Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999
To examine the association between exposure to drug trafficking (selling or delivering drugs) and exposure to other forms of community violence and risk behaviors among urban, low-income African American children and adolescents.
Community-based, cross-sectional survey.
Ten public housing developments in a large eastern city in the United States.
Three hundred forty-nine urban, low-income African American children and adolescents (198 boys and 151 girls), aged 9 to 15 years.
Main Outcome Measures
Exposure to drug trafficking and other forms of community violence (as either a victim or a witness), risk behaviors/perceptions including risk-taking/delinquency, drug use, perpetration of violence or other crimes, threats to school achievement, and perceived peer involvement.
Exploratory factor analysis was performed to examine whether exposure to drug trafficking is a risk factor that is distinct from other exposure to violence. Multivariate analysis of variance and χ2 tests were performed to assess the relationship between exposure to drug trafficking and other forms of community violence and risk behaviors/perceptions.
Of 349 participants, 63 (18%) had been asked to traffic drugs and 134 (38%) had seen someone else being asked to traffic drugs. Factor analysis indicates that exposure to drug trafficking appears to be different from other forms of community violence. However, having been asked and having seen other people being asked to traffic drugs were both strongly associated with exposure to other forms of community violence. Compared with children and adolescents who had not been exposed to drug trafficking, those who were exposed to drug trafficking reported more risk-taking and delinquent behaviors, drug use, threats to achievement, and a perception of more peer involvement in these risk behaviors.
Exposure to drug trafficking is a unique risk factor that is strongly associated with exposure to other forms of community violence and involvement in other risk behaviors.
DRUG TRAFFICKING among children and adolescents, hereafter referred to as "youth," represents a major risk to participants.1- 6 These youth are at an increased risk of subsequent drug use, possession of a weapon, fighting, incarceration, and drug-related violence, including death.1- 8 While national prevalence data are not available regarding the practice among youth, data from low-income, urban settings suggest that as many as 6% to 9% of youth aged 9 to 15 years may be involved.1,2,9- 11
Qualitative and quantitative data suggest that exposure to drug trafficking (ie, being asked to sell drugs or seeing others being asked to sell drugs) is even more prevalent than drug trafficking. For example, in a survey of 18,348 middle and high school students from Maryland, 7% of 6th graders, 14% of 8th graders, and 24% of 10th graders reported being asked to sell drugs. The rates were higher among boys, among those with a history of drug use, and among African Americans.12 In public schools in Washington, DC, 12% of boys and 3% of girls in grades 6 and 7 were asked to sell drugs and 20% of boys and 7% of girls in grades 7 and 8 were asked to sell drugs.9
Despite the high prevalence of exposure to drug trafficking, protective and risk factors associated with this exposure have received little attention and, therefore, little is known about the relationship between exposure to drug trafficking and other forms of community violence. For example, does exposure to drug trafficking simply represent one variant of exposure to violence? That is, if a child lives in a violent community, is the likelihood that he or she will be exposed to a mugging or beating (either as a witness or victim) similar to the likelihood that he or she will be exposed to drug trafficking? Or is there a unique aspect to this exposure? Is this exposure associated with an increase in other risk behaviors, but not necessarily other exposure to violence? We undertook this study to begin exploration of these questions.
Participants were 349 African American youth (198 boys and 151 girls), aged 9 through 15 years (median age, 12 years) as of February 1, 1996, living in 1 of 10 public housing developments in an eastern city in the United States. Participants had been recruited to participate in a randomized, controlled violence prevention effectiveness trial (Neighborhood in Action). Facilitators who resided in the 10 housing developments had been identified by the appropriate tenant housing association to assist research staff in identifying eligible candidates for the study. The candidates were then approached by project staff who explained the project and invited them to participate. A small proportion of youth and/or legal guardians from each housing development declined to participate, but no data are available on the number or characteristics of those who declined. The research protocol received clearance from the institutional review board at the University of Maryland at Baltimore.
Written informed consent was provided by both the child and a parent or legal guardian. Subsequently, baseline self-report measures, consisting of 7 scales, were completed by the child. The measures required approximately 55 to 70 minutes to complete. The survey was anonymous and the youth were told that only the aggregated results would be used for research purposes and that no one would identify their individual responses. In all 10 housing developments, the data were collected in designated community spaces. Project staff were available to provide assistance when needed. Questionnaires were read to those who required assistance. Participants were paid $5 for completing the survey.
To assess exposure to drug trafficking and other forms of community violence among the participants, a modified version of the Survey of Children's Exposure to Community Violence13 was administered. The original instrument had been used previously with urban, low-income youth and showed good psychometric properties.14 Six items examined exposure to drug trafficking. The first set of 3 items examined whether the participants had been asked to sell drugs. For any positive response, these items contained several key contextual factors such as who asked them to sell drugs (eg, a family member, someone they knew, a stranger) and where they were asked to sell drugs (eg, near home, at home, near school, at school). Similarly, the second set of 3 items examined whether the participants had seen other people being asked to sell drugs, along with the same contextual factors.
Another 26 items from the Survey of Children's Exposure to Community Violence13 were used to assess the frequency of adolescents' exposure to a variety of violence-related activities other than drug trafficking. These activities included shooting, beating, carrying a weapon, knifing, killing, and drug use. For each of these activities, participants were asked whether they had been victims (11 items) and whether they had been witnesses (15 items).
Most of the questions had a 4-category response format ranging from 1 (never) to 4 (>5 times). Items related to rape, suicide, killing, and having seen a deceased person had a 3-category response: 1 (never), 2 (1 time), 3 (>1 time). For the purpose of data analysis in the current study, the last 3 categories for 4-category responses or the last 2 categories for 3-category responses were combined into a single positive response at least 1 time.
To assess drug use, perpetration of violence or other crimes, and other problem behaviors and risk perceptions, an adapted version of the Children Health and Illness Profile–Adolescent Edition15 was administered. The Children Health and Illness Profile–Adolescent Edition has been used to assess adolescent self-perceptions of psychosocial functioning and quality of life within 4 broad domains, including risk, resilience, satisfaction, and achievement. The psychometrics of this instrument, including reliability and validity, have been found to be reasonably high when administered to adolescents in both urban and rural settings.15,16 Five subscales, using 37 Children Health and Illness Profile–Adolescent Edition items, were created in the current study to assess adolescent risk behaviors/perceptions. The questions, response options, and internal consistencies of the 5 subscales, as measured by Cronbach α, are displayed in Table 1.
First, frequency distributions were examined by sex and age (children [aged < 12 years] and adolescents [aged > 12 years]) to assess the rates of exposure to drug trafficking and other forms of violence in the study sample. To examine whether drug trafficking constitutes a unique exposure to violence (or rather represents one form of a wider array of exposure to violence), factor analysis was performed with oblique rotation on violence victimization and violence witnessing, respectively. χ2 Statistics were used to examine associations of exposure to drug trafficking (as a victim or a witness) with other forms of exposure to violence and risk behaviors/perceptions.
Finally, multivariate analysis of variance was performed using all subscales (ie, victimization, witnessing, and risk behaviors/perceptions). The victimization and witnessing subscales were retained from the exploratory factor analysis, as described previously. Age and sex were included in the analysis as covariates. Both multivariate and univariate tests of significance were obtained from the analysis to assess the effect of exposure to drug trafficking from a multivariate perspective as well as from individual domains. The Pillai F test was used as the test statistic for evaluating multivariate significance because the test retains statistical power when violations of homogeneity of matrices and distributional normality are present.17 The conventional F test was used for univariate testing and the t test was used to assess the significance of covariates.
As summarized in Table 2, 63 (18%) of the youth reported having been asked to sell illegal drugs. One hundred thirty-four (38%) reported having seen someone else being asked to sell or distribute drugs. Among the 63 youth who were asked to sell drugs, 47 (75%) also had seen someone else being asked to sell or distribute drugs. More boys than girls reported having been asked to sell drugs (ie, 24% vs 13%, P<.05). Among those who witnessed another person being asked to sell drugs, there were also more boys than girls. Among those who reported having been asked, two thirds had been approached by relatives or by someone they knew. One third were approached in their home or in school.
As given in Table 3, factor analysis with oblique rotation on the 12 victimization items yielded a 2-factor structure. Factor 1 was a non–drug-related factor and consisted of 10 items. The second factor included 2 drug-related items (eg, being asked to use drugs and to sell illegal drugs).
The 16 witnessing items had a 4-factor structure. One of the factors (factor 3) consisted of only a single item related to drug trafficking; the other 3 factors, consisting of non–drug-related items, reflect different aspects of community violence. All the factors, when applicable, demonstrated an acceptable level of internal consistency with Cronbach α ranging from .69 to .83.
The previous analyses demonstrated that exposure to drug trafficking appears to be different from other exposure to community violence. However, as indicated earlier, there is substantial evidence that drug trafficking is related to other forms of violence. In Table 4, the relationship between exposure to drug trafficking and other forms of violence is examined. Generally, exposure to drug trafficking was strongly associated with other forms of exposure to violence. More youth who were asked to sell drugs reported exposure to other violent events as both victims and witnesses than children who were not asked to sell drugs. Similarly, more youth who had seen someone else being asked to sell drugs experienced various violent events as both victims and witnesses.
As discussed earlier, involvement in drug trafficking has been associated with increased involvement in other risk behaviors. Table 5 examines the relationship between exposure to drug trafficking and involvement in other risk behaviors. Youth who were asked to sell drugs were more likely to have engaged in various risk behaviors and perceived that more of their friends were engaging in risk behaviors. Those who saw other people being asked to sell drugs were more likely to have engaged in other risk behaviors and perceived that more of their friends engaged in risk behaviors.
As given in Table 6, this analysis revealed a significant main effect for exposure to drug trafficking victimization (Pillai F = 4.72, P < .001) and witnessing (Pillai F = 3.88, P < .001). The univariate tests revealed that being asked to sell drugs was significantly associated with the other victimization factor, with 1 of the 3 witnessing non–drug-related violence factors and with 2 of the 5 risk behaviors/perception factors. The witnessing of drug trafficking showed a significant main effect on other victimization and witnessing factors and 3 of the 5 risk subscales (ie, risk taking/delinquency, perpetration of violence or other crimes, and perceived peer involvement). Interaction between drug trafficking victimization and witnessing was observed only for the perpetration scale (P < .05). Among youth who had not seen other people being asked to traffic drugs, perpetration of violence or other crimes was equally likely between those who were asked to traffic drugs and those who were not (mean score, .18 vs .18). However, among those who had seen other people being asked to sell drugs, the youth who were also asked to do so were perpetrators more often than those who were not asked (mean score, .48 vs .26; P<.01). Age was a significant covariate for non–drug-related violence victimization, risk-taking/delinquency, perpetration of violence or other crimes, threats to school achievement, and perceived peer involvement. Sex was a significant covariate for witnessing nonfatal violence.
These results confirm earlier reports of very high rates of community-based exposure to drug trafficking. Almost one fifth of the youth had been asked to sell drugs and one third had seen others being asked. Of particular concern is that a high percentage of this exposure occurred in places that should be safe, such as at home and at school. This study indicates that youth who are asked to sell drugs or who see others being asked to sell drugs are at increased risk of witnessing or experiencing other forms of community violence, but does not provide support for viewing drug trafficking simply as a variant of other forms of exposure to community violence.
The data in this study indicate that exposure to drug trafficking (being asked or seeing others being asked to sell drugs) constitutes a unique factor of victimization or witnessing. The factors pertaining to exposure to drug trafficking were separate from factors relevant to other forms of community violence. However, the results also indicate that exposure to drug trafficking places the youth at risk for increased exposure to other forms of violence and for increased involvement in risk behaviors.
The fact that participants in this study comprised a convenience sample assessed in a cross-sectional rather than longitudinal manner precludes both generalization to other youth and conclusions that exposure to drug trafficking causes other risks. Also, data are self-reported and participants may have misrepresented their exposure to drug trafficking or other behaviors assessed in this study. Finally, because we did not ask whether the participants were themselves involved in drug trafficking, we cannot sort out the independent contributions of involvement in drug trafficking vs exposure to drug trafficking.
A high percentage of youth are exposed to drug trafficking. Previous studies indicate that many youth who are asked to sell drugs will subsequently become involved in drug dealing.9 A growing literature has documented the direct and indirect risks experienced by youth who become involved in drug trafficking.1- 8 Therefore, a large percentage of youth exposed to drug trafficking (either as a victim or as a witness) face numerous threats to their physical and psychological well-being.
However, to the best of our knowledge, this is the first study to demonstrate that youth who have been asked to sell drugs or have seen others being asked to sell drugs are at increased risk of experiencing other forms of violence and high rates of participation in other risk behaviors.
We can only speculate on the reasons for these associations. Clearly, some of these victims and witnesses are drug traffickers themselves. However, data from youth in similar settings and of similar age ranges indicate that only about 6% to 9% have engaged in drug trafficking.1- 3,9- 11 Thus, it is unlikely that this would fully explain the association. Another possible reason is that these youth may already be participating in behaviors that place them at risk for exposure to drug trafficking, such as drug use. However, rates of drug use among the study population are substantially lower than rates of exposure to drug trafficking,18 so this possibility is also unlikely to explain the magnitude of the association. Further, given the high rates of exposure in homes and in school, places that youth cannot avoid, it would seem likely that a substantial proportion of the exposure is beyond the control of the child.
A third possible explanation is that these youth have certain characteristics that make them likely targets for persons who seek to involve them in drug trafficking. Given the association of drug trafficking with sensation seeking,19 this explanation may offer a partial explanation and merits further study.
Regardless of the reasons for these associations, this study indicates the magnitude of the epidemic of exposure to drug trafficking and suggests a range of possible adverse outcomes. Because exposure to drug trafficking does not appear to be interchangeable with other forms of violence exposure, it is likely that different prevention programs and strategies may be needed.
Accepted for publication July 22, 1998.
This research was supported by grant U01-HS07392 from the Agency for Health Care Policy and Research, Rockville, Md (Dr Stanton).
We thank other members of the Neighborhood in Action research team, including Izabel Ricardo, PhD, Donna Howard, DrPh, Carmen Nieves, MA, Laura Rachuba, MA, and Sheila Cross, MA. We also thank the children and parents for their participation. We are also grateful to Yvonne Summers for help in preparing the manuscript.
Corresponding author: Xiaoming Li, PhD, Department of Pediatrics, University of Maryland School of Medicine, 700 W Lombard St, Baltimore, MD 21201 (e-mail: email@example.com).
Editor's Note: The question here is, which way does the correlation go? What happened first—the high-risk behavior or being asked or seeing others asked to traffic drugs?—Catherine D. DeAngelis, MD
Li X, Stanton B, Feigelman S. Exposure to Drug Trafficking Among Urban, Low-Income African American Children and Adolescents. Arch Pediatr Adolesc Med. 1999;153(2):161-168. doi:10.1001/archpedi.153.2.161