Violence and illegal drug use among adolescents: evidence from the U.S. National Adolescent Student Health Survey.

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The International Journal o f the Addictions, 27( 12). 1445-1464. 1992

Violence and Illegal Drug Use among Adolescents: Evidence from the U.S. National Adolescent Student Health Survey Paul M. Kingery, Ph.D., M.P.H.,'v* 6. E. Pruitt, Ed.D.? and Robert S. Hurley, Ph.D.*

' Health Promotion Program, Texas A&M University, College Station, Texas 77843- 1255. Telephone: (409) 845-4 14 1 Division of Health Education, Department of Health and Kinesiology, Texas A&M University, College Station, Texas 77843

ABSTRACT The relationships between violence, drug use, and victimization were examined in a representative sample of American adolescents. The commonly used illegal drugs (marijuana, amyl/butyl nitrites, psychedelics, amphetamines, and cocaine) and alcohol were considered. Drug users, compared to nonusers, fought more, took more risks which predisposed them to assault, and were assaulted more both at school and outside school supervision. Adolescents who were victims at school were also more likely to be victimized outside of school supervision. This study clearly demonstrates that the aggressor may also be the victim, and that illegal drug/alcohol use is related to victimization. Key words. Adolescent; Drug; Alcohol; Violence; Victimization *To whom correspondence should be addressed. 1445

Copyright 01992 by Marcel Dekker, Inc.

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KINGERY, PRUTT, AND HURLEY


INTRODUCTION An intimate connection has been noted between violence and drug use (Kingery et al., 1991; Watts and Wright, 1990). Certain substances (e.g., PCP, ethanol, amphetamines, and cocaine) are regularly associated with aggressive patterns of behavior (Miller and Potter-Efrom, 1989). A study of adolescents incarcerated in 26 states revealed that 40% were being held for a violent offense, more than 60% used drugs regularly, and almost 40% were under the influence of drugs at the time of their offense (Beck et al., 1988). A study of 123 urban high school girls found that violent dating incidents were preceded by drug use by both the victim (14%) and the victim's dating partner (27%) and by alcohol use (1/3 of incidents; Burcky et al., 1988). An estimated 30% of urban juveniles arrested in the District of Columbia, 49% in Maricopa County (Phoenix), Arizona, 44% in San Diego, California (only males tested), and 35% in Tampa, Florida, tested positive for illicit drug use (District of Columbia Pretrial Services Agency, 1989; Treatment Assessment Screening Center, 1989; Uniform Crime Reports, 1989). Drug and alcohol use have been linked to aggression among adults (Schubert et al., 1988; Wolf et al., 1988), but evidence of that relationship has been equivocal among adolescents. Windle and Barnes (1988) found a significant correlation between alcohol consumption and delinquent behavior among both adolescent boys ( r = .49, p < .01) and girls (r = .62, p < .01). Marijuana use, however, did not appear to make a significant independent contribution to school problems (Kleinman et al., 1988). Causal relationships between violence and drug use have not yet been established, although the evidence of their relationship is compelling.

The Magnitude of the Violence and Drug Problem Arrests for violence and illegal drug use among adolescents provide an indicator of the more serious events which occur within public view. Drug arrests peaked in the mid-1970s in this group and declined through the mid1980s, but they have begun to increase sharply again in the last few years (Uniform Crime Reports, 1970-1990). Violent crime (murder, rape, robbery, assault, burglary, larcenyltheft, and arson) are at their highest levels in history for this troubled group. Drug use and violence-related arrests among adolescents show a disturbing increase in the past few years, especially in suburban areas (Fig. 1). In general, violence and drug use are more prevalent in urban areas than in suburban or rural areas, among older adolescents than among younger ones, and among boys than among girls (Uniform Crime Reports, 1967-1991). Of all age groups, teens ages 16-19 have the highest victimization rate for violent crimes (excluding homicide), while teens ages 12-15 have the third highest

VIOLENCE A N D ILLEGAL DRUG USE AMONG ADOLESCENTS

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Percentage of Arrests 14

12 10


8

6 4 2

0 1971

1973

1975

_c

1977

Urban

1979

1981

+Suburban

1983

1985

1987

1989

-m- Rural

Fig. 1. Trends in violence, weapons, and drug-related arrests as a percentage of total adolescent arrests in the United States (age group: 13 to 16 year olds).

rate (Bureau of Justice Statistics, 1986). Among victims of violent crimes, older teens are more likely than the general population to be attacked by strangers, while younger teens are more likely to be attacked by nonstrangers (Bureau of Justice Statistics, 1987). Crime statistics must be seen as gross underestimates of the magnitude of the violence problem, however, as much of the violence in schools and in families is hidden and never prosecuted. Psychological intimidation may have as serious an effect on adolescents as overt assault and yet is not detected by crime statistics. Surveys of adolescent behavior provide an indicator of self-reported violence and drug use. R e National Adolescent Student Health Survey (1989) found that nearly four of every 10 students reported having been involved in at least one physical fight in the past year. Seven of every 10 students believed they should fight if someone hits them (78%)or hurts someone they care about (72%).While at school or on the school bus during the past year, more than one-third (34%) reported that someone threatened to hurt them, 14%reported being robbed, and 13% reported being attacked. Nearly one in five girls (18%) reported that during the past year, while outside of school supervision, someone tried to force them to have sex. One-quarter of students reported having used marijuana and 6% reported having used cocaine previously. During the previous month, 6.4%of 8th graders and 17.5%of 10th graders had used an illegal drug.


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The accuracy of self-report surveys depends heavily on the methods of administration. Some degree of apprehension on the part of vulnerable adolescents and bravado on the part of more confident adolescents may cause some contamination of the data (Besag, 1989). Some degree of privacy is generally promised to adolescents responding to drug and violence surveys. If the teacher or other school officials are present when the survey is administered, the students may be less likely to respond accurately. If the survey administrator is walking around the room while students are recording their answers, students may feel their responses will be seen and therefore conform their responses to suit the behavioral code sanctioned by adults. Students may respond more honestly if the administrator promises to (1) seal the completed questionnaires inside a box at the end of the class within the sight of the students and (2) carry the box off campus immediately after class. Hospital admissions records present a picture of the more medically serious outcomes of violence. A survey of an urban municipal hospital, for example, revealed that the majority of intentional injuries among adolescents are the result of interpersonal conflicts between acquaintances (Hausman et al., 1989). Drugs are often involved in cases where serious injury is inflicted.

Environmental Factors in the School While the drug problem in schools is widely recognized, the problem of violence is generally underestimated. Victimization in schools often occurs without adult witness. Aggressors remain silent to avoid discipline. Observers adhere to a code of silence. Victims conceal the appearance of their social failure. Administrators fear that an admission of a violence problem could be read as incompetence and reflect badly on the school. As a result, they may refuse to participate in professional investigations of violence within their schools. School violence thrives on this secrecy (Besag, 1989). The risk of violence is generally greater in situations where people are confined and lack the power to remove themselves from the situation. Researchers have documented higher rates of victimization, for example, in prisons, in domestic situations where family ties become confining, and in urban slums where people are trapped by economic forces (Besag, 1989). While every effort is made to create ideal school environments where children may grow and learn, the reality is that school children may feel “trapped” in the school environment when faced with an aggressor. Their movement and behavior in school is tightly controlled. They are prohibited from leaving by the actions of school officials, law enforcement officials, parents, and other adults. This situation increases the likelihood of aggression while eliminating normal escape routes. Violence and drug use are common in schools (Crime and Violence in the Schools, 1984). Large, crowded urban schools with limited resources and


VIOLENCE AND ILLEGAL DRUG USE AMONG ADOLESCENTS

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fewer teachers in relation to students are generally perceived as experiencing more incidents of violence and a higher prevalence of drug use (Gottfredson and Gottfredson, 1985). The perpetual presence and the effects of drugs and violence have contributed to a decline in the quality of the educational environment (National Institute of Education, 1978; McDermott, 1979; West, 1983; Educator’s Views on School Discipline, 1984; Kramer, 1987; Condition of Education, 1989; Maiuro and Eberle, 1989).

characteristics of Aggressors Adolescents fight for a variety of reasons. Many react instinctively, lacking proficiency in conflict resolution by other means than fighting. Among younger adolescents, conflicts offer opportunities to achieve social status, personal growth, interpersonal insight, conflict resolution, and heroic drama (Opotow, 1989). Adolescents who are allowed to watch violent movies or television programs may also be encouraged to resolve their problems through violent means (Hoberman, 1990). Adolescents who fight are participating in and identifying with cultural/subcultural/environmental-specific norms and/or behaviors. Most adolescents have limited involvement in fighting, with no apparent psychological underpinnings. When the violence becomes more frequent, an underlying psychological disturbance is generally found upon examination. Patterned fighting behavior can generally be traced to a number of risk factors. The schoolyard bully is one example of patterned fighting. Bullies are generally 1-2 years older and usually larger than their victims (Olweus, 1987). Besag (1989) portrays the bully as a lonely child who is socially or academically inadequate and who attacks weaker victims to compensate. Bullies usually originate in a family that neglects or abuses children, or creates an environment of violence and aggression (Roberts, 1988). They usually lose their popularity in later teenage years. Violence involving drug use is more common among older adolescents, and tends toward more severe physical injury. Studies of adolescents incarcerated for violent acts reveal a unique typology. They are often unconcerned about the consequences of their violent actions (Slaby and Guerra, 1988). They fear neither physical harm nor prosecution from school authorities, juvenile authorities, or parents. They are more often repeat offenders.

Characteristics of Victims The victims of violence may have attitudinal or behavior traits which place them at higher risk for assault. Female victims of dating violence in high school were more likely to date many people and to have been exposed to violence from their parents (Reuterman and Burcky, 1989). Sexual assault victims score significantly higher than nonvictimized girls on the Trait Anxiety


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KINGERY. PRUITT. AND HURLEY

Index and the Beck Depression Index (Gidyoz and Koss, 1989). Whether depression and anxiety invite violence or are the outcome of violence is unclear. Sexual victimization has a direct effect on self-derogation and illicit drug use (Dembo et al., 1988, 1989). Perhaps their relationship is circular. One of the more controversial issues to arise from research is the question of whether or not an adolescent can be both aggressor and victim. Besag (1989) holds that the traditional aggressor is a child bullied by others but who attacks weaker victims to compensate. The more serious juvenile sexual offenses are committed by juveniles who themselves were previously victims of physical abuse (Smith, 1988). Olweus (1978), however, states that the personality and home background of aggressors and victims are so diverse that only a few children could encompass both roles.

Methods of Intervention Efforts to curb drug use among adolescents have met with varied degrees of success. Knowledge transfer alone has generally proven ineffective (Botvin, 1986; Bangert-Drowns, 1988; Thompson, 1978). Interventions which focus on decision-making skills and values clarification have sometimes changed attitudes, but have seldom been effective in curbing substance use (Dupont and Jason, 1984; Kinder et al., 1980). The “social competency approach” attempts to build skills which enable students to resist social pressures to use drugs, and it has shown some promise (Botvin, 1986; Botvin et al., 1983). Amid efforts to solve the drug problem, few attempts have been made to stem the constantly growing violence problem. While 84 % of American eighth and tenth graders surveyed in 1987 reported having received drug education since the beginning of seventh grade, only 43% reported receiving violence education since they entered seventh grade (The National Adolescent Student Health Survey, 1989). Violence prevention programs which emphasize social skills training utilize peer role models, behavioral rehearsal, and psychodrama with apparent success (Hammond et al., 1990). Further testing of educational strategies is certainly needed.

The Need for Research Early research which draws attention to the magnitude of the violence problem among adolescents may act as a catalyst for further research and intervention designed to treat the problem. For this reason, current research efforts generally address the question of the magnitude of the violence problem as a primary focus, and ask additional basic questions about the violence problem to the extent that logistical constraints will allow. One of the greatest needs, until recently, was to assess the magnitude of the violence and drug problem among American adolescents using a nationally representative sample.



I45 1

Various health agencies collaborated in 1987 and 1988 to conduct a comprehensive study of the health of American adolescents, including attitudes and behaviors pertaining to violence and drug use. The agencies involved included the American School Health Association, the Association for the Advancement of Health Education, the Society for Public Health Education, the Department of Health and Human Services, the Public Health Service, the Office of Disease Prevention and Health Promotion, the Centers for Disease Control, and the National Institute on Drug Abuse. The first product of their work was a report issued in 1989 entitled The National Adolescent Student Health Survey (NASHS): A Report on the Health of America’s Youth. That report provided the first descriptive data from the national survey assessing the magnitude of the violence problem, but it did not address associations between variables to probe deeper questions regarding the nature of the problem. This report focuses on the drug and violence portions of the broader NASH Survey, investigating relationships between peer influences, violent behavior, drug use, and victimization among eighth and tenth graders. The primary objective of the study was to identify behavior factors related to violence and illegal drug use that identify the adolescent at risk for victimization. Particular attention was paid to the connection between violence and illegal drug use.

METHODS A detailed account of the methods of survey development and data collection is available in the broader NASHS report ( n t e National Adolescent Student Health Survey, 1989). A steering committee, composed of representatives of various health organizations and agencies, identified violence and the use of drugs and alcohol as high priorities for study. Individuals specializing in those areas were assembled to delineate the most critical knowledge, attitudes, and behaviors to be assessed in each area, and made recommendations to the steering committee. The committee then determined the specific content for survey item development, and assigned IOX (International Objectives Exchange) Associates the task of devising the survey items. Content specialists reviewed the items and provided recommendations for item revision. The survey was field tested in small focus groups of eighth and tenth grade students, and revisions were suggested by teachers and school health education specialists. Following revision, a formal field test was conducted, and the results influenced the final form of the instrument. A stratified random sampling procedure was used to obtain a representative sample of American eighth and tenth graders. A total of 230 public and private school units were selected. Of these, 176 (76%) participated in the study. The 55 school units that did not agree to participate were replaced using stratified random sampling procedures. The final sample consisted of 224 school units. Each school unit was asked to provide the names of teachers of a


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KINGERY, PRUITT. A N D HURLEY

subject required of all students (e.g., English). That list was used to randomly select three classes from each school unit to participate. Figure 2 represents a map showing the approximate location of each city in which students were sampled. Surveys were administered by eight public school teachers and four health educators who attended a half-day training workshop. They were provided with a script of oral administration directions and were trained to create an environment that would encourage candid responses from students. To assure standard administration procedures, each data collector was observed by one of the project staff during their first survey administration. Student privacy was assured, participation was voluntary, responses were anonymous, and neither the data collector nor the teacher walked around the room while the students were working. Written permission of parents was required, and 3.1 % of students who were present did not participate. Another 9.4% of the enrolled students were absent. Students were told that thousands of students across the country were taking part in the survey, that the results would be used to improve programs that focus on the health concerns of teenagers, and that most of the questions have no right or wrong answers. The questionnaire was determined to have a 7th grade reading level and required approximately 1 hour to complete. Surveys were administered in November

L+ Fig. 2. Areas sampled.

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and December of 1987 and in January of 1988. Completed questionnaires were placed in sealed envelopes at the end of the class period, sealed in boxes, and returned for processing. Data were inspected using validity checks. Approximately 3% of cases were deleted because gender or grade had not been indicated, and another 2% were deleted due to highly contradictory or unlikely information such as patterned responding (e.g., marking all “3s”). The remaining sample of students was weighted to represent America’s eighth and tenth grade boys and girls. A total of 3,789 students who completed the drug use and violence questionnaire comprised the final sample. The authors obtained the NASHS data from the Association for the Advancement of Health Education (AAHE) in computer tape format. Descriptive statistics were computed to ensure accurate transferral of the data. Summary statistics were found to accurately reflect the published NASHS results. The weights provided with the data were corrected to prevent overestimates of statistical significance. This was accomplished by dividing each weight factor by the mean of all weight factors to produce the final weights. The resulting sample size was the same as the actual sample size. Composites were formed to represent related behaviors and outcomes by summing individual items which were related in content. Ordinal responses were summed to reflect the level of the perception or behavior. The number of items used to make each composite is presented in Table 1. Fighting behavior was assessed as the frequency of fighting during the past year (0times, 1 time, 2, 3-5, 6-9, and 10 or more times). The drug use score was the sum of scores Table 1. Test-Retest Reliability (r) and Internal Consistency (alpha) of Composite Indices of Adolescent Violence and Illegal Drug Use

Composite index

Number of test items in composite

Pearson rr,- r 2

Chronbach’s alpha

4

.64

.59

4

.91

.65

9

.I5

.I2

6 9 11

.82 .85 .5 1

.I5 .86 .92

~

Frequency of being assaulted at school or on school bus Frequency of being assaulted outside of school supervision Frequency of unsafe behaviors which may lead to assault Frequency of illegal personal drug use Perceived level of illegal drug use among friends Perceived disapproval of drug use among close friends


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KINGERY. PRUITT. A N D HURLEY

for lifetime use of the commonly used illegal drugs (marijuana, amyl/butyl nitrites, psychedelics, amphetamines, and cocaine) and alcohol. The mean drug use score for all adolescents responding to the survey in a respondent’s local SMSA provided an index of the local prevalence of drug use for that respondent’s area. The frequency of unsafe behavior during the past 12 months was formed by adding scores for the number of times (0, 1-2, 3-5, 6-9, or 2 10 times) in which the student went to a dangerous place, talked to strangers who tried to hinder them, showed the money they were carrying, went on a blind date, sold items door-to-door, hitchhiked, walked alone in unsafe neighborhoods, rode empty busses or trains, and walked alone outside at night. Victimization was measured using the composite of NASH items which examined the number of times (0, 1, 2, or 2 3 ) the student had something taken from them by force or threat of harm, the number of times they were threatened but not hurt, the number of times they were attacked, and the number of times someone tried to force them to have sex against their will. Victimization was examined in two settings over the previous 12 month period: (1) while at school or on a school bus and ( 2 ) while outside of school supervision. The composite for the perceived frequency of drug use among friends was formed by summing responses indicating the number of friends (none, a few, some, most, or all) who use (1) marijuana, (2)psychedelics, (3) amphetamines, (4) crack, (5) other forms of cocaine, (6) amyl/butyl nitrites, (7) other inhalants, (8) alcohol, and (9) enough alcohol to get drunk at least once a week. The composite for the perceived disapproval of drug use among close friends was formed by summing items related to ( I ) occasional or (2) regular marijuana use, (3) using psychedelics once or twice, (4)using amphetamines once or twice, (5) using cocaine once or twice, (6) occasionally, or (7) regularly, and (8) using alcohol once/twice, (9) occasionally, or (10) regularly. Each had been scored “not disapprove,” “disapprove,” or “strongly disapprove.” The internal consistency of items within each composite and the test-retest reliability of composites were examined in a convenient sample of 74 eighth and tenth graders attending health classes in a single school district. Similar procedures were followed in presenting the survey to students as were used in the NASH survey. Students were asked to draw a unique picture on the front of their booklet that only they could identify. Pretest and posttest surveys (administered 1 week apart) were then matched by identifying similar pictures. Each behavioral composite was subjected to two-way analysis of variance by grade and gender. Students who had used any particular illegal drug three or more times in their lifetime were classified as “users” and those who had not were classified as “nonusers.” These two groups were compared on composite measures using analysis of variance. Mean z-scores were computed for the purpose of comparing grade and gender groups and for comparing users versus nonusers on composites having otherwise diverse scales.


VIOLENCE A N D ILLEGAL DRUG USE AMONG ADOLESCENTS

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Relationships between variables were examined using correlation and multiple regression analysis. The frequency of victimization at school was compared to the frequency of victimization outside of school supervision using the Pearson correlation coefficient. Frequency of drug use was compared to the frequency of unsafe behaviors, fighting, drug use among friends, and disapproval of drug use among close friends using Pearson correlations. Stepwise multiple regression analysis was performed to examine demographic and peer influence factors related to the level of drug use among adolescents. In the first step, demographic variables were allowed to compete for entry into the regression. These included grade, gender, and local prevalence of drug use. Then two additional factors were considered: perceived use of illegal drugs among friends and perceived disapproval of drug use among close friends. All results were examined at the .01 level of significance.

RESULTS The composite measures are described in Table 1. The measures showed moderate to high test-retest reliability, ranging from .5 1 for “perceived disapproval of drug use among close friends” to .91 for “the frequency of victimization while outside school supervision.” Internal consistency (Chronbach’s alpha) ranged from .59 to .92 for the various composites. Composites having fewer component items revealed lower internal consistency. Each behavioral composite was subjected to two-way analysis of variance to examine main effects for grade and gender, the interaction between grade and gender, and the total significance of the model for the individual composite. The results are presented in Table 2 and Fig. 3. Both grade and gender main effects were observed for the frequency of fighting, the frequency of victimization while at school, the frequency of unsafe behavior, and the frequency of illegal drug use. Gender and grade interactions were significant for the frequency of fighting and the frequency of victimization both at school and outside school supervision. Post-hoc analyses revealed several trends. Eighth grade boys fought the most and reported the highest frequency of being assaulted both at school (or on the school bus) and while outside school supervision. Tenth graders, compared to eighth graders, used illegal drugs more. Boys, as compared to girls, fought more and took more risks which predisposed them to assault. Users and nonusers of illegal drugs are compared on the various composites in Table 3 and Fig. 4. All findings were statistically significant, and the differences were rather striking in nearly every case. Users fought more, took more risks which predisposed them to assault, and were more often victimized both at school and outside school supervision. Students who were victimized at school were also more likely to be victimized while outside school supervision (r = .53). Drug use was related to the perceived number of friends who use


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Table 2. Two-Way Analyses of Variance on Indices of Violence and Illegal Drug Use among American Adolescents by Gender and Grade

Effect

F

P

Gender Grade Gender x Grade Total

149.26 69.29 9.59 76.03

.Ooo

Frequency of being assaulted at school or on school bus


43.40 48.71 19.03 37.03

.Ooo .Ooo .Ooo .Ooo

Frequency of being assaulted while outside of school supervision

Gender Grade Gender Total

0.77

,382 ,588


Index Frequency of fighting in the past year

Frequency of unsafe behaviors which may lead 10assault

Frequency of illegal personal drug use

X

Grade

0.29 8.26 3.11

.m .002 .Ooo

.004 ,026 .Ooo


137.89 17.26 1.92 52.51

,166 .Ooo


16.68 149.54 5.61 57.26

.Ooo .Ooo ,018 .Ooo

.m

illegal drugs (r = .60), to the frequency of unsafe behavior (r = S O ) , and to perceived disapproval of drug use among close friends (r = - .45). The results of the multiple regression analysis are presented in Table 4. Grade, local prevalence of drug use, and gender explained 6% of the variance in the frequency of drug use among adolescents. After these factors were considered, the perceived number of friends who use illegal drugs and perceived disapproval of drug use among close friends explained an additional 35% of the variance in drug use, for a total explained variance of 41 %. Levels of illegal drug use were higher among boys, tenth graders, and adolescents living in areas having a higher mean prevalence of drug use. Adolescents who used drugs more frequently had more friends who used illegal drugs compared to their nonusing counterparts, and had fewer close friends who disapprove of the use of illegal drugs.


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Boys-8th

0.38


Girls-8th

Boys-10th

Girls-10th 7--

-0.4

-0.3

-0.2

-0.1

0

0.1

0.2

m Drug Use

Unsafe Activities

@&!

Victim “on-School)

Victim (School)

0.3

0.4

0.5

Fighting

Fig. 3. Risk behavior and victimization among adolescents by gender and grade (mean z-score on variable for group).

Fighting

Unsafe Activities ~~~

~

Victim (School)

Victim (Non-School)

-0.2

o

0.2 0.4 0.6 0.8 Mean z-Score for Group

I

1.2

Fig. 4. Drug use (illegal use of drug 3 or more times) and related factors among American adolescents.

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KINGERY, PRUITT, AND HURLEY

Table 3. Differences between American Adolescents Who Have Used Illegal Drugs/Alcohol Three or More Times (n = 370)in the Past 12 Months and Those Who Have Not (n = 3,304) on Indices of Fighting, Assault, and Risk Behavior Group

Meanz

S.D.

F

P

Frequency of fighting in the past year

User Nonuser

0.51 -0.07

1.20 0.95

142.90

.Ooo

Frequency of being assaulted at school or on the bus

User Nonuser

0.35 -0.04

1.43 0.93

50.25

.Ooo

Frequency of being assaulted outside of school supervision

User Nonuser

1.29 0.95

19.14

.Ooo

-0.05

Frequency of unsafe behaviors which may lead to assault

User Nonuser

0.95 -0.10

1.35 0.90

394.90

.m


Index

0.44

DISCUSSION Eighth grade boys were most commonly both the perpetrators and victims of violence. Of the four age and gender groups examined, eighth grade boys were the ones most frequently involved in fights and were the ones most frequently assaulted both at school (or on the school bus) and outside school supervision. Fighting among eighth grade boys, in the absence of heavy drug use, cannot be blamed on the effects of drug use. The more likely case is that they were fighting mainly among themselves, perhaps because they acted instinctively to hostile aggression in a tightly controlled environment where fighting is commonplace and because both they and their counterparts lacked Table 4. Stepwise Multiple Regression Analysis of the Factors Associated with Illegal Drug Use in a Representative Sample of American Eighth and Tenth Graders (N = 3,789) Variable Step 1 : Demographic variables: Grade Local prevalence of drug use Gender Step 2: Peer influence: Drug use among friends Disapproval of drug use among close friends

R

R2

F

P

0.20 0.23 0.24

0.04

139.43 95.02 69.61

.ooo

0.05 0.06

0.61

0.31

501.29

.Ooo

0.64

0.41

454.59

.Ooo

.Ooo .Ooo



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the skills to resolve their disputes by other means. They may have been influenced by the violence in their immediate environment as well as the violence they see glamorized on television and in the movies. Some may be fighting to compensate for psychological disturbances related to abuse, neglect, or academic and social deficiencies. While eighth grade boys were most often the perpetrators and victims of violence, tenth grade boys more often used illegal drugs. Tenth grade boys used illegal drugs more frequently than girls or younger boys. Similarly, boys (particularly tenth grade boys) entered dangerous situations more often than girls. Drug use was related to the perceived number of friends who use illegal drugs, the frequency of unsafe behaviors, and perceived disapproval of drug use among close friends. Violence among these older adolescents, in the presence of illegal drug use, is probably of a more serious nature. To some degree their aggression may be attributed to the means of acquiring drugs or to the use of drugs. Several factors were coincident among adolescents during a 12-month period: Using illegal drugs, having friends who use illegal drugs, having close friends who do not disapprove of using illegal drugs, unsafe behaviors, and being a victim of violent assault. Adolescents who live in places where illegal drug use is more common are at higher risk for the other problems in this group. Peer influence appears to be a strong force in the decision to use drugs. Drug use may draw these adolescents into dangerous situations. Conflicts which arise over drug deals, or while under the influence of drugs, may be more dangerous than those which occur among younger adolescents in the absence of heavy drug use. Future research which examines violence among adolescents should examine differences between younger and older adolescents in the severity of violence.

CONCLUSIONS Violence and drug use are on the rise among American adolescents. The two problems are significantly related among 13 to 16-year-olds. Violence is more prevalent among younger adolescents while illegal drug use is more prevalent among older adolescents. Violence among older adolescents, as compared to younger adolescents, is more likely to involve illegal drug and alcohol use. Further research is needed to determine whether violence which occurs among drug users has more serious health consequences than violence which occurs among nonusers. If violence is more severe among drug users, a resurgence of drug use among adolescents would be a greater threat to the health of adolescents than was expected. Victim-blaming is an easy way out of dealing with the problems of violence and drug use. This study clearly demonstrates, however, that the perpetrator of violence is also the victim of violence, and that the drug user is


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more likely to be a victim of assault. Adolescents identified as drug users should be considered at higher risk for victimization. Early identification of high-risk adolescents and referral to sound interventions is critical to the safety of adolescents. Parents and school officials blaming one another for the victimization of adolescents is as misdirected as blaming the adolescent. Juvenile services agencies often act as the revolving door through which the troubled adolescent passes between school, community, and home, each of which blames the others for the problem. The solution to the violence problem must involve the student, parents, school officials, and juvenile authorities working together. Drug education is fairly common among adolescents. If prevention/ intervention programs are of poor quality and/or ineffective, however, the actual number of these programs is irrelevant. Violence education is seldom systematically attempted. Children can learn appropriate ways to avoid fighting, learn to deal with their feelings in other ways, learn to communicate better and to resolve conflicts peacefully, learn which behaviors place them at higher risk for victimization, learn to resist peer influences, and learn how to get help when they are afraid. The fact that violence and drug use are intertwined suggests that violence education should be linked with drug education. Effective strategies for both are desperately needed. Further research is needed to unravel the complexities of violence and drug use among adolescents. Findings will be more helpful if researchers provide meaningful comparisons between adolescents living in urban, suburban, or rural areas, in stable or unstable environments, cohesive or volatile environments, those who are economically advantaged or disadvantaged, and other risk-factor groupings. The success/failure rates of specific intervention methods should be carefully measured to allow comparisons. Violence and drug education, in the meantime, is hindered by our limited knowledge of the behaviors which place one at risk for violence and by the lack of proven intervention strategies. Intervention should continue, nevertheless, as innovators grapple with an immediate and growing violence problem among American adolescents.

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THE AUTHORS Paul M. Kingery received his masters degree in African Studies from the University of Florida, his M.P.H. degree in International Health from the University of Texas, and his Ph.D. in Community Health from the University of Oregon. He worked for 2 years with Zulus in South Africa. He has served for the past 5 years as Assistant Professor of Health Education at Texas A&M University where he also now serves as Director of the Health Promotion Program.

B. E. Pruitt received his B.S. from the University of Texas, his M.Ed. from Southwest Texas State University, and his Ed.D. from the University of North Texas. He is currently Associate Professor of Health Education at Texas A&M University and Adjunct Professor of Allied Health at Baylor College of Medicine.



Robert S. Hurley received his master’s degree at the University of Michigan and his Ph.D. at the University of Utah. He has served for the past 16 years as Professor and Chair of Health Education at Texas A&M University. His professional interests include curriculum development and health promotion among adolescents.

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