Presenter Disclosures (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past

Presenter Disclosures

(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

Deborah Goebert

“No relationships to disclose”

Youth Violence and Substance Use

Deborah Goebert, Dr.P.H. ([email protected])

&

Investigators & Staff, Asian/Pacific Islander Youth Violence Prevention Center & Alcohol Research Center of Hawaiì

Department of Psychiatry, University of Hawai‘i at Mānoa

May 22, 2008

Recent Headlines – May 18, 2008

Recent Headlines – April 2, 2008

Recent Headlines – March 28, 2008



Recent Headlines – February 24, 2008

Recent Headlines – January 15, 2008

API Youth Substance Use and Violence

• >12 million API population in U.S. (Census 2000)• Minimal knowledge of API youth violence and substance use

regarding prevalence & risk-protective factors• Available knowledge typically aggregates different Asian groups

& Pacific Islander groups together• Misleading because Asians tend to have lower rates than

Pacific Islanders• Misleading because even within the Asian groups, there are

differences (e.g., Cambodian youths > Chinese youths)• Does not address the issue of those of mixed ancestry

API Youth Substance Use and Violence

• Adolescence is a period of great vulnerability• Youth who begin to abuse alcohol or drugs at earlier

ages are at greater risk for developing future substance use problems

• Alcohol use associated with other risk behaviors, including violence

• In contrast to the number of studies on risk factors, only a few studies have examined protective factors regarding the development of substance use disorders and violence.

Importance of Disaggregation

48.7

22.7

41.4

50.7

33.1

40.2 39.9

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Percent

N-Am Asian A-Am Pacific Cauc Multiple Hisp

Ethnicity (Adolescents)

In Physical Fight Past 12 Months (Youth Risk Behavior Survey)

N-Am = Native American; A-Am = African American; Pacific = Pacific Islander, including Hawaiian;Multiple = Multiple, non-Hispanic; Hisp = Hispanic


13.2

7.7 7.6

15.6

6.6

9.3 9.8

0.0

2.04.0

6.0

8.010.0

12.0

14.016.0

Percent

N-Am Asian A-Am Pacific Cauc Multiple Hisp

Ethnicity

Threatened or Injured w/Weapon on School Property in Past Year

N-Am = Native American; A-Am = African American; Pacific = Pacific Islander, including Hawaiian;Multiple = Multiple, non-Hispanic; Hisp = Hispanic


Over-representation at Hawai‘i Youth Correctional Facility:• Hawaiians• Samoans• African Americans

Under-representation:• Caucasians• Filipinos• East Asians (e.g., Japanese, Chinese)

From: Kassebaum, 1995a/b.

Research – Youth Violence and Substance Use-Related Data Sets

No. Type Sample Approximate Sample Size

Year(s)

1 Risk-protective Three Oàhu High Schools 340 2003-2004

2 Risk-protective Two Oàhu High Schools 700 2006-2007

3 Risk-protective + objective school data

One Oàhu High School 250

150

2004-2005

2008-2009

4 Risk-protective Two Neighboring Communities 55

100

2006

2007

5 School-climate baseline

One Oàhu High School 150 2008-2009

6 Substance use Two Oàhu High Schools 200 2005-2006

Results: Substance Use Prevalence

50.0

63.6

33.3

53

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Percent

Filipino Hawaiian Japanese Samoan

Ethnicity (p < .05)

Ever Used Substance in Lifetime


27.0

12

41.0

20.5 16.7

6.7

34.7

15.3

0.0

10.0

20.0

30.0

40.0

50.0Percent


Ethnicity (p < .05)

Drank beer

Last year Currently


20.424.2

9.1

32.6

0

5

10

15

20

25

30

35

Percent

Filipino Haw. Japanese Samoan

Ethnicity (p < .05)

Use of Substance Caused Problems in Life

Results: Violence Prevalence

77.367.4

51.5

75.9

0.0

10.0

20.0

30.040.0

50.0

60.0

70.0

80.0

Percent


Ethnicity (p < .05)

Witnessed fights between different groups at school*

*Within past 6 months.


24.6

30.3

12.1

33.7

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

Percent


Ethnicity (p < .05)

Hit a family member or boyfriend/girlfriend*



10.0

4.06.1

20.5

0.0

5.0

10.0

15.0

20.0

25.0

Percent


Ethnicity (p<0.05)

Thrown objects such as rocks or bottles at people*


Results: Correlates

IV DV Odds Ratio P value

Ever used substances Hit family member 2.78 <.0001

Ever used substances Thrown objects 5.92 <.0001

Ever used substances Attacked someone 6.09 .0047

Ever used substances Carried gun, knife 3.18 .0093

Currently drink beer Hit family member 2.76 .0039

Currently drink beer Thrown objects 5.32 .0002

Currently drink beer Used weapon to get money 12.10 .0398

Results:2003-2004, Three High Schools Survey

• Youth violence: Samoans > Hawaiians, Filipinos, Japanese• Substance use: Hawaiian girls > Hawaiian boys• Overall delinquency: Filipinos, Hawaiians, Samoans >

Japanese

Results:2003-2004, Three High Schools Survey

Community, School, Media

Family & Peers

Youth

Community, School, Media:- school suspensions+ grade-point average- ever been arrested+ favorable school attitudes- easy access to weapons- stressful life events (victimization)- participated in group activity- job in past year

Family & Peers:- difficulty living w/lots of family members- difficulty getting along w/parents- punishment used- importance of religion/ spirituality to parents- peer delinquency (drugs, violence)- gang membership/exposure- hang out w/friends in trouble

- friends not good students- pressure to choose betw. school & friends- dating &/or sexually active- gender roles

Youth:- substance use- self-reported delinquency- favorable attitudes to delinquency- impulsivity

- gender (males)- low self-esteem- ethnicity (Samoan youths)+ ethnic identity = commit- ethnic identity = negative affect- ethnic identity = pride- poor physical health- recent counseling/MH services+ = protective; - = risk

Future Directions

• Conduct further research on ethnic identity:• Why are there ethnic-group differences in prevalences?

• How do the quality, frequency, duration, & magnitude of ethnic-identity engagement impact youth violence?

• What are the similarities & differences in the acculturative process for indigenous Hawaiians vs. later generations of immigrant populations vs. recent immigrants?

• What does it mean to be “mixed” in ethnicity & ethnic identity, and how does this impact youth violence & why?

• Conduct longitudinal research to determine causation• Develop, implement, &/or evaluate prevention& treatment

programs that are responsive to the diversity of Hawai‘i’s people

State of Hawai‘i Department of HealthFigure 1. Three-year rates* of non-fatal injuries from assaults, all ages,

2003-2005

*Rates are per 1,000 residents as estimated by 2000 U.S. Census

0

10

20

30

40

50

60

70

80

0 to 4y

5 to 9

10 to 14

15 to 19

20 to 29

30 to 39

40 to 49

50 to 64

65 to 74

75 + y

0 to 4y

5 to 9

10 to 14

15 to 19

20 to 29

30 to 39

40 to 49

50 to 64

65 to 74

75 + y

Females Males

Community B

Community A

Rest of Hawaii

State of Hawai‘i Department of HealthFigure 2. Three-year rates* of non-fatal injuries from assaults, among

children, 2003-2005

*Rates are per 1,000 residents as estimated by 2000 U.S. Census

0

20

40

60

80

0.7 2.1

19.1

2.7 7.8

41.7

0

15.2

24.9

0

7

70.8

1.2 4.7

13.4

1.9

8.1

29.7

05-9y 10-14y 15-19y 05-9y 10-14y 15-19y

Females Males

Community B Community A Rest of Hawaii

Results: 2007, Community Outcomes(% Strongly Agree or Agree)

51

78

97

95

0 20 40 60 80 100

I feel safe walking down street in communityat night

I feel safe walking down street in communityduring day

I feel safe in community I live in

I think youth violence/delinquency is aproblem in my area

Results: 2007, Youth Outcomes(% Strongly Agree or Agree)

66

67

68

75

84

0 20 40 60 80 100

Property damage

Bullying

Being exposed to domestic violence

Robbery or burglary

Reckless driving/speeding (not DUI)


63

63

64

64

66

0 20 40 60 80 100

Truancy

Verbal/emotional violence

Drunk driving

Homelessness

Loitering


25

42

51

54

58

0 20 40 60 80 100

Cyber-bullying

Possession of weapons

Spreading rumors

Being abused/neglected as child

Physical violence (assault, harm)


9

17

22

22

23

0 20 40 60 80 100

Murder

Gang violence

Dating violence

Sexual assault

Gangs

Results: 2007, Community SurveyRisk-Protective Factors

1. Demographics

2. Community

3. Causes of Youth Violence

4. Protective Factors

5. Youth Substance Use

6. Perceived Support

7. Physical Health

8. Religion, Spirituality

9. Ethnic Identity

10.Colonialism

11.Parent Supervision & Involvement


Risk-Protective Domains Outcome R2 p value

(-) Community – Resources

(+) Religion & Spirituality

Total

Youth Violence

.052

.078

.123

.0224

.0050

.0018

(-) Community – Resources

(+) Parent Supervision – Negative Discipline

(-) Parent Supervision – Calmly discuss what happened

Total

Overall Youth Violence & Delinquency

.086

.074

.085

.203

.0034

.0426

.0308

.0085

Community Resources:• recreation, safety, crime/violence prevention• education, health, social services, government satisfaction• general community cohesion, community-school cohesion


Risk-Protective Domains Outcome R2 p value

(+) Community – Good Neighbors Community Safety

.182 < .0001

Good Neighbors:• Familiarity and influence of neighbors• Community activities and cooperation with neighbors• Common community values

2007 Oàhu High School Survey: What Causes Fights?

41.5

19.7

25.3 24.3

76.5

34.4

24.2 23

0

10

20

30

40

50

60

70

80

90

Rumors Dating Respect Conflict b/tSchools

Boys

Girls

2007 Oàhu High School Survey: Attitudes Toward Fighting

24

29

34

37

27

24

14

10

0 10 20 30 40

If a student hits mefirst, my family

would want me tohit them back.

If a kid hits me, it isharder to report

them to a teacherthan just to hit

them back.

StronglyDisagree

Disagree

Agree

StronglyAgree

58%

66%

Comparison to YRBS (2005)

Item Description (Youth Risk Behavior Survey) One Oàhu High School

Hawai‘I U.S.

In physical fight 28% 27% 36%

In physical fight on school property 17% 10% 14%

Felt unsafe to go to school within past 30 days 10% 6% 7%

Threatened/injured with weapon on school property 3% 7% 8%

Seriously considered suicide 17% 20% 17%

Ever forced to have sexual intercourse 8% 10% 8%

2007 One Oàhu High School Survey (Preliminary)

Item Description (One Oàhu High School Survey) Boys Girls

Had your property (e.g., car, clothing, or books) damaged on school property within past 30 days

39.0% 28.3%

Gotten into a physical fight while under the influence of alcohol or drugs

8.6% 9.7%

Gotten into a physical fight because you were bullied 16.5% 12.6%

Gotten into a physical fight because rumors were spread about you

15.1% 21.1%

My partner went through my cell phone to check my calls or text messages

38.2% 51.0%

My partner kept track of whom I was with and where I was 39.2% 54.3%

My partner has threatened to commit suicide to get me to stay with him/her

5.9% 23.7%

Ecological Model:Examples of Prevention Strategies

Individual•Social development programs•Cultural enrichment

Relationship•Parenting programmes• Home visitation• Family therapy

Community•Reducing alcohol availability • Identify and refer people at risk for substance abuse or violence

Societal•Public information • Strengthen police and judicial systems• Reduce poverty and inequality

Implications

• The findings highlight the need to implement interventions designed to reduce and prevent drinking and violence.

• Interventions should factor in:• Cultural appropriateness

• Quality/type of cultural socialization might be key (i.e., commitment vs. pride)

• Community resources, including schools, churches, health agencies, law enforcement

• Social networks, including family & peers

• Youth focused

• Gender, attitudes, talents (e.g., educational achievement), substance use, etc.

School Complex

Community A

Community

B

High School

Community Partnership and Mobilization

Community Work Group

Religious Groups

Teen Organizations

Cultural Groups

Women’s Group

Local Business

Youth Development

Private Schools

Home Associations

Community Togetherness

Meetings

More individuals & organizations

coming in

Community Meetings

“Facilitating community mobilization for sustainable violence and substance abuse reduction”

Training – Collective problem-solving

– Grant writing

– Fun youth development exercises

Resource Sharing– Agency/organization presentations

– Website technical assistance

– Resource directory and map

Program Development– Parenting class

– Youth retreat

Work Groups at the High School

Students:

Safe School Task Force

Faculty & Staff

Counselors

Students:

Safe School Task Force


• Health Fair

• Research Development

• Movie & a Message (M&M) Night 2007

Counselors


• Training in therapeutic techniques and programs

• Counseling Groups

Faculty & Staff


• Freshman Jump Start

• Movie & a Message (M&M) Night

• Ethnic Studies

• DOE PDERI Summer Course

2004-2005,Oàhu High School-Only School-Wide

INDEPENDENT VARIABLESINDEPENDENT VARIABLES

Impulsivity (acting without thinking)***

Self-esteem

Temperament/irritability (negative mood)***

Ethnic identity (cultural pride)

Victimization (been bullied)***

Locus of control (thinks controls one’s own future)

Anxiety

Depression

Family support

Peer pressure

Attitudes toward school

Gender stereotype (sexism)***

Substance Use (smoking cigarettes***; alcohol; marijuana)

Jumpstart Day Background

DEPENDENT DEPENDENT VARIABLEVARIABLE

Outcome of “Violence” (# of times Outcome of “Violence” (# of times getting into fights within the past getting into fights within the past 12 months)12 months)

Of the 13 variables on the left, we tested to see which ones associated significantly with getting into fight within the last year.

Wanted to address these 5 issues that associated significantly with fighting in skits made by high school students for incoming freshmen. (IDEA PROPSED & DESIGNED BY TEACHERS WORKGROUP)

Research and Program Development

• APIYVPC Core Research & Program Development

– 2005-2006 = literature reviews

– 2006-2007 = focus groups, school-wide surveys

– 2007-2008 = program development

– 2008-2009 = program implementation & evaluation

– 2009-2010 = dissemination

Program Development

School Level

Peers

Youth

Youth: Ethnic Studies; Jump Start; PTP Mentoring Class

Peers: Safe Schools Task Force

School Level: Challenge Day; Prevent Team; Outreach College for Teacher Training

Examples

What is School Climate?

Safety

Physical

Social-emotional

Teaching and Learning

Quality of instruction

Professional development

Leadership

Relationships

Respect for diversity

Sense of community

Morale

Environment

Cleanliness/order of facilities

Adequate space and materials

School Climate Research

Research shows that students in schools with a positive school climate have:

Greater academic achievement

Lower levels of misconduct

Lower levels of violence

Lower levels of substance abuse

Also, research shows that teachers in schools with a positive school climate have higher job satisfaction.

School Climate Dimensions

Safety:I feel safe in all areas in and around my school. 64%Students being disruptive keep me from learning. 56%Students threatening other students make it hard to learn. 48%The classrooms and hallways are kept under control. 41%When students are spreading rumors, most of my

teachers know what to do to stop it. 33%

Relationships:Teachers are fair in dealing with students. 57%The school rules are fairly enforced. 48% Teachers are respected. 38%Most teachers at my school want to stop fights from happening. 84% Most students at my school want to stop fights from happening. 18%

Next Steps

1. Community: Continue community efforts to address youth violence & development

2. Research: Continue surveillance studies of students in school & community

3. Program: Develop, evaluate, & disseminate an effective, culturally appropriate prevention/intervention program

4. Train: Continue to train teachers, school officials, community members, practitioners, & academicians

5. Dissemination: Disseminate our findings

6. Evaluate: Continue to evaluate & improve the APIYVPC

7. Renew: Renewal application at end 2009

Community – Summary

Goals Activities/Events Description

School 1. Safe School Task Force

2. JumpStart Day

3. Ethnic Studies

4. Teacher Training

5. Counselor Training

1. Student leadership group

2. Freshmen orientation

3. High school curriculum

4. Anti-bullying

5. Counseling techniques

School-Community Involvement

1. Movie & a Message (M&M) Night

1. Family gathering with a message on prevention

Community 1. Community Work Group Meetings

1. Community gathering, sharing, collaboration, training, projects

Need for unified message

Approaches to Research with Different Cultural Communities

• Every community is different—typically very people-dependent

• Trust & relationships are the cornerstones of university-community/school partnerships– universities/researchers may not have a good reputation

• Assist in research projects that build genuine “good will” & trust– cognitive styles instrument & linked with youth violence

Approaches to Research with Different Cultural Communities

• Respect confidentiality not only of individual personal information, but also regarding community stigma & stereotype– continually ask for school & community feedback &

“permission” to disseminate findings with or without identifying their school/community

• Be unassuming & patient, but still advocate how the partnership can be a win-win

Challenges to Program Design & Implementation

Epistemology (how knowledge is gained)– spiritual, subjective, personal, private

– empirical (data-driven), objective, public, repeatable

Potential Solutions:– respect different views; not all may be resolvable

– try & work within their framework

– conceptualize the empirical approach as supplemental rather than contradictory

– use mixed methods (i.e., qualitative & quantitative)


Control Group (especially randomized)– viewed as “unethical” in that it deprives interventions to a sub-

group

Potential Solutions:– note that the “intervention” has not yet been proven– use quasi-experimental designs, simplest being pre-post design

(try & rule out alternative explanations)– use “wait listed” individuals as the comparison group– use a “lag” research design model where both groups receive the

intervention, but at different points in time– use covariates to control for other important factors (e.g.,

exposure to other variables between pre & post)


Intervention

(experimental)

Other Activity

(follow-up)

Other Activity

(control)

Intervention

(experimental)

Pre-Test 1

Post-Test 1

Post-Test 2

Pre-Test 1

Pre-Test 2

Post-Test 1

Group 2

Group 1

Period 1 Period 2

Pre-Test 1

Pre/Post

Post-Test 1

Period 1 Period 2


Integration of Culture– adoption of already-existing “valid” measures & interventions

seen as culturally inappropriate

Potential Solutions:– be patient; factor in time for feedback, modifications, IRB

approvals, etc.– conduct informal &/or formal interviews & focus groups on

more culturally appropriate measures & interventions• Year 1 of API Center

– utilize general ethnic identity measure (Phinney) AND culture-specific identity measures (Hawaiian, Filipino, Samoan, Japanese)

Thank You

Documents

Presenter Disclosures (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past