Challenging Dogma - Spring 2008

...Using social sciences to improve the practice of public health

Monday, April 21, 2008

Back to the Streets: A Critique on the Failure of Youth Prevention Programs to Address Key Social and Cultural Factors —Robin DaSilva

The widespread epidemic of youth violence has become an important public health problem. According to the Center for Disease and Control (CDC), youth violence refers to harmful behaviors that can start early and continue into young adulthood. Youth violence includes bullying, slapping, hitting robbery, assault, or rape, and can lead to serious injury or even death. According to the CDC, in 2003, 5,570 young people ages 10 to 24 were murdered—an average of 15 each day. Of these victims, 82% were killed with firearms. In 2004, the CDC reported more than 750,000 young people ages 10 to 24 were treated in emergency departments for injuries sustained due to violence (1). In a nationwide survey of high school students: 33% reported being in a physical fight one or more times in the 12 months preceding the survey; 17% reported carrying a weapon (e.g., gun, knife, or club) on one or more of the 30 days preceding the survey; and an estimated 30% of 6th to 10th graders in the United States were involved in bullying as a bully, a target of bullying, or both (2,3).

Consequently, as communities struggle to deal with the violence epidemic continuing to sweep the nation, the demand for effective violence prevention programs heightens. The US Department of Health and Human Services states, “most of the violence prevention programs currently employed at both the national and local levels either have not been evaluated with rigor or have been evaluated and found to be ineffective.” (4) Researchers found that many programs designed to combat juvenile delinquency are ineffective, leading to the cynical conclusion that "nothing works." (5).

The Nation cannot afford to waste resources on ineffective prevention programs or to further jeopardize the well being of youth who may be assigned to ineffective programs. It is essential to disseminate scientifically validated studies, to provide resources and incentives for their implementation, and to provide schools and communities the resources needed to evaluate programs that appear promising (5).

As youth violence continues to elevate on the national agenda of important problems facing the United States, youth violence prevention programs fail to address the essential factors that motivate the nation’s youth to engage in violence. Before prevention programs can be implemented, developers must understand what motivates and influences the behavior of our youth. Although, individual factors must be taken into account, many existing prevention programs do not address the social, environmental, and cultural factors driving youth to behave violently. These factors are important in determining the cause for behavior.

Building Skills
Youth violence prevention programs such as Scared Straight involve organized visits to prisons by juvenile delinquents or children at risk for criminal behavior. Scared Straight is designed to deter participants from committing future criminal behavior through first-hand observation of prison. However, there is little evidence that traditional institutional programs, such as Scared Straight are effective. In some cases, these programs are implemented since they are less expensive than alternatives and may have a favorable cost-benefit effect compared to alternatives. The shock/scare strategy that the Scared Straight program applies has also demonstrated harmful effects, increasing the risk of violent or delinquent behavior. (6)

Scared Straight and other shock/scare strategy programs are not addressing the real issue. Shock/scare strategy programs only illustrates to youth the consequences of criminal behavior. The programs fail to take into account Bandura’s social cognitive theory, educating youth with the skills needed to face difficult social situations.

Bandura’s social-cognitive theory provides a framework for understanding, predicting, and changing human behavior. The theory identifies human behavior as an interaction of personal factors, behavior, and the environment. Social-cognitive prevention and intervention programs strive to equip children with the skills they need to deal effectively with difficult social situations, such as being teased or bullied. Social-cognitive prevention and intervention programs incorporate didactic teaching, modeling, and role-playing to enhance positive social interactions, teach nonviolent methods for resolving conflict, and establish or strengthen nonviolent beliefs in young people.

Researchers have linked a lack of social problem-solving skills to youth violence. When children and adolescents are faced with social situations for which they are unprepared emotionally and cognitively, they may respond with aggression or violence. Many assert that we can improve children’s ability to avoid situations and solve problems nonviolently by enhancing their social relationships with peers, teaching them how to interpret behavioral cues, and improving their conflict-resolution skills (7).

Programs, such as Scared Straight only offer youth a chance to see the consequences of criminal behavior. Shock/scare strategy programs fail to emphasize social and emotional competence, problem solving, and family functioning to reduce aggression and violence.

Strictly the environment
Environmental factors play an important role in creating conditions that can contribute to a culture of violence among a particular group of people or community. A program that fails to go beyond the school boundaries is Drug Abuse Resistance Education or D.A.R.E. D.A.R.E. is an education program that seeks to prevent use of illegal drugs, membership in gangs, and violent behavior. However, the program reaches out to youth only in their school environment. The program does not engage in building relationships with the community, or parents. Students may adhere to the teachings of D.A.R.E. at school because of the support of the D.A.R.E. program. However, because of the lack of established relationships with the parents and great community, students may become involved with drugs, gangs, or violent behavior in their communities, as it is environmentally acceptable.

Youth violence prevention programs such as D.A.R.E. fail to account for all the environmental factors that comprise the social/ physical environment surrounding individuals outside of school boundaries. The National Youth Violence Prevention Resource Center found that “environmental factors that have been linked to violence include poverty, exposure to violence, the general disenfranchisement of youths, socioeconomic status, depressed economic conditions and limited economic opportunity” (8).

Research demonstrates that family dynamics and parental or caregiver involvement are significantly correlated with an individual's propensity to engage in violent behavior. A lack of parental interaction and involvement increases the risk for violence, particularly among males (9). Failure to set clear expectations, inadequate youth supervision and monitoring, and severe or inconsistent family discipline practices can also lead to criminal and violent behavior.

At the community level, the risks for youth violence include the availability of drugs and weapons, community deterioration or disorganization, and access to quality educational and recreational opportunities. Researchers have found that the prevalence of drugs and weapons in a community predicts a greater likelihood of violent behavior (10). Public policy, law enforcement, and community dynamics combine to influence the local accessibility of drugs and weapons. Within communities, the availability of drugs or weapons varies, influenced by the presence of existing violence, gang activity, or an active drug trade. These factors are connected to existing socioeconomic conditions. In a particular community, limited economic opportunities may legitimize a local drug trade, creating an alternative economy offering the potential of significant financial gain, status and power.

Community disorganization is another predictor for violent activity. This factor is defined as the presence of high crime rates, gang activity, poor housing, and general deterioration in a given community (11). These communities also may have a lack of schools and recreational facilities, limiting youth access to positive and productive development experiences. Increasingly, many parents are working beyond school hours, creating a rise in "latchkey children." Without positive after school opportunities, children are involved in drugs, gangs, and youth violence after school.

Youth violence prevention programs, such as D.A.R.E., do not to address all the environmental factors influencing youth violent behavior. D.A.R.E. fails to connect parents, schools, and communities in order to create and better protect children from all environmental hazards. Failure to include family members plays a significant role in hindering protection for youth from violence by emphasizing the importance of education and offering support. The prevention programs also do not assist to build strong community infrastructure that can create opportunities for youth to participate in activities where they have choices, decision-making power, and shared responsibility. Such experiences help them to develop new skills, increase self-confidence, and offer a chance to make a difference.

Lack of Cultural Competency
In 2001, the Youth Violence Report of the Surgeon General describes risk and protective factors for youth violence without specifically addressing cultural differences. Yet, the report suggests that cultural minorities are over-represented as both offenders and victims of violence. With a continuously increasing population of minorities that are disproportionately affected by violence, it is important to teach cultural competency to public health professionals the causes and trends in violence among minority youth.

Cultural factors play a significant role in the lives of minority youth and their families, however, culture is not always considered when designing appropriate prevention or intervention programs. Researchers have identified ethnic identity and bicultural self-efficacy as likely protective factors, while acculturation can be a potential risk factor for youth violence (12).

Studies also suggest that the process of acculturation for immigrant youth, particularly for second-generation youth, is significantly associated with delinquency and violence. A particular study done by Le and Stockdale explored the acculturation-violence link with respect to acculturative dissonance. The results revealed in a sample of 329 Chinese, Cambodian, Mien/Laotian, and Vietnamese youth that “acculturative dissonance was significantly predictive of serious violence, with full mediation through peer delinquency. The results provided support for the inclusion of cultural factors in youth violence prevention and intervention efforts” (13).

Youth violence prevention programs have yet to recognize the role of broader cultural factors affecting youth in and outside the home. In many culturally homogeneous communities, prevention programs fail to provide culturally focused non-violent alternatives for resolving conflicts appear to have higher rates of youth violence. Future violence prevention programs need to consider incorporating culturally specific strategies for ethnic youth to reduce their risk for violence. Strategies that focus on cultural competence, ethnic identity, and bicultural self-efficacy are necessary and need further structuring.

Parents Resource Institute for Drug Education or PRIDE is the nation’s oldest and largest peer-to-peer organization devoted to drug abuse and violence prevention through education. Each year PRIDE organizes, implements, and hosts the world’s largest youth drug and violence prevention conference. However, missing from the program’s conference schedule is education about culturally competency related to youth violence. The program fails to address the importance of culture and its role in youth violence.

Public health professionals also need improved education regarding youth violence risk and protective factors, including a focus on culture. A curriculum grounded in experiential learning theory is being developed that builds on these concepts. Learners will reflect on their own experiences, as well as the experiences of people in their communities to develop better approaches to address youth violence. Applying these constructs to assess multicultural youths’ relationships with their families and community may lead to more appropriate public health interventions to reduce and prevent youth violence (12).

Moving Forward
Youth violence remains a major public health problem in the U.S. and the world. Although, we continue to examine the causes and implications of youth violence in our communities, some promising areas of research may further improve and enhance existing primary prevention efforts. In particular, more research is needed in the role of social, environmental and cultural factors in influencing adolescent potential for violent behavior.

Youth violence is a complex, multifactorial issue that affects diverse communities throughout the nation. No single solution or program can fully address the problem. Therefore, more appropriate prevention programs will need to address individual, social, environmental, and cultural influences affecting our youth. As mentioned, programs such as Sacred Straight and D.A.R.E. fail to identify key factors, consequently resulting in ineffective programming.

1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS), 2006.
2. Centers for Disease Control and Prevention. Youth risk behavioral surveillance—United States, 2005. MMWR, Surveillance Summaries 2006; 55.
3. Nansel TR, Overpeck M, Pilla RS, Ruan WJ, Simons-Morton B, and Scheidt P. Bullying behaviors among US youth: prevalence and association with psychosocial adjustment. Journal of the American Medical Association 2001; 285: 2094–100.
4. Satcher, David. Surgeon General's Column. Commissioned Corps Bulletin. 2001; 3: 2.
5. Lipsey, M. W., & Wilson, D. B. Effective intervention for serious juvenile offenders: A synthesis of research. Vanderbilt Institute for Public Policy Studies. Nashville, TN, 1997.
6. Sherman, L.W., Gottfredson, D., MacKenzie, D., Eck, J., Reuter, P., & Bushway, S. Preventing Crime: What Works, What Doesn't, What's Promising. Washington, DC: U.S. Department of Justice, Office of Justice Programs, 1997.
7. T.N. Thorton, C.A. Craf, L.L. Dahlberg et al. Youth Violence Prevention: A sourcebook for community action. Nova Publishers, 2005; 110.
8. National Youth Violence Prevention Resource Center. Risk and Protective Factors for Youth Violence Fact Sheet.
9. J. David Hawkins, Todd I. Herrenkohl, David P. Farrington, Devon Brewer, Richard F. Catalano, Tracy W. Harachi, and Lynn Cothern. Predictors of Youth Violence, Office of Juvenile Justice and Delinquency Prevention, April 2000.
10. J. David Hawkins, Todd I. Herrenkohl, David P. Farrington, Devon Brewer, Richard F. Catalano, Tracy W. Harachi, and Lynn Cothern. Predictors of Youth Violence, Office of Juvenile Justice and Delinquency Prevention, April 2000.
11. J. David Hawkins, Todd I. Herrenkohl, David P. Farrington, Devon Brewer, Richard F. Catalano, Tracy W. Harachi, and Lynn Cothern. Predictors of Youth Violence, Office of Juvenile Justice and Delinquency Prevention, April 2000.
12. Soriano, Fernando; Rivera, Lourdes ; Williams, Kara; Daley, Sandra ; and Reznik, Vivian. Navigating between cultures: The role of culture in Youth violence. Journal of Adolescent Health. 2004; 34:169-176
13. Le, Thao N.; Stockdale, Gary. Acculturative dissonance, ethnic identity, and youth violence.

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