the psychological consequences to adolescents of exposure to gang violence in the community: an...

The Psychological Consequences to Adolescents ofExposure to Gang Violence in the Community:An Integrated Review of the Literaturejcap_225 61..73

Sarah Kelly, RN, PhD

PROBLEM: Gang violence affects many

adolescents in the United States, and there

has been an increase in violent crimes

against adolescents in recent years.

METHOD: A literature review examined

studies related to gang violence.

FINDINGS: Little research has focused on

adolescents’ exposure to gang violence and

its effects on adolescents’ mental health.

Adolescents develop internalizing symptoms

and externalizing behaviors after exposure to

violence; but other factors influence

adolescents’ exposure and reaction to

violence.

CONCLUSION: With the increase in gang

violence over the years, more research is

needed on gang violence and its effects on

adolescents and their mental health.

Search terms: Adolescents, exposure to

community or gang violence, psychological

problems

Sarah Kelly, RN, PhD, is Assistant Professor, School ofNursing, University of North Carolina at Greensboro,North Carolina.

Gang violence is an escalating public health problem inour society (Denninghoff, Knox, Cunningham, & Partain,2002; Goguen, 2005; Kyriacou, Hutson, Anglin, Peek-Asa, &Kraus, 1999). The National Youth Gang Survey (NYGS) hasestimated that there are 24,000 active gangs in the UnitedStates, and according to the Department of Justice: Office ofJustice Programs (OJP), there are 760,000 active gangmembers (Department of Justice, OJP, 2006). Most gang vio-lence is committed against African Americans or Hispanics,males, and adolescents aged 12–19 (Department of Justice,OJP, 2005). Violent crimes against adolescents have grownfrom 10 per 1,000 in 2002 to 18 per 1,000 in 2003. In 2000,approximately 23% (446,000) of the victims of violent crimeswere adolescents aged 12–17 (Crimes against ChildrenResearch Center [CCRC], 2002). Further, from 1993 to 2005,adolescents aged 12–17 were more likely to be victims ofviolent crimes than adults.

Numerous studies have focused on community andschool violence exposure, adolescents’ reaction to it, and theneed for posttrauma medical care (Cooley-Quille, Boyd,Frantz, & Walsh, 2001; Farver, Xu, Eppe, Fernandez, &Schwartz, 2005; Finkelhor, Ormrod, Turner, & Hamby, 2005).According to the National Center for Children Exposed toViolence (2006), community violence is any act of interper-sonal violence towards an individual by another individualwith no relationship to the victim. Common forms of com-munity violence include physical and sexual assaults, shoot-ings, acts of violence committed by gang members, drugs,and burglary. Gang violence is defined more narrowly as anyphysical interaction involving active gang members, either asthe victim or perpetrator (Hutson, Anglin, & Pratts, 1994).However, in several studies, gang violence has been treatedas part of community violence (DuRant et al., 2000; Farveret al., 2005).

Adolescents who witness violence in the community canhave profound psychological problems (Farver et al., 2005;Finkelhor et al., 2005; Goguen, 2005). Bronfenbrenner (1979)described human development as an interaction betweenthe ecological environment and the growing child, andthis conceptualization provides a useful framework for

doi: 10.1111/j.1744-6171.2010.00225.x© 2010 Wiley Periodicals, Inc.

Journal of Child and Adolescent Psychiatric Nursing, Volume 23,Number 2, pp. 61–73

JCAPN Volume 23, Number 2, May, 2010 61

understanding the effects that exposure to gang violence canhave on adolescents. The interaction between adolescentsand the environment, in this case exposure to gang violenceand adolescents, may have a negative impact on their devel-opment and behavior, leading to mental health problems.Few studies, however, have focused specifically on adoles-cents’ exposure to gang violence and its effects on theseadolescents (Bility, 1999; Stoll, Dukes, & Smith, 1997; Zun &Rosen, 2003). This review of literature explored the question:“what are the effects of exposure to gang violence on adoles-cents’ psychological health?” The studies included in thisreview rely on these definitions of community and gangviolence, and exposure was defined as witnessing any gangrelated violent act in the community.

Methods

Medline, ERIC, Pubmed, Psycho Info, Social WorkAbstracts, Sociological Abstracts, and Academic SearchPremier were used to search the literature from 1990 to 2008.Keywords and phrases used were community violence andadolescents, gang violence and adolescents, exposure tocommunity violence, and exposure to gang violence. Criteriafor inclusion in the review included specific references toexposure to gang violence or the use of a survey reflectingexposure to community violence that included items relatedto gang violence, adolescent respondents, and the develop-ment of psychological issues after exposure to the violence.Articles also had to be published in peer-reviewed journals,in English.

The databases used to search the literature yielded 103studies (see Table 1). Many of the studies focused on adoles-cent experiences with exposure to community violence, withno mention, however, of exposure to gang violence and ado-lescents’ reactions to exposure to violence. Fifteen studiesincluded gang violence as a part of community violence, andtwo studies focused specifically on the impact of gang vio-lence on adolescents. Thus, 17 studies met the criteria forinclusion in the review (see Table 2).

Findings

Exposure to violence in the community is not uncommon.Adolescents living in violent communities have describedexperiences with various forms of community violence(DuRant et al., 2000; Ho, 2008; van der Merwe & Dawes,2000), and several researchers have reported that many ado-lescents encounter gang violence in their community (Bility,1999; Hill & Jones, 1997; Kliewer et al., 1998; Stoll et al., 1997).A variety of instruments, including Richters and Saltzman’s(1990) Survey of Exposure to Community Violence (SECV),have been used to measure exposure to community violence.The SECV contains 54 items that focus on acts of community

violence, including gang violence, selling drugs, policearrests, and physical and sexual assault. This instrument hasbeen used to measure children’s or adolescents’ direct (vic-timization) and indirect (witnessing) exposure to violence inthe community, either in its original form or in a modifiedversion (Barkin et al., 2001; DuRant et al., 2000). Fourteenstudies included in this review used the SECV in its originalor modified form to explore adolescents’ exposure to com-munity violence (see Table 1).

Externalizing Behaviors or Aggressionand Violence

Investigators have used cross-sectional surveys, informalfocus groups, and direct observations to examine the influ-ence that gangs and gang violence have on adolescents andtheir mental health. For many adolescents, their encounterswith community and gang violence influence their behaviors(Barkin et al., 2001; DuRant et al., 2000; DuRant, Cadenhead,et al., 1994; DuRant, Pendergrast, et al., 1994; DuRant et al.,1996; Ho, 2008). Use of violence, intent to use violence, andaggression, all of which are termed externalizing behaviors,have all been associated with adolescents’ exposure to com-munity violence.

Investigators have used cross-sectional

surveys, informal focus groups, and direct

observations to examine the influence that

gangs and gang violence have on adolescents

and their mental health.

In an early study, DuRant, Cadenhead, et al. (1994)reported that adolescents’ use of violence was associatedwith their exposure to community violence. A second studysuggested that adolescents’ physical fights and attacks,aimed at someone they lived with, were linked to their expo-sure to community violence (DuRant, Pendergrast, et al.,1994). In a study of 225 adolescents, DuRant et al. (1996)found a significant relationship between exposure to com-munity violence and adolescents’ intent to use violence.Barkin et al. (2001) also reported that exposure to communityviolence was associated with adolescents’ intent to use vio-lence. Similarly, Ho’s (2008) recent study of adolescents ofCambodian and Vietnamese descent found that exposure tocommunity violence was associated with adolescents’aggression and rule-breaking behavior. However, Ho also

The Psychological Consequences to Adolescents of Exposure to Gang Violence in theCommunity: An Integrated Review of the Literature

62 JCAPN Volume 23, Number 2, May, 2010

Table 1. The Articles Reviewed for Inclusion in the Review of Literature

Articles

Inclusion criteria

Reference to gangviolence or the a surveythat included itemsrelated to gang violence

Adolescentrespondents

Development ofpsychological issuesafter exposure toviolence

Aisenberg (2001) XAisenberg and Herrenkohl (2008) X XAisenberg, Ayon, and Orozco-Figueroa (2008) X XBailey, Hannigan, Delaney-Black, Covington, and Sokol (2006) X XBailey et al. (2005) X XBarkin, Kreiter, and DuRant (2001) X X XBerman, Kurtines, Silverman, and Serafini (1996) X XBility (1999) X X XBoyd, Cooley, Lambert, and Ialongo (2003) XBuka, Stichick, Birdthistle, and Earls (2001) X XCarothers, Borkowski, and Whitman (2006) XCeballo (2000) X XCeballo, Dahl, Aretakis, and Ramirez (2001) X XCooley, Boyd, and Grados (2004) X XCooley-Quille et al. (2001) X XCooley-Quille, Turner, Beidel (1995) X XCurry, Latkin, and Davey-Rothwell (2008) X XDempsey (2002) X XDuRant, Pendergrast, and Cadenhead (1994) X X XDuRant, Cadenhead, Pendergrast, Slavens, and Linder (1994) X X XDuRant, Getts, Cadenhead, Emans, and Woods (1995) X X XDuRant et al. (1996) X X XDuRant et al. (2000) X X XEdlynn, Miller, Gaylord-Harden, and Richards X XEitle and Turner (2002) XErwin (2002) X XFarrell and Bruce (1997) X XFarver, Natera, and Frosch (1999) X XFarver et al. (2005) X XFerreira-Pinto, Ramos, and Mata (1997) XFinkelhor, Ormrod, Turner, and Hamby (2005) X XFoster, Kuperminc, and Price (2004) X X XGorman-Smith and Tolan (1998) X XGrant et al. (2005) X X XGrant et al. (2004) X XGrogan-Kaylor, Ruffolo, Ortega, and Clarke (2008) X XGuterman and Cameron (1999) X XHaden and Scarpa (2008) X XHammack, Richards, Luo, Edlynn, and Roy (2004) X XHill and Jones (1997) X X XHill and Madhere (1996) X XHo (2008) X X XHuston et al. (1994) X XJones (2007) X XKennedy and Bennett (2006) XKliewer, Lepore, Oskin, and Johnson (1998) X X XLambert, Ialongo, Boyd, and Cooley (2005) X XLuna (2006) X XLynch and Cicchetti (2002) X X XMalik (2008) X XMargolin and Gordis (2000) X X


Table 1. Continued.

Articles

Inclusion criteria

Reference to gangviolence or the a surveythat included itemsrelated to gang violence

Adolescentrespondents

Development ofpsychological issuesafter exposure toviolence

Martinez and Richters (1993) X XMazza and Reynolds (1999) X XMcGee, Barber, Joseph, Dudley, and Howell (2005) X X XMinnis et al. (2008) X XMrug, Loosier, and Windle (2008) X XMurphy, Rosenheck, Berkowitz, and Marans (2005) X XO’Keefe (1997) X XOrdog, Shoemaker, Wasserberger, and Bishop (1995) X XOverstreet and Braun (2000) X XOzer (2005) X XOzer and McDonald (2006) X XOzer and Weinstein (2004) X XPatchin, Huebner, McCluskey, Varano, and Bynum (2006) XProctor (2006) X XPynoos and Nader (1990) X XRatner et al. (2006) X XRichters and Martinez X XRosenthal (2000) X XRosenthal and Wilson (2003a) X XRosenthal and Wilson (2003b) X XSalzinger, Ng-Mak, Feldman, Kam, and Rosario (2006) X XSanders-Phillips (1997) X XScarpa (2001) X XScarpa and Haden (2006) X XScarpa et al. (2002) X XSelf-Brown et al. (2006) X XSheidow et al. (2008) X XShields, Nadasen, and Pierce (2008) X XSieger, Rojas-Vilches, McKinney, and Renk (2004) XSinger, Anglin, Song, and Lunghofer (1995) X XSkeem et al. (2006) X XSpano, Rivera, and Bolland (2006) X XStoll et al. (1997) X X XSweatt, Harding, Knight-Lynn, Rasheed, and Carter (2002) X XSwetnam and Pope (2001) X XTaylor and Kliewer (2006) X X XTaylor et al. (2008) X XThompson and Massat (2005) X XTonorezos et al. (2008) X XUsta and Farver (2005) X Xvan der Merwe and Dawes (2000) X X XVernberg and Jacobs (1999) X XWall and Levy (2005) X XWalsh, MacMillan, Trocme, Jamieson, and Boyle (2008) X XWatkins (2008) X XWhite, Bruce, Farrell, and Kliewer (1998) X XWilson and Rosenthal (2003) X XWingood et al. (2002) X XYoungstrom, Wiest, and Albus (2003) X XZavaschi, Benetti, Polyanczyk, Soles, and Sanchotene (2002) X XZun and Rosen (2003) X X



Table 2. Adolescents’ Exposure to Gang Violence in the Community and the Methods and Instruments Used to MeasureThis Phenomenon

Author/date Purpose Subjects

Research methods andinstruments used tomeasure exposure toviolence Results

Barkin et al.(2001)

To examine adolescents’exposure to violence and intentto use violence

702adolescents

Cross-sectional survey• Survey of Exposure to

Community Violence(SECV)

Intent to use violence wasassociated with adolescents’exposure to community violence.Exposure to violence and interestin gang violence predictedfemales’ intent to engage inviolence. Males were more likelyto join a gang and engage inviolence after exposure toviolence.

Bility (1999) To explore high schoolstudents’ perceptions of gangactivity

60adolescents

Qualitative design• Focus groups

Adolescents’ discussion of gangactivity increased their anxietylevel. Several adolescentsexpressed concerns about safety inschool because of gangs.

DuRant,Pendergrast,et al. (1994)

To examine adolescents’exposure to communityviolence and their participationin illegal activities

225adolescents

Cross-sectional survey• SECV

Adolescent exposure to violencein the community was associatedwith adolescents engaging inphysical fights. Further, exposureto violence influenced adolescents’participation in gangs and gangactivity.

DuRant,Cadenhead,et al. (1994)

To explore factors associatedwith the use of violence amongadolescents who were exposedto community violence

225adolescents


Adolescents’ exposure tocommunity violence was asignificant predictor ofadolescents’ use of violence.

DuRantet al. (1995)

To examine the relationshipsbetween exposure to violence,victimization, depression,hopelessness, and life purpose

225adolescents


Exposure to community violenceled adolescents to feelhopelessness and lack a purposein life.

DuRantet al. (1996)

To describe the influence ofexposure to violence,depression, church attendance,drug use, and demographicvariables on adolescents’ intentto engage in violence

225adolescents


Exposure to community violencewas correlated with adolescents’intent to use violence.

DuRantet al. (2000)

To investigate the relationshipsamong adolescents’ exposureto community violence,tobacco, alcohol, and substanceuse, depression, churchattendance, and use of violence

722adolescents


Alcohol, drug use, and living in oraround public housing werecorrelated with adolescents’ use ofviolence.

Hill & Jones(1997)

To explore adolescents’exposure to violence and theperceptions their parents hadof their experiences

96adolescents

Cross-sectional survey• Children’s Interview

on CommunityViolence

Adolescents’ perceived level ofsocial support and anxiety wereinfluenced by parental awarenessof gang violence.

Ho (2008) To investigate the influencethat exposure to communityviolence had on adolescents ofCambodian and Vietnamesedescent

80adolescents


Adolescents’ exposure tocommunity violence was relatedto aggression and rule breakingbehavior


Table 2. Continued.

Author/date Purpose Subjects

Research methods andinstruments used tomeasure exposure toviolence Results

Foster et al.(2004)

To examine differences basedon gender in exposure tocommunity violence and levelsof posttraumatic stress andother symptomatology

146adolescents

Cross-sectional survey• Children’s Exposure

to CommunityViolence Checklist

Exposure to community violenceincreased adolescent girls’ anxietyand posttraumatic stress level.Girls also reported higher levelsof depression after exposure.

Grant et al.(2005)

To determine whetherexposure to violence was amediator between poverty andpsychological problems

105adolescents

Cross-sectional survey• SECV—screen version

Exposure to community violencewas not associated withadolescents’ socioeconomic status.

Klieweret al. (1998)

To examine the relationshipbetween exposure tocommunity violence andadolescents’ mental health

99adolescents

Cross-sectional survey• SECVIn home interviews withmothers and adolescents

Adolescents’ exposure to violenceand amount of social supportinfluenced their intrusivethoughts.

Lynch andCicchetti(2002)

To examine adolescents’exposure to communityviolence and the relationshipadolescents have with theirmothers

127adolescents

Cross-sectional survey• Community Violence

Survey

Adolescents with greater exposureto community violence had higherlevels of separation anxiety fromtheir mothers. In addition,adolescents with more exposureto violence were more likely tofeel insecure than adolescentswith less exposure.

McGee et al.(2005)

To examine the differences invictimization, internal andexternal symptoms amongLatino adolescents

202adolescents

Cross-sectional survey• Survey of Children’sExposure to CommunityViolence

Males who live with only oneparent are more likely to havewitnessed violence in thecommunity. However, girlsreported higher levels of exposureto violence and internalsymptoms.

Stoll et al.(1997)

To describe the impact of gangsand gang activity on students

72adolescents• 9

middleschoolstudents

• 43freshmanandsophomores

• 20juniorandsenior

Qualitative design• Focus groups

Freshman and sophomorestudents were concerned for theirsafety because of the gang activityin school. Middle school studentsreported feeling powerlessnessand a lack of control. Junior andsenior students indicated that ifthey avoided gangs, there wouldbe no reason to be concernedabout their safety.

Taylor andKliewer(2006)

To describe risk and protectivefactors that influence therelationship between exposureto community violence andalcohol use

101adolescents

Longitudinal study• 2 interviews over a

6-month• SECV

Exposure to community violencewas associated with use ofalcohol.

van derMerwe andDawes(2000)

To describe the development ofantisocial and prosocialbehaviors in adolescentsexposed to communityviolence

78adolescents


There was no significantcorrelation between exposure toviolence and the development ofantisocial behaviors.



reported that aggression and use of violence were not simplyassociated with adolescents’ exposure to community vio-lence. Other stressful life situations were also significantlyassociated with these externalizing behaviors.

DuRant, Cadenhead, et al. (1994) reported that witnessingviolence in the community or being victimized was the stron-gest predictor of adolescents’ use of violence. In addition,past exposure to community violence predicted adolescents’intent to engage in violence, and intent to engage in violencewas related to the use of violence. The DuRant et al. (1996)study found an indirect relationship between exposure tocommunity violence and adolescents’ use of violence.However, it did not find a direct connection between expo-sure to community violence and use of violence.

Researchers have also found that exposure to violence wasassociated with adolescents’ use of alcohol (Taylor &Kliewer, 2006). Alcohol and drug use in turn influenced theadolescents’ intention to use violence (DuRant et al., 1996)and their use of violence (DuRant et al., 2000). The combina-tion of alcohol, drug use, and smoking cigarettes affectedadolescents’ intent to engage in violence (DuRant et al.,1996), and these unhealthy behaviors, along with living in oraround public housing, also increased adolescents’ actualuse of violence (DuRant et al., 2000). Although socioeco-nomic status seems to influence adolescents’ use of violence,Grant et al. (2005) found that while violence occurred in dif-ferent communities, adolescents’ socioeconomic status didnot influence their exposure to community violence.

Barkin et al. (2001) examined the relationship betweenexposure to community violence and intent to use violenceamong 702 adolescents living in or around public housing.They found that gender and the neighborhood environmentinfluenced both adolescents’ intent to use violence and theiruse of violence. Living in or around public housing andexposure to community violence predicted males’ intent touse violence, while exposure to violence and interest in ganginvolvement predicted females’ intent to use violence.

Adolescents’ exposure to community violence has beenassociated with interest in gangs (Barkin et al., 2001). DuRantet al. (2000) reported that adolescents’ experiences with com-munity violence tended to enhance their interest in joining agang, and their desire to belong to a gang was associatedwith their intent to engage in violence. In one study (DuRant,Pendergrast, et al., 1994), exposure to community violenceseemed to increase adolescents’ participation in gangs andgang activity. In addition, the combination of exposure tocommunity violence and past victimization influenced ado-lescents’ desire to participate in gang violence. A survey of722 adolescents exposed to community violence found that22% either wanted to join a gang or were already active inone (DuRant et al., 2000). However, experiences with com-munity violence were not the only factor that influencedadolescents’ participation in gangs.

Gender is one influence on adolescents’ participation ingang activity. Although Barkin et al. (2001) reported that ado-lescent girls’ exposure to violence and interest in ganginvolvement predicted their intent to engage in violence,adolescent boys were more likely to join a gang and engagein violence after exposure to violence. All of these studiessupport the view that adolescents’ exposure to communityviolence can lead to problems with externalizing behaviors.However, not all researchers have reached this conclusion.For example, van der Merwe and Dawes (2000) found that amajority of the 78 adolescents they surveyed had beenexposed to some form of community violence, and 40% hadwitnessed gang violence in their community. Yet thoughmany had witnessed some form of violence, there was nosignificant relationship between adolescents’ exposure toviolence and the development of antisocial behaviors.

Unfortunately, all of these studies had limitations, includ-ing the use of convenience samples, self-reports, and cross-sectional surveys, and a lack of causal links betweenvariables. Further, in some cases, small samples reduced thegeneralizability of results. These limitations suggest a needfor further research in this area.

Internalizing Symptoms

Adolescents have been found to display aggression andintent to use violence when exposed to violence. However,studies have shown that adolescents who are exposed toviolence may also have increased internalizing symptoms,defined as negative change in one’s emotions (Bility, 1999;Grant et al., 2005). For example, anxiety is a commonproblem among adolescents (National Mental Health Asso-ciation, 2006), and it has been linked to exposure to commu-nity violence (Foster et al., 2004; Grant et al., 2005; Kliewer,2006; Lynch & Cicchetti, 2002).

Adolescents have been found to display increased anxietywhen talking about gang activity (Bility, 1999) and witness-ing community violence (Foster et al., 2004). In talking to 60high school students, Bility found a noticeable increase inanxiety when the topic focused on their experiences with andfeelings about gangs and gang activity. Anxiety also seems todiffer based on gender. In a recent study using the TraumaSymptom Checklist for Children, Foster et al. found that girlswho were exposed to community violence reported highlevels of anxiety and posttraumatic stress, while boys did notreport high levels of either. Other studies, however, havereported that gender did not influence the development ofinternalizing symptoms (Grant et al., 2005; Kliewer, 2006;Kliewer et al., 1998) even when girls witnessed more com-munity violence (Kliewer et al.).

Parental awareness of violence in the community caninfluence adolescents’ experiences. Hill and Jones (1997)found that although 46% of the adolescents they interviewed


reported witnessing gang violence, only 50% of their parentswere aware of their exposure. Lack of awareness by parentscan lead to problems with social support, and the amount ofsupport adolescents perceive from their parents and friendscan in turn influence anxiety (Hill & Jones; Kliewer et al.,1998).

Hill and Jones (1997), for example, found that whenparents agreed with their child’s report of witnessing vio-lence, their child tended to feel more social support fromfriends. Adolescents who reported witnessing violence yethad parents who disagreed with them perceived less socialsupport. Further, the lack of social support tended topromote more anxiety-related problems (t = 2.11, df = 66.8, p< .05). Similar results were reported by Kliewer et al. (1998),who suggested that adolescents’ anxiety stemmed from therelationship between perceived social support and intrusivethoughts. They found that adolescents with more exposureto violence and less perceived social support had more intru-sive thoughts, which in turn led to an increase in disturbingthoughts and more anxiety and depression.

. . . adolescents with more exposure to violence

and less perceived social support had more

intrusive thoughts, which in turn led to an

increase in disturbing thoughts and more

anxiety and depression.

Lynch and Cicchetti (2002), who interviewed 127 adoles-cents, found that greater exposure to community violence ledto greater anxiety about separation from their mothers(F = 5.67, p < .05). Anxiety however, is not the only emotionadolescents experience after exposure to community or gangviolence. Depression is also a common reaction (DuRant et al.,1995; Foster et al., 2004; Kliewer et al., 1998). As noted above,Kliewer et al. found that depression after exposure to com-munity violence was linked to adolescents’ perceptions ofsocial support and their intrusive thoughts. Other researchershave identified feelings of hopelessness and lacking a purposein life as emotional reactions to adolescent exposure to com-munity violence (DuRant et al., 1995). Foster et al. found thatexposure to community violence was a significant predictor ofanxiety, depression, posttraumatic stress, anger, and dissocia-tion among adolescents. Also, they noted that girls reportedhigher levels of depression than boys.

Adolescents’ exposure to community violence has alsobeen associated with concerns about their own safety

(DuRant et al., 2000). Indeed, safety is a major concern forthese adolescents. In one study (DuRant et al., 2000), adoles-cents suggested that they would not live past their 25thbirthday. Further, there was a strong association betweendepression and lack of purpose in life and the feeling thatthey would not live past their 25th birthday (DuRant et al.1995). Similarly, Lynch and Cicchetti (2002) reported thatadolescents exposed to higher levels of community violencewere more likely to feel insecure (c2 = 12.91; p < .001) thanadolescents with less exposure.

Bility (1999) and Stoll et al. (1997) used qualitativemethods to examine adolescents’ perceptions of gangs inschools. In focus groups with 60 high school students, Bilityfound that they expressed fears regarding gang activity, andmany suggested that “gangsterism [was] the most importantsafety and health concern . . . ” (p. 290) for them at school.Some also believed that schools were not immune to gangactivity, and this affected students’ safety. However, not allstudents felt this way. A few adolescents reported positiveexperiences with gangs at school. They commented thatalthough gangs are violent and dangerous, one has to adaptto their culture and “learn to live with them” (p. 290). Thegrade level of students was not noted, however, and theremay have been differences in students’ perceptions based ontheir educational level.

Stoll et al. (1997) used focus groups to gather informationfrom 72 middle school and high school students. The middleschool students felt a lack of control and powerlessness, butthey were resigned to the presence of gang activity in theirschool. High school freshmen and sophomores (n = 43; 60%)were concerned about their safety because of gang activity atschool, and expressed the belief that they would get shot,stabbed, or even killed during gang conflicts. In contrast,junior and senior students felt that if they avoided gangs andstayed out of trouble, there would be no reason to be con-cerned about their safety.

Two studies have addressed the relationship betweenadolescents’ exposure to community violence and their per-ceptions of maternal acceptance and behavior (Lynch & Cic-chetti, 2002; Taylor & Kliewer, 2006). In addition to theproblem of separation anxiety, Lynch and Cicchetti reportedthat exposure to community violence had a negative impacton adolescents’ perceptions of their mothers’ behavior (F =13.82, p < .001). They concluded that adolescents need andseek out more parental support when they are frequentlyexposed to community violence. Parents’ inability to providesupport to adolescents can lead to feelings of insecurity,separation anxiety, and negative perceptions of parentalbehavior.

Taylor and Kliewer (2006) explored risk and protectivefactors associated with exposure to community violence andalcohol use among 101 adolescents and their mothers. Theyfound that adolescents who reported alcohol use and



exposure to community violence had a more negative per-ception of acceptance from their mothers, and this associa-tion was significant (r = -.53, p < .001). Clearly familydynamics affect adolescents’ reactions to exposure to com-munity violence.

Adolescents’ relationship with their family also appears toinfluence their experiences with community violence.DuRant, Cadenhead, et al. (1994) found a moderate associa-tion between family conflict and adolescents’ exposure tocommunity violence. In their sample of 225 adolescents, lowfamily conflict was related to decreased exposure to violence.Thus, in addition to the influence of the neighborhoodenvironment (Barkin et al., 2001), adolescents are influencedby their emotional surroundings (maternal acceptance andfamily conflict) (DuRant, Cadenhead, et al.; Taylor & Kliewer,2006).

Conclusion

In recent years, several studies have explored the effectsof community violence on adolescents, including externaliz-ing behaviors such as aggression and intent to use violence,and internalizing symptoms such as anxiety and depression.Unfortunately, little of the research has focused specificallyon gang violence. Many of the studies dealt with communityviolence, and only mentioned gang violence as a part ofcommunity violence. The two studies (Bility, 1999; Stoll et al.,1997) that dealt specifically with gang violence focused onadolescents’ perceptions of gangs in school settings. Thesestudies provide evidence that gang activity occurs at schooland students either are fearful of gangs or learn to adapt totheir presence. Unfortunately, shortcomings in the studieslimit the generalizability of the findings. With the increase ingang violence in recent years, more research is clearlyneeded on gang violence and its effects on adolescents andtheir mental health.

As is evident from this review, adolescents encounter vio-lence in their communities, and they have different reactionsto the violence. One reaction is the use of violence. It is notsurprising that adolescents who are exposed to violence alsouse violence. In communities where violence is prevalent,adolescents may feel that they have to participate in gangs inorder to gain a sense of belonging (DuRant et al., 1996). Inter-estingly several studies have found that exposure to violenceand past victimization influence adolescents’ desire to par-ticipate in gangs. Gangs provide a sense of security andacceptance that adolescents may not find elsewhere, andjoining a gang might make adolescents feel like part of afamily (Yablonsky, 1997). Further, engaging in violence mayenable adolescents to feel superior. One interesting findingfrom the studies was the fact that gang involvement pre-dicted use of violence by adolescent girls. One would havethought that exposure to community violence and interest in

gang activity would be more predictive of adolescent boys’use of violence.

However, externalizing behaviors are not the only conse-quences for adolescents. Adolescents who witness violencein the community also have internalizing symptoms thataffect their mental health. Anxiety, fear, hopelessness, anddepression are common among adolescents who have beenexposed to violence (DuRant et al., 1995).

Parental support influences adolescents’ perceptions oftheir experiences with violence and their reactions to it (Hill& Jones, 1997). Lack of parental support has been shown tolead to problems with anxiety. Parents may be unaware of theexperiences that their children are exposed to, and this lackof awareness is a problem that, if corrected, could helpdecrease their children’s exposure. The support of family andfriends may also help adolescents deal with encounters withgang violence.

Parents may be unaware of the experiences

that their children are exposed to, and this lack

of awareness is a problem that, if corrected,

could help decrease their children’s exposure.

Nurses can play an important role in addressing the issueof gang violence and the effect it has on adolescents’ mentalhealth. However, in order to deal with the influence expo-sure to gang violence can have on adolescents, nurses need tohave a basic understanding of what the psychological impactis for adolescents. Nurses and nursing practice should beinfluenced by relevant and current knowledge. Developing aknowledge base related to the effects of exposure to gangviolence on adolescents will enable nurses to assess, plan,and implement research-based interventions and educa-tional programs specifically focused on adolescent exposureto gang violence.

Nursing practice does not need to change when dealingwith adolescents’ exposure to gang violence; nurses stillneed to assess, plan, implement, and evaluate adolescents’plan of care. However, nurses can incorporate a few strate-gies that specifically address adolescents who were exposedto gang violence. For example, understanding what adoles-cents were exposed to can alter the way nurses interact withthem. So, maintaining current knowledge on gangs and gangviolence is important. Nurse–patient interactions are vital todeveloping a positive environment for adolescents to focuson their problems. If nurses have some knowledge of gangsand gang violence, adolescents might be more inclined to


listen and interact with them. Further, adolescents may feel agreater sense of security with nurses who are knowledge-able, thus more willing to discuss their experiences.

Education is very important not only for nurses, but alsofor adolescents. For example, nurses can identify strategiesfor adolescents to use when they encounter gang violenceor even to decrease their exposure to gang violence in thecommunity, such as walking away from the potential con-flict or participating in supervised activities. Another strat-egy nurses can use is to educate adolescents about gangsand the hazards of that lifestyle. As evident from thisreview, some adolescents who were exposed to gang vio-lence were interested in joining a gang, so providingexamples of what can happen to gang members may deteradolescents.

Nurses cannot change the affects of gang violencewithout the support of research-based efforts. The potentialfor research associated with gang violence on adolescents isvast. For example, exploring the longitudinal influence thatgang violence has on girls and comparing it to adolescentboys is just one area for further research. Examining thedifferences in older adolescents when compared withyounger adolescents’ exposure to gang violence could leadto the development of age-specific interventions. In addition,nurses could focus on comparing adolescents’ exposure togang violence with adolescents’ exposure to community vio-lence to identify any significant differences between the twoforms of violence.

Other areas for research focus on the collaborativeapproach with psychologists, social workers, sociologists,and public health workers. The team approach allows eachdiscipline to bring their knowledge and enhance theoutcome. Collaborative research aimed at decreasing theinfluence of exposure of gang violence will provide for aholistic view of the problem and the development ofresearch-based interventions.

Author contact: [email protected], with a copy to theEditor: [email protected]

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