Arizona's Response to Increased Collegiate Gun Violence: A Paradox – Tanya J. Bascombe

In the U.S., gun violence continues to be a threat to the well-being of society. According to data from the Federal Bureau of Investigation, violent crime increased 1% between 2005 and 2006 [1]. Although this may seem to be a non-significant increase, any increase amplifies the current issue of gun violence. Between 1993 and 2001 the FBI received 160,396 reports on murders and non-negligent manslaughters of persons age 12 or older from local law enforcement agencies [2]. Listed as focus area #15 by Healthy People 2010, it is the goal of public health to reduce the actions and effects of gun violence. Objective 15 – 3 of this focus area reflects the goal to reduce the number of firearm-related deaths from 10.3 deaths per 100,000 to 3.6 deaths per 100,000 by 2010 [3]. Objective 15 – 5 of this focus area simultaneously seeks to reduce the numbers of nonfatal firearm-related injuries from 23.5 injuries per 100,000 to 9.1 injuries per 100,000 by 2010 [3]. In spite of these aims, decreasing gun violence has often come in the form of gun control and legislative restrictions on the sale of guns rather than by usual public health prevention measures.
There have been efforts to reduce the number of deaths and injuries from gun use in the nation overall through the implementation of specific gun control laws. However, such laws have not been successful in the wake of terrifying acts of gun violence specifically within school settings during the past 10 years. Of the 172 homicides of both students and non-students that took place at school or on school property in the U.S. between 1994 and 1999, 69% were committed with a firearm. Of the firearm homicides at school, 75% were committed with handguns [2]. Gun violence in schools and on school grounds proves to be a concerning and pressing issue to be addressed in the U.S. On April 20, 1999, two high school gunmen opened fire in Littleton, Colorado's Columbine High School killing 12 students, one teacher, and wounding 24 others before killing themselves [4]. In another incident on April 16, 2007, an armed gunman opened fire in a lecture room at Virginia Tech killing 32 people and wounding 25 others before killing himself [5]. The Virginia Tech shootings were preceded by deadly violence on at least 12 other college campuses dating back to the well-known Kent State shootings of 1970 [6]. Most recently on February 18 earlier this year, an armed gunman opened fire at Northern Illinois University killing 5 people and wounding 16 others before killing himself [7].
Arizona's Response: Senate Bill 1214
In response to these recent college shootings, Arizona State Senator Karen S. Johnson has sponsored a bill in an effort to reduce the risk of gun violence in Arizona schools. According to the bill, people with a valid concealed weapons permit would be allowed to carry their firearms at public colleges and universities within the state of Arizona [8-9]. The bill, SB1214, would apply to all individuals over the age of 21, including students, faculty and staff [8].The belief that the shootings at Northern Illinois University could have been prevented or limited if an armed student or professor had intercepted the gunman is the basis of SB 1214 [8]. Senator Johnson initially wanted the bill to apply to all public schools from kindergarten through college education [8].
Perhaps Arizona's personal history of college gun violence has also influenced the proposal of SB1214. In October 2002 an Arizona nursing student at the University of Arizona Nursing College opened fire, killing three others and then himself [5]. Arizona has always been considered a "gun-friendly" state where individuals are allowed to carry weapons openly in public [10]. In light of Healthy People 2010's initiative to reduce gun violence, Arizona's gun proposal is not an appropriate response. Arizona's proposed bill to decrease the risk of gun violence on college campuses is set up for failure because it does not address the actual causes of gun violence, it does not target the appropriate audience and, it is in itself a contradictory initiative that is likely to result in a higher level of gun violence overall.
SB 1214 does not address the causes of gun violence.
One of the most important aspects of any intervention concerns the context in which the issue is framed. Unfortunately, the Arizona Senate has provided a 'downstream frame' of the issue, reflective in the bill itself. A downstream frame aims to solve a problem by focusing mainly on the consequences of a problem rather than on the causes of the problem. This downstream frame responds to the incidents of NIU and VA Tech by addressing the effects of gun violence: fear and feelings of less security. Instead, the proposed bill set forth by the senate should adopt an 'upstream frame' by attempting to prevent gun violence by addressing its fundamental causes. Arizona law makers did not consider contextualizing the issue of gun violence before proposing this bill. Had they considered fundamental causes, the Senate would have recognized that there are certain risk factors in place that in turn put people at risk of gun violence [11].
The Ecological Model correctly assumes that behavior is influenced by the complex interactions between the individual and the environment [12]. The proposed bill, however, has equated the lack of guns for protection as a possible risk factor for gun violence. Even if this were the case, Link and Phelan confirm that there are some public health problems that have a fundamental cause whereby nothing happens when a proximal risk factor is eliminated [11]. This means that eliminating the risk of lack of guns by increasing the number of guns on college campuses will not guarantee a decrease in gun violence on school grounds. Underlying/fundamental causes of gun violence may possibly include mental illness of the individual, school-related stress, inadequate social supports, etc. Finding the specific markers that lead to increased risk of violence should be an integral part of public policy [6]. Overall, the bill neglects these possible underlying causes and instead puts too much emphasis on ways to respond to gun violence.
SB 1214 inappropriately targets the individual and uses coercion
As previously stated, SB 1214 inherently neglects the impact of societal influences on gun violence. Similar to the Health Belief Model, SB 1214 seeks to decrease gun violence by solely influencing the behavior of the individual. It is easy to target the individual as a possible means of controlling gun violence, but the issue of violence reflects a larger issue at hand. The Health Belief Model has proven to be inadequate because you cannot assume that an individual will start or end a behavior based solely on intention [12]. It is not realistic to think that a gunman who wants to kill himself and others would be deterred by a "gun-friendly" environment for fear of being killed. The Ecological model confirms that individual actions are reflective of socioeconomic circumstances, environmental conditions, or public policies and regulations [12]. Public policies such as SB 1214 should instead target issues surrounding gun availability and the sale of guns to unstable individuals, on-campus security and rapid response measures, and on-campus support facilities for individuals with mental health problems.
Currently, SB 1214 has been proposed in the Power-Coercive form of intervention. The power-coercive form of intervention uses force via the law in order to change people's behavior. In this case, SB 1214 powerfully encourages students, faculty, and staff to carry weapons by allowing it in state law. This strategy does not seek to inform the individual on the safe practices of gun use, or how to use a handgun in the event of an on-campus shooting. According to the Arizona Department of Public Safety's website, it is likely that college students will not know how to adequately respond to a campus shooting emergency with the same level of skill as trained professionals [10]. The firearms safety training that must be satisfactorily completed by each concealed weapons permit holder is not enough to ensure that the student or faculty member will know how to respond in an emergency [8]. An alternative to the power-coercive model of the bill is the normative-re-educative model; this model would seek to change social norms and thinking about gun use.
SB 1214 faces opposition by public opinion and may result in higher gun violence.
The success of any public health intervention or policy can be largely determined by its acceptance among the target population. A well supported intervention by the public will most likely be far more successful in reaching the target goal. Although Arizona is generally a gun-friendly state, SB 1214 has been met with great public opposition. A recent telephone poll conducted by the Walter Cronkite School of Journalism in Arizona found that 73% of Arizona voters would oppose a bill allowing the carrying of concealed weapons on a college campus [13]. Only 20% of polled voters were in support of the bill while 7% remained undecided on the issue [13]. Opposition also comes strongly from the college administration. According to a newspaper article, University of Arizona president Robert Shelton expressed his opposition to the bill in an email [14]. Some faculty of the University of Arizona expressed that campus disputes would be heightened and result in more deaths with more guns on campus [14]. It is against the ideals of public health and the goals of Healthy People 2010 to "force" individuals to perform a behavior that is not accepted by the community.
The Social Learning Theory upholds that modeling leads to behavior [12]. SB 1214 seeks to decrease gun violence by increasing the number of weapons in an area to deter potential criminals from attempting a killing spree. However, applying social learning theory to SB 1214, it is assumed that having guns on campus will further encourage the use of guns as a threat and/or defense mechanism for students on campus and to society as a whole. Encouragement of such behavior will result in an increase in fear and an increase in gun violence. The main flaw within the social learning theory is that it may sometimes encourage behaviors opposite of what is being modeled. Any intervention modeled after social learning theory, such as SB1214, will be too narrow to be useful.
Other than the theoretical flaws found in the proposed bill in relation to public health, there are other more logical issues to consider. It is generally thought by some supporters of the bill that any armed citizen could have stopped the mass murders at VA Tech [15]. However, allowing everyone to carry guns on a college campus would make the situation more dangerous in the event of a VA Tech-like shooting. This law would make it hard for the police to sort a dangerous man from a crowd of others with guns [8]. The Brady Center and Brady Campaign to Prevent Gun Violence released a report stating that college gun owners are more likely to participate in activities that would put others at risk for life-threatening injuries [16]. All in all, adding more guns to an already dangerous and life-threatening situation would further cause more confusion and ultimately more deaths and injuries.
Conclusion
It is evident that SB1214 share the same goals set forth by Healthy People 2010 focus area 15: to reduce the incidence of death and injury from gun violence. However, it is also clear that SB1214's method of intervention can lead to an increase in gun violence instead of a decrease. The proposed bill does not attempt to define or examine the underlying causes of campus gun violence and neglects the influence of societal factors in aiding the incidence of gun violence. The bill, taking the stance of the Health Belief Model, mainly focuses on the individual rather than on other institutions such as gun sellers, campus police, and support staff. These flaws along with faint support from Arizona residents reflect the strong impossibility of SB1214 to successfully reduce gun violence. It has been proven that there is no basis that right-to-carry laws impact violent crime [17]. Therefore, a new initiative that encourages all people to drop their weapons instead of pick them up is needed in order to reduce gun violence in the U.S.
References
1. FBI. Uniform Crime Reports: 2007 (Preliminary) Table 3. Federal Bureau of Investigation. Retrieved from http://www.fbi.gov/ucr/ucr.htm
2. Perkins C. National Crime Victimization Survey, 1993-2001: Weapon Use and Violent Crime. Bureau of Justice Statistics Special Report (September 2003) Retrieved from http://ojp.usdoj.gov/bjs/pub/pdf/wuvc01.pdf
3. CDC. -Injury and violence prevention. Healthy People 2010 midcourse review 2007. Retrieved from http://www.healthypeople.gov/data/midcourse/pdf/fa15.pdf
4. Jefferson County. Sheriff's Report. Retrieved from http://www.cnn.com/SPECIALS/2000/columbine.cd/Pages/TOC.htm
5. Smith L. Major Shootings on American College Campuses (Chronology). The Chronicle of Higher Education 53.34 (April 27,2007) Retrieved from http://find.galegroup.com.ezproxy.bu.edu/itx/starts.do?prodId=AONE
6. Jenson JM. Aggression and Violence in the United States: Reflections on the Virginia Tech Shootings. Social Work Research 31: 3:131 – 134.
7. Bohn K. 6 shot dead, including gunman, at Northern Illinois University. CNN.com (February 14, 2008) Retrieved from http://www.cnn.com/2008/US/02/14/university.shooting/#cnnSTCText
8. Archibold RC. Arizona weighs bill to allow guns on campuses. The New York Times (March 5, 2008). Retrieved from http://www.nytimes.com/2008/03/05/us/05guns.html
9. State of Arizona Senate. SB1214: An act amending section 13-3102, Arizona revised statutes; relating to weapons. Forty-eighth Legislature 2008: 2nd Regular Session
10. Daily Bruin. Editorial: Dangers of lax gun laws outweigh the benefits. The Daily Bruin (March 7, 2008) Retrieved from http://dailybruin.com/news/2008/mar/07/editorial-dangers-lax-gun-laws-outweigh-benefits/
11. Link BG, Phelan J. Social conditions as fundamental causes of disease. Journal of Health and Social Behavior 1995; 35(extra issue):80 – 94.
12. Edberg M. Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones and Bartlett Publishers, 2007.
13. Eight/KAET. Cronkite-Eight Poll. Horizon Website Retrieved from http://www.azpbs.org/horizon/poll/
14. Santa Cruz N. Officials resist gun bill. Arizona Daily Wildcat (January 30,2008) Retrieved from http://media.wildcat.arizona.edu/media/storage/paper997/news/2008/01/30/News/Officials.Resist.Gun.Bill-3176218.shtml
15. American City and County. Platform: Local Gun Control. American City and County May 2007: 8 – 10. Retrieved from www.americancityandcounty.com
16. Lane R. Arizona Senator wants students to bear arms. The Marquette Tribune (March 11, 2008). Retrieved from http://media.www.marquettetribune.org/media/storage/paper1130/news/2008/03/11/News/Arizona.Senator.Wants.Students.To.Bear.Arms-3261558.shtml
17. Black DA, Nagin DS. Do right-to-carry laws deter violent crime? Journal of Legal Studies 1998; 27:209 – 219.

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.

References
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. http://www.safeyouth.org
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.