Community violence exposure, coping, and problematic alcohol and drug use among urban, female caregivers: A prospective study

Highlights

• Witnessing violence is associated with increased substance use over time.

• Witnessing violence is associated with increases in avoidant coping over time.

• Changes in avoidant coping predict changes in drug use in female caregivers.

• Religious coping is associated with decreases in avoidant coping over time.

• Social support is associated with decreases in avoidant coping over time.

Abstract

Victimization is associated with substance use in women, but less is known about linkages between witnessing community violence and substance use, even though more women witness versus directly experience violence. Further, factors that contribute to or protect against women’s problematic substance use are less well understood. Urban female caregivers (N = 318; >92% African American/black) living in low-income communities were interviewed annually for three waves regarding exposure to community violence, coping behaviors, substance use, and protective factors. Path analyses revealed that lifetime witnessing of violence, but not victimization, assessed at baseline, was associated with changes in avoidant coping, but not active coping, one year later; avoidant coping, in turn, was related to changes in and higher levels of problematic drug use the following year. Victimization was directly related to problematic drug use, but not to alcohol use. Regression analyses indicated that high levels of religious commitment and social support at baseline were prospectively associated with lower levels of avoidant coping. Because caregivers are important role models for their children, it is important to attend to the factors that contribute to their substance use and abuse.

Introduction

As many as 70% of individuals living in urban communities are exposed to community violence (Stein, Jaycox, Katoka, Rhodes, & Vestal, 2003). Community violence (CV), defined as “violence between individuals who are unrelated, and who may or may not know each other, generally taking place outside the home” can include physical and sexual assault and neglect (Krug, Mercy, Dahlberg, Lozano, & Zwi, 2002). Community violence exposure (CVE) includes both witnessing violent acts and being victimized. Many more people are indirectly exposed to CV than are directly victimized by it (Stein et al., 2003), making it important from an attributable risk perspective (Rothman & Greenland, 1998).

Parents’ exposure to CVE is associated with maladaptive parenting practices and child outcomes (e.g., Zhang and Anderson, 2010, Zhang and Eamon, 2011). Further, links between parent substance use and negative adolescent outcomes are well-established in the literature (e.g., Hops, Duncan, Duncan, & Stoolmiller, 1996), with more recent work suggesting that maternal substance use has a greater influence on adolescent outcomes than paternal use (Ohannessian et al., 2004). Given these findings, understanding the impact of CVE on female caregivers is an important priority from a prevention standpoint. Thus, the first purpose of the present study was to document associations between both witnessing and victimization by community violence and problematic alcohol and other drug use in a sample of low-income, largely minority female caregivers.

Researchers (e.g., Sher, 1996) have emphasized alternative pathways to substance abuse. One pathway focuses on the tendency toward deviant behavior generally, a second pathway focuses on the reinforcing effects of substances, and a third pathway focuses on stress and negative affect. Lazarus and Folkman (1984) theory of stress and coping falls in the latter category and is the perspective embraced here. Lazarus and Folkman’s theory argues that violence exposure is stressful and when particular types of coping are enacted this increases the likelihood of substance use.

In support of this perspective, a few recent models linking violence and drug use have proposed coping skills as an important factor (Merrill et al., 2001, Min et al., 2007). Although there are several ways to conceptualize coping, active or engaged versus avoidant or disengaged is one commonly used rubric (Lazarus & Folkman, 1984). Avoidant coping refers to the act of consciously denying, minimizing, or delaying interaction with a stressor. Min, Farkas, Minnes, and Singer (2007) found that avoidant coping mediated the link between childhood trauma and substance abuse in adulthood. Other researchers have shown that more frequent use of avoidant coping strategies is associated with violence exposure (Haden & Scarpa, 2008), and with more substance use and abuse (Feil & Hasking, 2008).

A few studies to date have examined victimization by violence, coping and substance use among women within one model. This work has linked avoidant coping with greater PTSD symptoms in female victims of interpersonal violence (Krause, Kaltman, Goodman, & Dutton, 2008) and with increased substance abuse and psychological distress in a sample of urban, primarily African–American mothers of whom more than half had suffered at least one childhood trauma (Min et al., 2007). However, we are aware of no studies to date that have tested models linking witnessing community violence, coping, and substance use among women. This is an important question to address because more women witness versus directly experience violence, and because coping is modifiable and a viable target for intervention (Brown & Lewinsohn, 1984). Further, this question is even more important to understand among parents, as caregivers are powerful role models for their children (Kliewer, 2010), and understanding the factors that contribute to their problematic substance use has implications for preventing alcohol and drug abuse in their offspring. Thus, the second purpose of the study was to test a model prospectively linking victimization and witnessing community violence, use of active and avoidant coping, and problematic alcohol and other drug use.

Not all caregivers are equally affected by violence; protective factors can attenuate the relations between violence exposure, coping, and substance use, particularly those that promote approach coping. Approach coping has been linked with less alcohol and drug use and fewer drinking problems (e.g., Forys, McKellar, & Moos, 2007). It follows then that factors that promote engagement and discourage disengagement and avoidance of stressful events may best buffer against problematic use of alcohol and illicit drugs. One protective factor that might promote approach coping, reduce avoidant coping, and buffer against substance use is religious commitment. Religiousness has been defined in various ways within the literature, but measures that have included items about the importance of religion in a person’s life – regardless of the particular religion embraced – and its influence on a person’s decisions and daily activities have found that high religiosity buffers against past year alcohol and drug use, and past year alcohol abuse (Edlund, Booth, & Feldman, 2009). Given the empirical links between religious commitment and substance use, we felt this was an important factor to consider. Further, as noted in the 2007 US Religious Landscape Survey (http://www.pewforum.org/a-religious-portrait-of-african-americans.aspx), African Americans are more religious than the general US population, with 87% describing themselves as belonging to a religious group. The majority of the participants in our study were African American.

A second protective factor that might promote active coping and discourage avoidant coping is social support. Social support predicts reduced alcohol and drug use (Hamdan-Mansour, Puskar, & Sereika, 2007). Research additionally has suggested that social support has both direct effects on positive adjustment outcomes and indirect effects on adjustment through approach coping (Holland & Holahan, 2003). Thus, the third and final purpose of the present study was to examine religious commitment and social support as predictors of coping and buffers of the relation between violence exposure and coping.

We used a prospective design to evaluate a model linking CVE, coping, and problematic substance use. We hypothesized that lifetime CVE would be associated with increases in avoidant coping and decreases in active coping, which in turn would be related to increases in problematic levels of alcohol and drug use. We also anticipated direct, positive associations between CVE and alcohol and drug use. Our study contributes to the extant literature by including a focus on the effects of witnessing violence and low-income women, which is much more common in the population than direct victimization.

Secondly, we evaluated factors that theoretically reduce the likelihood of engaging in avoidant coping and enhance the use of active coping. We hypothesized that CVE’s impact on avoidant coping would be attenuated by high levels of religious commitment and social support. By including a focus on protective factors, our study contributes to the literature in that we identify possible areas or strategies of intervention.