Substance Use and Violence Among Youth: A Daily Calendar Analysis

Abstract

Background: While researchers have identified factors that contribute to youth violence, less is known about the details of violent incidents. In addition, substance use has been linked to youth violence; however, little is known about actual substance use on days in which violence occurs. Objective: This study examined reasons for peer violence and the association between substance use and violence using daily calendar-based analyses among at-risk urban youth. Methods: Data were collected from Emergency Department (ED) patients (ages 14–24; n = 599; 59% male, 65% African American) who screened positive for substance use in the past 6 months. Daily data regarding past 30-day substance use and violence and reasons for violent incidents were obtained via semi-structured interviews. Multi-level multinomial regression models were conducted to test the associations between substance use and peer violence incidents (i.e., none, moderate and severe). Results: Conflict over ‘personal belongings’ was a common reason for violence among males; ‘jealousy’/‘rumors’ were common reasons among females. Moderate victimization was more likely to be reported on days in which participants reported alcohol and cocaine use. Severe victimization was more likely to be reported on days in which participants reported alcohol use. Moderate or severe aggression was more likely to be reported on days in which participants reported alcohol and non-medical sedative use. Conclusions: Results suggest that youth violence prevention that addresses differential reasons for violence among males and females as well as substance use would be beneficial.

Keywords :

• Adolescents
• peer violence
• alcohol use
• substance use

THE AUTHORS

Sarah A. Stoddard, Ph.D., is an Assistant Professor in the School of Nursing, University of Michigan. Dr. Stoddard is also an Assistant Professor in the Department of Health Behavior and Health Education, University of Michigan School of Public Health. Her research focuses on understanding the interaction between individual-level factors and social and environmental factors and their influence on psychosocial development and health trajectories of at-risk youth. She is also interested in the application of behavioral and ecological approaches to preventing substance use and aggression among youth.

Quyen M. Epstein-Ngo, Ph.D., is a Research Assistant Professor and Clinical Psychologist at the Institute for Research on Women and Gender, University of Michigan. Dr. Epstein-Ngo is also a Fellow with the Michigan Institute for Clinical and Health Research and the University of Michigan Injury Center. Her research focuses on biopsychosocial factors that influence associations between substance use and aggression.

Maureen Walton, M.P.H., Ph.D., is an Associate Professor in the Department of Psychiatry and Addiction Research Center at the University of Michigan. Her research interests include developing and testing the efficacy of interventions for alcohol, drug use, and violence in community health care settings, such as the emergency department, primary care, and substance use treatment. Her research focuses on the interrelationship among multiple risk behaviors such as alcohol, illicit drugs, and violence, particularly among traditionally understudied populations such as adolescents, women, and African-Americans.

Marc A. Zimmerman, Ph.D., is a Professor of Health Behavior and Health Education and Psychology at the University of Michigan. Dr. Zimmerman is also the Director of the CDC funded Youth Violence Prevention Center and the Associate Director of the CDC funded Injury Center. His research focuses on adolescent health and resiliency, and empowerment theory and includes both longitudinal studies of development and evaluation of community-based prevention programs. He is also editor of Youth & Society.

Stephen T. Chermack, Ph.D., is a Clinical Psychologist, Chief of the Mental Health Service at the VA Ann Arbor Healthcare System and an Associate Professor in the Department of Psychiatry, University of Michigan. His research focuses on substance use screening and brief interventions in medical care settings, developing violence therapy for substance abusers, and mental health and substance use health services utilization, treatment engagement and outcomes.

Frederic C. Blow, Ph.D., is a Professor in the Department of Psychiatry and adjunct Associate Professor in the Department of Psychology, University of Michigan. Dr. Blow is also Director of the Mental Health Services Outcomes and Translation Section in the Department of Psychiatry. His research focuses on substance use prevention from a lifespan developmental perspective, alcoholism screening and diagnosis for older adults, mental disorders and concurrent substance use, brief alcohol and drug abuse interventions in health care settings, risk factors for suicide and mental health services research.

THE AUTHORS

Brenda M. Booth, PhD is Professor in the Departments of Psychiatry and Biostatistics at the University of Arkansas for Medical Sciences. She has worked in health services research since the mid 1980's. Dr. Booth has more recently focused on longitudinal community studies of substance abusers, including a large multi-state telephone interview study of rural and urban at-risk drinkers a multi-state community-based study of rural stimulant users in the mid-2000's. Recently she participated in an HIV-prevention clinical trial and a cross-sectional study of perceived need for treatment, both focused on African-American cocaine users.

Rebecca M. Cunningham, M.D., is a Professor in the Department of Emergency Medicine, University of Michigan School of Medicine, and an Associate Professor in the Department of Health Behavior and Health Education, University of Michigan School of Public Health. She is also the director of the University of Michigan Injury Center, has a distinguished career in researching intentional injury and substance use prevention, particularly of youth and young adult populations. Her focus on brief interventions in the emergency room has helped position the emergency department as a critical location for public health interventions, specifically for violence. She is currently leading two NIH-funded studies on substance abuse: one focusing on the intersection of youth violence and drug use, and one focusing on underage alcohol misuse and associated injury. She concurrently continues her work as a practicing Emergency Department physician at the University of Michigan Health System.

GLOSSARY

• Multi-level multinomial logistic regression: An analysis method that accounts for the fact that individuals reported multiple incidents of violent conflict and that these incidents were nested within individuals. Data is organized in a two-level structure in which an each violent incident is at level 1; the participant is at level 2. Multinomial logistic regression is a mixture of several logistic regression analyses in which the different categories are compared to a reference category.

• Non-partner violence: Interpersonal violence that occurs between individual such as friend or strangers but not dating partners. For youth, non-partner violence is often termed `peer violence'.

• Peer violence: Interpersonal violence that occurs between youth how may be friends or strangers but not dating partners.

• Timeline follow-back interview (TLFB): A technique that uses a calendar and structured interview to assist retrospective recall of daily alcohol and drug use over a specified time period. It has also been adapted to assess other health risk behaviors such as violence and aggression. The aggression module used in the current study assists in retrospective recall of incidents of specific interpersonal conflicts.

• Youth violence: Interpersonal violence that occurs between the ages of 10–24. Interpersonal violence is defined as the intentional use of physical force or power, threatened or actual, against another person or against a group or community that results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.