Rates and Correlates of Violent Behaviors Among Adolescents Treated in an Urban Emergency Department

doi:10.1016/j.jadohealth.2008.12.005

Journal of Adolescent Health

Volume 45, Issue 1, July 2009, Pages 77-83

https://doi.org/10.1016/j.jadohealth.2008.12.005 Get rights and content

Abstract

Purpose

Violence is a leading cause of death for adolescents in inner–city settings. This article describes violent behaviors in relation to other risk behaviors (e.g., substance use) among adolescents screened in an urban emergency department (ED).

Methods

Patients aged 14–18 years were approached to self–administer a computerized survey assessing violent behaviors (i.e., physical aggression), substance use (cigarettes, alcohol, marijuana), and weapon carriage.

Results

A total of 1128 adolescents (83.8% participation rate; 45.9% male; 58.0% African–American) were surveyed. In the past year, 75.3% of adolescents reported peer violence, 27.6% reported dating violence, and 23.5% reported carrying a weapon. In the past year, 28.0% drank alcohol, 14.4% binge drank, 5.7% reported alcohol–related fighting, and 36.9% smoked marijuana. Logistic regression analyses predicting violent behaviors were significant. Teens reporting peer violence were more likely to be younger, African–American, on public assistance, carry a weapon, binge drink, and smoke marijuana. Teens reporting dating violence were more likely to be female, African–American, carry a weapon, binge drink, screen positive for alcohol problems, and smoke marijuana. Teens reporting alcohol–related fighting were more likely to carry a weapon, binge drink, screen positive for alcohol problems, and smoke marijuana.

Conclusions

Adolescents presenting to an urban ED have elevated rates of violent behaviors. Substance use (i.e., binge drinking and smoking marijuana) is an important risk factor for violent behaviors among urban adolescents. Universal screening and intervention protocols to address multiple risk behaviors, including violent behaviors and substance use, may be useful to prevent injury among adolescents presenting to the urban ED.

Section snippets

Methods

This study used a cross–sectional design. A consecutive sample of adolescent ED patients (aged 14–18 years), presenting during the afternoon/evening shift, were approached by staff 7 days/week to complete a screening questionnaire as part of a randomized controlled trial of an intervention for alcohol use and violent (aggressive) behaviors; this paper reports on a 1–year period (September 2006 to September 2007). The study site, Hurley Medical Center (HMC), is a 540–bed teaching hospital and a

Results

Patients were excluded if they could not provide informed consent because of the following: age less than 18 years and no parent/guardian present (n = 302), actively suicidal (n = 140), abnormal vital signs (n = 121), insufficient cognitive orientation (n = 27), acute intoxication (n = 10), schizophrenia diagnosis (n = 5), and other (n = 9). Among 1604 potentially eligible patients who presented to the ED during the recruitment period, 83.9% (n = 1346) were approached and 16.1% (n = 258) were

Discussion

The present findings show that adolescents presenting to an urban ED have alarming rates of violent behaviors. Specifically, approximately 75% of adolescents reported peer violence in the past year; the majority of this violence (∼60%) was severe and could likely result in injury. Although direct comparisons are limited by differences in violence measures, these rates of peer violence appear to exceed those of national samples [2] and prior school–based and ED–based studies in Flint, Michigan

Acknowledgments

This project was supported by a grant (#014889) from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). We thank project staff for their work on the project and likewise thank Pat Bergeron for administrative assistance. Finally, special thanks are expressed to the patients and medical staff at Hurley Medical Center for their support of this project.

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Conocer las características de la violencia de género que subyace entre los jóvenes en contextos de ocio, sus actitudes y cómo resuelven estos conflictos en los contextos de ocio donde consumen alcohol.
Estudio cualitativo, de enfoque etnográfico y feminista, con la participación de jóvenes de 16 a 22 años, frecuentadores de contextos de ocio nocturno y consumidores de alcohol, residentes en dos provincias de Andalucía y en una de Castilla-La Mancha. Los participantes fueron seleccionados mediante muestreo intencional y entrevistados en profundidad.
Las jóvenes sufren con frecuencia violencia de género en los contextos de ocio que asumen con normalidad como parte del juego y la diversión mientras utilizan estrategias de protección para minimizar los riesgos. El abuso de alcohol y otras drogas aumenta la posibilidad de sucesos de violencia de género en los contextos de ocio.
La violencia de género entre los jóvenes en contexto de ocio presenta unas características especiales que es necesario conocer para diseñar políticas preventivas. Las más vulnerables son las mujeres jóvenes que realizan consumos intensivos de alcohol. Suelen acudir al servicio de urgencias por presentar estado de inconsciencia.
To know the characteristics of gender violence that underlies among adolescents in the context of leisure, their behavior and how they overcome these conflicts in leisure contexts where the consume alcohol.
Qualitative study, with an ethnographic and feminist approach, with the participation of young people aged 16 to 22, frequenters of nightlife contexts and alcohol consumers, residents of two Andalusian provinces and one of Castilla-La Mancha. The participants were selected through intentional sampling and interviewed in depth.
Adolescents frequently suffer from gender-based violence in leisure contexts that they assume normally as part of the role of having fun, while they use their own protection strategies to minimize risks. The abuse of alcohol and other drugs increases the possibility that a gender violence event take place.
Gender-based violence among young people in the context of leisure, presents special characteristics that it is necessary to know in order to design preventive policies. The most vulnerable are young women who consume alcohol intensively. They usually go to the hospital emergency department for being unconscious due to alcohol consumption.
Violence prevention emergency tool (VPET) screening of youth in the pediatric ED
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Background
Violence is an increasingly common and significant problem for youth worldwide. Youth who rely on treatment at urban EDs are more likely to die as the result of violence than any other disease/condition for which they seek care. The first step in helping youth that are at risk, is identifying them. We developed a 7–item screening tool called VPET. The purpose of this study is to validate the VPET screening tool in identifying high-risk youth.
Methods and findings
We prospectively enrolled a convenience sample of children during the index ED visit who were called 3 months and 6 months after this visit. 269 youth (33%) completed 3-month follow up (44.2% male); 240 youth (29.4%) completed 6-month follow up (45% male); 84.0% reported some level of violence exposure after 3-months and 84.2% (n = 240) reported some level of violence exposure after 6-months.
Predictive validity was assessed by Spearman's correlation between VPET score and follow-up score at 3-months and 6-months post-enrollment; logistic regression to calculate odds ratios between positive VPET item responses and positive follow-up score; ROC curve analysis. VPET score had internal consistency, as tested by Cronbach's alpha (α = 0.642). Children who were male, non-white, and had been hurt at home or school reported the highest VPET scores.
Conclusion
VPET has sufficiently strong psychometric function and performs well as a screening tool to predict future violence exposure for youth ages 8–17. Five questions on the VPET screening tool are independently predictive of violence reported at 6 months and four questions at 3 months.
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This study examined the association between baseline substance use and mental health, and non-partner violence trajectories among youth presenting to an urban emergency department who screened positive for drug use. Non-partner violence is physically violent victimization or aggression involving someone other than a dating partner.
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Interpersonal violence is a significant public health problem, with substance use a key risk factor. Intensive longitudinal methods (ILMs) provide data on daily patterns/relationships between substance use and violence, informing prevention. Prior daily research has not focused on these relationships among urban minority samples.
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Among a high-risk urban minority sample, we found that higher baseline retaliatory attitudes and anxiety, as well as same-day binge drinking, non-medical prescription opioid use, and illicit drug use were associated with daily violence, likely reflecting both pharmacological and socio-contextual factors. Addressing substance use and retaliatory violence with tailored prevention efforts may aid in decreasing negative interpersonal violence outcomes.
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Original articleRates and Correlates of Violent Behaviors Among Adolescents Treated in an Urban Emergency Department

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Acknowledgments

J Adolesc Health

J Adolesc Health

J Adolesc Health

Addict Behav

J Pediatr

Drug Alcohol Depend

J Pediatr

J Adolesc Health

J Adolesc Health

J Adolesc Health

Aggress Viol Behav

Am J Prev Med

Health Care Financing Administration. The International Classification of Diseases, 9th Revision, Clinical Modification: ICD–9–CM

US Department of Health and Human Services

Pediatric violence–related injuries in Boston: Results of a city–wide emergency department surveillance program

Arch Pediatr Adolesc Med

National Hospital Ambulatory Medical Care Survey: 2001 Emergency department summary

Adv Data

Ten–year prospective study of public health problems associated with early drinking

Pediatrics

Adolescence–limited versus persistent delinquency: Extending Moffitt's hypothesis into adulthood

J Abnorm Psychol

Risk factors predicting changes in marijuana involvement in teenagers

Arch Gen Psychiatry

Original article
Rates and Correlates of Violent Behaviors Among Adolescents Treated in an Urban Emergency Department