Violence continues to be a major cause of early mortality among adolescents1 despite a proliferation of prevention efforts. There is increasing recognition that a public health approach to violence prevention is necessary. A public health approach recognizes that violence needs to be addressed holistically (eg, policy considerations, social context). Rather than focusing solely on individual risk behavior, a public health approach appropriately accounts for not only individual risk factors but also the environmental and social context in which violence occurs. A public health perspective guides prevention programming, community-based interventions, and public policy through the identification of contextual factors related to violence.2 The article by Culyba and colleagues3 helps further our understanding of a public health approach to adolescent violence by studying not only individual risk behavior of youth but also the social context in which violence occurs.
The article by Culyba et al3 assesses individual and social factors that interact among different types of violence. For instance, a variety of social context protective factors (eg, social support and school engagement) were measured. The inclusion of social context protective factors furthers a public health focus on violence prevention by simply understanding that social context matters for youth. Moreover, the authors take a novel approach to depicting co-occurrence of these variables through dendrograms and heatmaps. These visualization tools are helpful in showing how context matters when exploring patterns of violence. For example, while previous research4 has consistently shown a reciprocal association between violence perpetration and being a victim of violence, hot spots (ie, clusters of strong associations) identified by Culyba and colleagues3 did not depict this association. Instead, clustered variables showed the strongest associations among types of violence perpetration, including sexual violence, dating violence, weapon-related violence, and bullying. Interestingly, gang affiliation and delinquency (eg, school suspension) were associated more closely with being a victim of violence than other types of violence perpetration. The authors rightly point out that examining more nuanced association profiles—like those that emerged in their research—can have important implications for violence prevention efforts.
By including both social support and natural mentoring relationships in the analyses, Culyba and colleagues also reemphasize the important role of social context and connections in the study of violence. Overall, youth reporting social connections in their lives evidenced fewer risk and more protective behaviors, supporting research findings that social connections are associated with positive youth outcomes. In contrast, youth with natural mentors were also more likely to show stronger associations among types of violence perpetration compared with youth without natural mentors. There were also more complex findings that warrant further discussion. Specifically, heatmaps identified youth with high social support and natural mentors in tandem with violence hot spots of sexual violence being more intense and associated with violence and bullying. This finding highlights the complex role families and mentors play in intervening with youth in communities with high levels of violence. Longitudinal research is needed to further understand this complex research finding. This finding may be explained further through identifying ideal developmental timing for intervening for youth in communities with high rates of violence. For instance, when youth are either confronted with violence or perpetrating violence, caregivers and natural mentors may become more activated and interact with youth on a more regular and intense basis. Regardless, longitudinal research exploring these dynamics can help inform violence prevention efforts.
There are several implications of the work by Culyba and colleagues.3 First, as the authors discuss, violence prevention and intervention programs need to target multiple types of violence. An exclusive focus on specific types of violence (eg, gun, dating) may limit program impact owing to the clustering of violent behaviors. Moreover, integrated approaches should also recognize that youth can both engage in violence perpetration and be victims of violence. Second, asserting the importance of natural mentors is timely. Although mentoring programs for at-risk youth have existed for many decades,5 more recently the association of these relationships with improved youth outcomes has become clearer.6 Mentorship is quite effective in improving youth outcomes. However, what is less obvious is how communities, and specifically organizations that serve youth, can foster environments that create and maintain natural, as opposed to more formal, mentorship relationships in the community. The role of natural mentors is incredibly important and the work by Culyba and colleagues3 highlights the important role these relationships have for adolescent health.
Published: September 13, 2019. doi:10.1001/jamanetworkopen.2019.11374
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Aalsma MC. JAMA Network Open.
Corresponding Author: Matthew C. Aalsma, PhD, Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th St, Ste 2025, Indianapolis, IN 46204 (firstname.lastname@example.org).
Conflict of Interest Disclosures: None reported.
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Aalsma MC. The Importance of Connection and Context in Adolescent Violence. JAMA Netw Open. 2019;2(9):e1911374. doi:https://doi.org/10.1001/jamanetworkopen.2019.11374
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