceived support from parents and family members Family social support

Psychological distressR

.43

P-react

Internalizing

.18

V-react

Anxiety

< .01, nsB

ns

5,775

Parental support

Anxiety

.92, nsB

ns

5,775

Parental support

Melancholia

.91, nsB

ns

5,775

Parental support

Hopelessness

.61, nsB

ns

Psychological distressR

.37, ns

ns

349

Family communication and problem solving skills Mother Helpfulness

.06

ns

Urban youth, Grade 7 Urban youth, Grade 7

349

Father helpfulness

Adaptive Function teacher report Depression

.04

ns

349

Father helpfulness

.09

ns

Urban youth, Grade 7 Urban youth, Grade 7

349

Sibling helpfulness

Adaptive Function teacher report PTSD

.04

ns

349

Sibling helpfulness

.03

ns

US

Urban youth, Grade 12

947

Emotional social support

Adaptive Function teacher report Dysphoria

CS

Italy

516

Parental monitoring

CS

Italy

Urban youth, Grades 11 and 13 Urban youth, Grades 11 and 13

516

Parental monitoring

Kaynak et al. (2011)

L

US

Ozer and Weinstein (2004) Ozer and Weinstein (2004) Ozer and Weinstein (2004) Ozer and Weinstein (2004) Salzinger et al. (2010)

CS

US

CS

US

CS

US

CS

US

L

US

LeBlanc et al. (2011)

CS

US

Li et al. (2007)

CS

US

White et al. (1998)

L

US


CS

Colombia


CS

Colombia


CS

Colombia


CS

US

Ozer and Weinstein (2004)

CS

US

Ozer and Weinstein (2004) Ozer and Weinstein (2004)

CS

US

CS

US

Ozer and Weinstein (2004) Ozer and Weinstein (2004)

CS

US

CS

US

Rosenthal and Wilson (2008) Parental monitoring Bacchini et al. (2011) Bacchini et al. (2011)

CS

Urban youth, Grade 7 African American Urban youth, Grade 7 Urban youth, Grade 7 Urban youth, Grade 7 Urban youth, Grade 7 Urban youth, age 11–14 Hispanic and African AmericansH Urban youth, age 13–20 mostly African American female Urban youth, ages 10–15 African American Urban youth, age 10–14 African American Representative sample of youth, age 12–18 Representative sample of youth, age 12–18 Representative sample of youth, age 12–18 Urban youth, age 13–20 mostly African American female Urban youth, Grade 7

258

263

285

114

Anxiety= Depression Anxiety= Depression

6.15, nsF

.13

,W

.05, nsV

ns

P-enhanW nsV

(Continued )


23

TABLE B1 Continued

Authors

Location

Sample

N

Family Variable

Dependent Variable

ES

Pattern

Urban youth, age 11–15 male, African American and LatinoH Urban youth, age 11–15 male, African American and LatinoH

245

Discipline

Anxiety= DepressionR

.09, ns

ns

245

Monitoring

Anxiety= DepressionR

.17, ns

ns

Urban youth, age 7–18 African AmericanH Urban youth, age 10–15 African AmericanH Urban youth, age 10–15 African AmericanH Urban youth, age 10–15 African AmericanH Urban youth, age 10–15 African AmericanH

221

Males present at home

PTSD

.44

75

Mother present at home

Depression

75

Family size

PTSD

.09, nsB

ns

75

Mother present at home

PTSD

.12, nsB

ns

75

Family size

Depression

1.05, nsB

ns

Gambia


653

School climate

CS

US


349

Teacher Helpfulness


CS

US


349

School safety

Ludwig and Warren (2009) O’Donnell et al. (2011)

CS

US

175

Teacher support

CS

Gambia

Urban youth, age 14–19 Youth, Grades 10–11

Traumatic Stress Response Adaptive Function teacher report Adaptive Function teacher report Hope

653

School climate

Ludwig and Warren (2009) Hardaway et al. (2012)

CS

US

175

CS

US

Urban youth, age 14–19 Urban youth, age 13–17H

Identification with school School climate


CS

US


391

Extracurricular activities in school

Ozer and Weinstein (2004) Ozer and Weinstein (2004) Ozer and Weinstein (2004) Ozer and Weinstein (2004) Community Salzinger et al. (2010)

CS

US

349

Teacher Helpfulness

CS

US

349

Teacher Helpfulness

CS

US

349

CS

US

Urban youth, Grade 7 Urban youth, Grade 7 Urban youth, Grade 7 Urban youth, Grade 7

Internalizing problems; anxiety; lonelinessR Internalizing problems; anxiety; lonelinessR Depression

L

US

Gorman-Smith and Tolan (1998)

L

US


L

US

CS

US

Overstreet and Dempsey (1999)

CS

US


CS

US


CS

US


CS

US

CS


Structure Fitzpatrick and Boldizar (1993)


Design

School O’Donnell et al. (2011)

Urban youth, age 11–14 Hispanic and African AmericansH

391

Traumatic Stress Response Hope

,B

P-stab

,B

P-stab

7.21

.10

,W

P-enhan

.21

P-enhan

.12

P-enhan

.60

P-stab

.12

,V

.01

P-react

Unique

.07, ns

ns

.02, ns

ns

< .01

ns

PTSD

.04

ns

School safety

Depression

.03

ns

349

School safety

PTSD

.08

ns

590

Friend attachment


.11

P-stab

U

(Continued )

24


Authors Ozer and Weinstein (2004) Ozer and Weinstein (2004) Ozer and Weinstein (2004)

Design CS

US

CS

US

CS

US

Externalizing symptoms Close and warm relationship Hardaway et al. CS (2012)


Location

Sample

N

Family Variable

Dependent Variable

ES

Pattern

Urban youth, Grade 7 Urban youth, Grade 7 Urban youth, Grade 7

349

Friend helpfulness

Depression

.05

ns

349

Friend helpfulness

PTSD

.07

ns

349

Friend helpfulness

Adaptive Function teacher report

.09

ns

US


391

Parent-child relations

.19

P-stab

Representative sample of youth, age 12–17 Urban and rural youth, age 18 Urban and rural youth, age 18 Representative sample of youth, age 12–21

2,511

Externalizing problems; delinquencyR Delinquency

.16

P-stab

.01

4,599

Family cohesion

Representative sample of youth, age 12–21 Representative sample of youth, age 12–21 Representative sample of youth, age 12–21

4,599

Family cohesion

Antisocial behaviorR Risk-taking behaviorR Use of drugs other than alcohol or tobacco Alcohol problems

4,599

Family cohesion

5,241

Family cohesion

Representative sample of youth, age 12–21 Urban youth, grades 7–12 H Urban youth, ages 9–13 African Americans H Urban youth, age 11–15 male, African American and Latino H Representative sample of youth, age 12–21 Representative sample of youth, age 12–21 Representative sample of youth, age 12–21 Representative sample of youth, age 12–21 Representative sample of youth, age 12–21

5,241

2,197

Barr et al. (2012)

L

US

McKelvey et al. (2011) McKelvey et al. (2011) Kliewer,Murrelle et al. (2006)

L

US

L

US

CS

Panama

Kliewer,Murrelle et al. (2006)

CS

Panama


CS

Panama


CS

Costa Rica


CS

Costa Rica

Lee (2012)

CS

US


L

US


L

US


CS

Panama


CS

Panama


CS

Costa Rica


CS

Costa Rica


CS

Costa Rica

Family cohesion

728

Family conflict

728

Family conflict

,B

P-stabM

,B

P-stabM

.15

.07

P-stab

.04

P-stabO

Drug problems

.09

P-stab

.08

P-stab

Family cohesion

Use of drugs other than alcohol or tobacco Drug problems

.03

P-stabO

Positive parenting

Substance abuse

101

Felt acceptance from caregiver

ExternalizingR

.03, ns

ns

245

Family cohesion

AggressionR

.05, ns

ns

4,599

Family cohesion

Lifetime drunkenness

.01, ns

ns

4,599

Family cohesion

Lifetime tobacco use

< .01, ns

ns

5,241

Family cohesion


.03, ns

ns

5,241

Family cohesion


< .01, ns

ns

5,241

Family cohesion

Alcohol problems

.03, ns

ns

ns

ns

(Continued )


25


TABLE B1 Continued

Authors

Design

Support Ozer (2005)

L

US

Sullivan et al. (2004) Sullivan et al. (2004) Ozer (2005)

L

US

L

US

L

US

Ozer (2005)

L

US

Salzinger et al. (2010)

L

US

Sullivan et al. (2004) Sullivan et al. (2004) Li et al. (2007)

L

US

L

US

CS

US


CS

US


CS

US


CS

US


CS

US

CS

Panama


CS

Costa Rica


CS

Costa Rica


CS

Costa Rica

Low and Espelage (2014)

L

US

Bacchini et al. (2011)

CS

Italy

Parental monitoring Kliewer,Murrelle et al. (2006)

Location

Sample

Urban youth, Grade 7–8 Rural youth, mean age of 11 Rural youth, mean age of 11 Urban youth, Grade 7–8 Urban youth, Grade 7–8 Urban youth ages 11–14 Hispanic and African American H Rural youth, mean age of 11 Rural youth, mean age of 11 Urban youth ages 10–15 African American Urban youth, age 13–20 mostly African American female Urban youth, age 13–20 mostly African American female Urban youth, age 13–20 mostly African American female Urban youth, age 13–20 mostly African American female Representative sample of youth, age 12–21 Representative sample of youth, age 12–21 Representative sample of youth, age 12–21 Representative sample of youth, age 12–21 Adolescents, M age ¼ 14

Urban youth, grades 11 and 13

N

Family Variable

Dependent Variable

115

Mother helpful

Aggression

1,282

Family support

1,282

Family support

115

Father helpful

Cigarettes use initiation Advanced alcohol use Aggression

115

Sibling helpful

590

ES

Pattern

.24

P-stab

,OR

P-react

,OR

P-react

1.2 1.2

.04, ns

ns

Aggression

.94, ns

ns

Parental attachment

Externalizing problems

.07, ns

ns

1,282

Family support

1,282

Family support

Beer & wine use initiation Liquor initiation Externalizing

263

114

114

114

114

Perceived Support from parents and family members Family communication and problem solving skills Family communication and problem solving skills Family communication and problem solving skills Family communication and problem solving skills

1.1

OR

ns

1.1

OR

ns

ns

ns

Adaptive skillsR

.32, ns

ns

Adaptive skillsR

.02, ns

ns

RisksR

.03, ns

ns

RisksR

.25, ns

ns

4,599

Monitoring

Drug problems

.06

P-stab

5,241

Monitoring

.12

P-stab

5,241

Monitoring

Use of drugs other than alcohol= tobacco Alcohol problems

.06

P-stab

5,241

Monitoring

Drug problems

.14

P-stab

1,232

Parental monitoring

.09

P-stab

516

Parental monitoring

Deviancy: delinquency, delinquent peers, & substance use Antisocial behavior

.17

V

P-react

(Continued )

26


Authors


Sullivan et al. (2004) Sullivan et al. (2004) Lee (2012)

Design L

Location US

L

US

CS

US


L

US


L

US

Bacchini et al. (2011) Kliewer,Murrelle et al. (2006)

CS

Italy

CS

Panama


CS

Panama


CS

Panama


CS

Panama


CS

Costa Rica


CS

Costa Rica

L

US

L

US

CS

US


CS

Ozer (2005)

Sullivan et al. (2004) Sullivan et al. (2004) School Hardaway et al. (2012)

Community Li et al. (2007)

Sample Rural youth, M age ¼ 11 Rural youth, M age ¼ 11 Urban youth, Grades 7–12H Urban youth, age 11–15 male, African American and LatinoH Urban youth, age 11–15 male, African American and LatinoH Urban youth, Grades 11 and 13 Representative sample of youth, age 12–21 Representative sample of youth, age 12–21 Representative sample of youth, age 12–21

N 1,282

Family Variable Parental monitoring

Dependent Variable

ES 1.4

Pattern

OR

P-react

OR

Prot

1,282

Parental monitoring

2,197

Parental monitoring

Advanced alcohol use Cigarettes use initiation rugs

245

Monitoring

Aggression

R

.01, ns

ns

245

Discipline

Aggression

R

.08, ns

ns

516

Parental monitoring

Anti-social behavior Lifetime drunkenness

.01, nsW

nsW

.01, ns

ns

1.2 ns

ns

4,599

Monitoring

4,599

Monitoring


.01, ns

ns

4,599

Monitoring

.04, ns

ns

4,599

Monitoring

Use of drugs other than alcohol or tobacco Alcohol problems

.02, ns

ns

5,241

Monitoring


.02, ns

ns

5,241

Monitoring


.01, ns

ns

1,282

Parental monitoring

1,282

Parental monitoring

Beer & wine use initiation Liquor initiation


391

Extracurricular activities in school

US


391

School climate

L

US


CS

US


Representative sample of youth, age 12–21 Representative sample of youth, age 12–21 Representative sample of youth, age 12–21 Rural youth, M age ¼ 11 Rural youth, M age ¼ 11

73

263

Perceived School Connection Positive neighborhood

Externalizing prob.; delinquencyR Externalizing problems; delinquency R Aggression

Externalizing

1.1OR

ns

1.0OR

ns

.15

P-stab

.01, ns

ns

< .01, ns

ns

.15

P-stab

Note. Prot ¼ protective; P-stab ¼ protective–stabilizing; P-react ¼ protective–reactive; P-enhan ¼ protective–enhancing; V-react ¼ vulnerable– reactive; H ¼ high risk; R ¼ multireporters of exposure and symptoms; B ¼ figure represents B (nonstandardized coefficients); F ¼ result for female; M ¼ result for male; W ¼ result for witnessing; V ¼ result for victims; O ¼ figure represents older youth; OR ¼ odds ratio; U ¼ unique pattern; PTSD ¼ posttraumatic stress disorder.

Risk factors as moderators of recovery during and after interventions for children exposed to interparental violence.

Community violence exposure and severe posttraumatic stress in suburban American youth: risk and protective factors.

Academic Failure and Child-to-Parent Violence: Family Protective Factors.

Dating Violence and Injury Among Youth Exposed to Violence.

Linking community protective factors to intimate partner violence perpetration.

Neighborhood Factors and Dating Violence Among Youth: A Systematic Review.

Behavior Problems Among Adolescents Exposed to Family and Community Violence in Chile.

School intervention related to school and community violence.

Family and peer social support and their links to psychological distress among hurricane-exposed minority youth.

Bullying in medically fragile youth: a review of risks, protective factors, and recommendations for medical providers.

The covariates of parent and youth reporting differences on youth secondary exposure to community violence.

Prevalence of Family Violence and Associated Factors Among In-School Adolescents in São Paulo, SP, Brazil.

Differential Adjustment Among Rural Adolescents Exposed to Family Violence.

Self-harm in adolescence: protective health assets in the family, school and community.

A Qualitative Analysis of Substance Use among Liberian Youth: Understanding Behaviors, Consequences, and Protective Factors Involving School Youth and the School Milieu.

Effects of the communities that care prevention system on youth reports of protective factors.

Examining Protective Factors Against Violence among High-risk Youth: Findings from the Seattle Social Development Project.

Family Functioning and Children's Post-Traumatic Stress Symptoms in a Referred Sample Exposed to Interparental Violence.

Mediators and Treatment Factors in Intervention for Children Exposed to Interparental Violence.

Implementing and Evaluating Comprehensive Evidence-Based Approaches to Prevent Youth Violence: Partnering to Create Communities Where Youth Are Safe From Violence.

Changes in dynamic risk and protective factors for violence during inpatient forensic psychiatric treatment: predicting reductions in postdischarge community recidivism.

Risk and Protective Factors Associated to Peer School Victimization.

Family, school, and community partnerships: practical strategies for afterschool programs.

Attention bias and anxiety in young children exposed to family violence.