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Presenter Disclosures. Deborah Goebert. “No relationships to disclose”. (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:. Youth Violence and Substance Use.

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Presenter disclosures

Presenter Disclosures

Deborah Goebert

“No relationships to disclose”

  • (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:


Youth violence and substance use

Youth Violence and Substance Use

Deborah Goebert, Dr.P.H. ([email protected])

&

Investigators & Staff, Asian/Pacific Islander Youth Violence Prevention Center & Alcohol Research Center of Hawai`i

Department of Psychiatry, University of Hawai‘i at Mānoa

May 22, 2008


Recent headlines may 18 2008

Recent Headlines – May 18, 2008


Recent headlines april 2 2008

Recent Headlines – April 2, 2008


Recent headlines march 28 2008

Recent Headlines – March 28, 2008


Recent headlines march 18 2008

Recent Headlines – March 18, 2008


Recent headlines march 10 2008

Recent Headlines – March 10, 2008


Recent headlines february 24 2008

Recent Headlines – February 24, 2008


Recent headlines january 15 2008

Recent Headlines – January 15, 2008


Api youth substance use and violence

API Youth Substance Use and Violence

  • >12 million API population in U.S. (Census 2000)

  • Minimal knowledge of API youth violence and substance use regarding prevalence & risk-protective factors

  • Available knowledge typically aggregates different Asian groups & Pacific Islander groups together

    • Misleading because Asians tend to have lower rates than Pacific Islanders

    • Misleading because even within the Asian groups, there are differences (e.g., Cambodian youths > Chinese youths)

    • Does not address the issue of those of mixed ancestry


Api youth substance use and violence1

API Youth Substance Use and Violence

  • Adolescence is a period of great vulnerability

  • Youth who begin to abuse alcohol or drugs at earlier ages are at greater risk for developing future substance use problems

  • Alcohol use associated with other risk behaviors, including violence

  • In contrast to the number of studies on risk factors, only a few studies have examined protective factors regarding the development of substance use disorders and violence.


Presenter disclosures

Importance of Disaggregation

In Physical Fight Past 12 Months (Youth Risk Behavior Survey)

N-Am = Native American; A-Am = African American; Pacific = Pacific Islander, including Hawaiian;

Multiple = Multiple, non-Hispanic; Hisp = Hispanic


Presenter disclosures

Importance of Disaggregation

Threatened or Injured w/Weapon on School Property in Past Year

N-Am = Native American; A-Am = African American; Pacific = Pacific Islander, including Hawaiian;

Multiple = Multiple, non-Hispanic; Hisp = Hispanic


Importance of disaggregation

Importance of Disaggregation

  • Over-representation at Hawai‘i Youth Correctional Facility:

    • Hawaiians

    • Samoans

    • African Americans

  • Under-representation:

    • Caucasians

    • Filipinos

    • East Asians (e.g., Japanese, Chinese)

  • From: Kassebaum, 1995a/b.


    Research youth violence and substance use related data sets

    Research – Youth Violence and Substance Use-Related Data Sets


    Presenter disclosures

    Results: Substance Use Prevalence


    Presenter disclosures

    Results: Substance Use Prevalence


    Presenter disclosures

    Results: Substance Use Prevalence


    Presenter disclosures

    Results: Violence Prevalence

    *Within past 6 months.


    Presenter disclosures

    Results: Violence Prevalence

    *Within past 6 months.


    Presenter disclosures

    Results: Violence Prevalence

    *Within past 6 months.


    Presenter disclosures

    Results: Correlates


    Results 2003 2004 three high schools survey

    Results:2003-2004, Three High Schools Survey

    • Youth violence: Samoans > Hawaiians, Filipinos, Japanese

    • Substance use: Hawaiian girls > Hawaiian boys

    • Overall delinquency: Filipinos, Hawaiians, Samoans > Japanese


    Results 2003 2004 three high schools survey1

    Results:2003-2004, Three High Schools Survey

    • Community, School, Media:

    • school suspensions

    • + grade-point average

    • - ever been arrested

    • + favorable school attitudes

    • easy access to weapons

    • stressful life events

    • (victimization)

    • - participated in group activity

    • - job in past year

    • Family & Peers:

    • difficulty living w/lots of

    • family members

    • - difficulty getting along

    • w/parents

    • punishment used

    • importance of religion/

    • spirituality to parents

    • peer delinquency (drugs,

    • violence)

    • gang membership/exposure

    • hang out w/friends in trouble

    • - friends not good students

    • - pressure to choose betw.

    • school & friends

    • - dating &/or sexually active

    • - gender roles

    • Youth:

    • substance use

    • self-reported delinquency

    • favorable attitudes to

    • delinquency

    • impulsivity

    • gender (males)

    • low self-esteem

    • - ethnicity (Samoan youths)

    • + ethnic identity = commit

    • ethnic identity = negative

    • affect

    • - ethnic identity = pride

    • - poor physical health

    • recent counseling/MH

    • services

    Community, School, Media

    Family & Peers

    Youth

    + = protective; - = risk


    Presenter disclosures

    Future Directions

    • Conduct further research on ethnic identity:

      • Why are there ethnic-group differences in prevalences?

      • How do the quality, frequency, duration, & magnitude of ethnic-identity engagement impact youth violence?

      • What are the similarities & differences in the acculturative process for indigenous Hawaiians vs. later generations of immigrant populations vs. recent immigrants?

      • What does it mean to be “mixed” in ethnicity & ethnic identity, and how does this impact youth violence & why?

  • Conduct longitudinal research to determine causation

  • Develop, implement, &/or evaluate prevention& treatment programs that are responsive to the diversity of Hawai‘i’s people


  • Presenter disclosures

    State of Hawai‘i Department of HealthFigure 1. Three-year rates* of non-fatal injuries from assaults, all ages, 2003-2005

    *Rates are per 1,000 residents as estimated by 2000 U.S. Census


    Presenter disclosures

    State of Hawai‘i Department of HealthFigure 2. Three-year rates* of non-fatal injuries from assaults, among children, 2003-2005

    *Rates are per 1,000 residents as estimated by 2000 U.S. Census


    Results 2007 community outcomes strongly agree or agree

    Results: 2007, Community Outcomes(% Strongly Agree or Agree)


    Results 2007 youth outcomes strongly agree or agree

    Results: 2007, Youth Outcomes(% Strongly Agree or Agree)


    Results 2007 youth outcomes strongly agree or agree1

    Results: 2007, Youth Outcomes(% Strongly Agree or Agree)


    Results 2007 youth outcomes strongly agree or agree2

    Results: 2007, Youth Outcomes(% Strongly Agree or Agree)


    Results 2007 youth outcomes strongly agree or agree3

    Results: 2007, Youth Outcomes(% Strongly Agree or Agree)


    Results 2007 community survey risk protective factors

    Demographics

    Community

    Causes of Youth Violence

    Protective Factors

    Youth Substance Use

    Perceived Support

    Physical Health

    Religion, Spirituality

    Ethnic Identity

    Colonialism

    Parent Supervision & Involvement

    Results: 2007, Community SurveyRisk-Protective Factors


    Results 2007 community survey risk protective factors1

    Results: 2007, Community SurveyRisk-Protective Factors

    • Community Resources:

      • recreation, safety, crime/violence prevention

      • education, health, social services, government satisfaction

      • general community cohesion, community-school cohesion


    Results 2007 community survey risk protective factors2

    Results: 2007, Community SurveyRisk-Protective Factors

    • Good Neighbors:

      • Familiarity and influence of neighbors

      • Community activities and cooperation with neighbors

      • Common community values


    2007 o ahu high school survey what causes fights

    2007 O`ahu High School Survey: What Causes Fights?


    2007 o ahu high school survey attitudes toward fighting

    2007 O`ahu High School Survey: Attitudes Toward Fighting

    66%

    58%


    Comparison to yrbs 2005

    Comparison to YRBS (2005)


    2007 one o ahu high school survey preliminary

    2007 One O`ahu High School Survey (Preliminary)


    Ecological model examples of prevention strategies

    Ecological Model:Examples of Prevention Strategies

    • Societal

    • Public information

    • Strengthen police and judicial systems

    • Reduce poverty and inequality

    • Community

    • Reducing alcohol availability

    • Identify and refer people at risk for substance abuse or violence

    • Relationship

    • Parenting programmes

    • Home visitation

    • Family therapy

    • Individual

    • Social development programs

    • Cultural enrichment


    Presenter disclosures

    Implications

    • The findings highlight the need to implement interventions designed to reduce and prevent drinking and violence.

    • Interventions should factor in:

      • Cultural appropriateness

        • Quality/type of cultural socialization might be key (i.e., commitment vs. pride)

      • Community resources, including schools, churches, health agencies, law enforcement

      • Social networks, including family & peers

      • Youth focused

        • Gender, attitudes, talents (e.g., educational achievement), substance use, etc.


    Community partnership and mobilization

    Community Partnership and Mobilization

    High School

    Community A

    Community

    B

    School Complex


    Community work group

    Community Work Group

    Cultural Groups

    Youth Development

    Women’s Group

    Community Togetherness Meetings

    Private Schools

    Teen Organizations

    Home Associations

    Religious Groups

    More individuals

    & organizations

    coming in

    Local Business


    Community meetings

    Community Meetings

    • “Facilitating community mobilization for sustainable violence and substance abuse reduction”

    • Training

      • Collective problem-solving

      • Grant writing

      • Fun youth development exercises

    • Resource Sharing

      • Agency/organization presentations

      • Website technical assistance

      • Resource directory and map

    • Program Development

      • Parenting class

      • Youth retreat


    Work groups at the high school

    Work Groups at the High School

    Faculty & Staff

    Students:

    Safe School Task Force

    Counselors


    Work groups at the high school1

    Work Groups at the High School

    Students:

    Safe School Task Force

    • Health Fair

    • Research Development

    • Movie & a Message (M&M) Night 2007


    Work groups at the high school2

    Work Groups at the High School

    Counselors

    • Training in therapeutic techniques and programs

    • Counseling Groups


    Work groups at the high school3

    Work Groups at the High School

    Faculty & Staff

    • Freshman Jump Start

    • Movie & a Message (M&M) Night

    • Ethnic Studies

    • DOE PDERI Summer Course


    Presenter disclosures

    2004-2005,O`ahu High School-Only School-Wide

    Jumpstart Day Background

    DEPENDENT VARIABLE

    Outcome of “Violence” (# of times getting into fights within the past 12 months)

    Of the 13 variables on the left, we tested to see which ones associated significantly with getting into fight within the last year.

    Wanted to address these 5 issues that associated significantly with fighting in skits made by high school students for incoming freshmen. (IDEA PROPSED & DESIGNED BY TEACHERS WORKGROUP)


    Research and program development

    Research and Program Development

    • APIYVPC Core Research & Program Development

      • 2005-2006 = literature reviews

      • 2006-2007 = focus groups, school-wide surveys

      • 2007-2008 = program development

      • 2008-2009 = program implementation & evaluation

      • 2009-2010 = dissemination


    Program development

    Program Development

    Examples

    School Level

    • Youth: Ethnic Studies; Jump Start; PTP Mentoring Class

    • Peers: Safe Schools Task Force

    • School Level: Challenge Day; Prevent Team; Outreach College for Teacher Training

    Peers

    Youth


    What is school climate

    What is School Climate?


    School climate research

    School Climate Research

    • Research shows that students in schools with a positive school climate have:

    • Greater academic achievement

    • Lower levels of misconduct

    • Lower levels of violence

    • Lower levels of substance abuse

    • Also, research shows that teachers in schools with a positive school climate have higher job satisfaction.


    School climate dimensions

    School Climate Dimensions

    • Safety:

    • I feel safe in all areas in and around my school.64%

    • Students being disruptive keep me from learning. 56%

    • Students threatening other students make it hard to learn.48%

    • The classrooms and hallways are kept under control. 41%

    • When students are spreading rumors, most of my

    • teachers know what to do to stop it.33%

    • Relationships:

    • Teachers are fair in dealing with students. 57%

    • The school rules are fairly enforced. 48%

    • Teachers are respected.38%

    • Most teachers at my school want to stop fights from happening. 84%

    • Most students at my school want to stop fights from happening.18%


    Next steps

    Next Steps

    • Community: Continue community efforts to address youth violence & development

    • Research: Continue surveillance studies of students in school & community

    • Program: Develop, evaluate, & disseminate an effective, culturally appropriate prevention/intervention program

    • Train: Continue to train teachers, school officials, community members, practitioners, & academicians

    • Dissemination: Disseminate our findings

    • Evaluate: Continue to evaluate & improve the APIYVPC

    • Renew: Renewal application at end 2009


    Community summary

    Community – Summary

    Need for unified message


    Approaches to research with different cultural communities

    Approaches to Research with Different Cultural Communities

    • Every community is different—typically very people-dependent

    • Trust & relationships are the cornerstones of university-community/school partnerships

      • universities/researchers may not have a good reputation

    • Assist in research projects that build genuine “good will” & trust

      • cognitive styles instrument & linked with youth violence


    Approaches to research with different cultural communities1

    Approaches to Research with Different Cultural Communities

    • Respect confidentiality not only of individual personal information, but also regarding community stigma & stereotype

      • continually ask for school & community feedback & “permission” to disseminate findings with or without identifying their school/community

    • Be unassuming & patient, but still advocate how the partnership can be a win-win


    Challenges to program design implementation

    Challenges to Program Design & Implementation

    • Epistemology (how knowledge is gained)

      • spiritual, subjective, personal, private

      • empirical (data-driven), objective, public, repeatable

    • Potential Solutions:

      • respect different views; not all may be resolvable

      • try & work within their framework

      • conceptualize the empirical approach as supplemental rather than contradictory

      • use mixed methods (i.e., qualitative & quantitative)


    Challenges to program design implementation1

    Challenges to Program Design & Implementation

    • Control Group (especially randomized)

      • viewed as “unethical” in that it deprives interventions to a sub-group

    • Potential Solutions:

      • note that the “intervention” has not yet been proven

      • use quasi-experimental designs, simplest being pre-post design (try & rule out alternative explanations)

      • use “wait listed” individuals as the comparison group

      • use a “lag” research design model where both groups receive the intervention, but at different points in time

      • use covariates to control for other important factors (e.g., exposure to other variables between pre & post)


    Challenges to program design implementation2

    Challenges to Program Design & Implementation

    Pre-

    Test 1

    Post-

    Test 1

    Post-

    Test 2

    Period 1

    Period 2

    Period 1

    Period 2

    Group 1

    Group 2

    Pre-

    Test 1

    Pre-

    Test 2

    Post-

    Test 1

    Pre-

    Test 1

    Pre/

    Post

    Post-

    Test 1


    Challenges to program design implementation3

    Challenges to Program Design & Implementation

    • Integration of Culture

      • adoption of already-existing “valid” measures & interventions seen as culturally inappropriate

    • Potential Solutions:

      • be patient; factor in time for feedback, modifications, IRB approvals, etc.

      • conduct informal &/or formal interviews & focus groups on more culturally appropriate measures & interventions

        • Year 1 of API Center

      • utilize general ethnic identity measure (Phinney) AND culture-specific identity measures (Hawaiian, Filipino, Samoan, Japanese)


    Thank you

    Thank You


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