Presenter Disclosures

1. 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:

2. Youth Violence and Substance Use Deborah Goebert, Dr.P.H. (goebertd@dop.hawaii.edu) & 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

3. Recent Headlines – May 18, 2008

4. Recent Headlines – April 2, 2008

5. Recent Headlines – March 28, 2008

6. Recent Headlines – March 18, 2008

7. Recent Headlines – March 10, 2008

8. Recent Headlines – February 24, 2008

9. Recent Headlines – January 15, 2008

11. 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

12. 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.

13. 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

14. 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

15. 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.

16. Research – Youth Violence and Substance Use-Related Data Sets

17. Results: Substance Use Prevalence

18. Results: Substance Use Prevalence

19. Results: Substance Use Prevalence

20. Results: Violence Prevalence *Within past 6 months.

21. Results: Violence Prevalence *Within past 6 months.

22. Results: Violence Prevalence *Within past 6 months.

23. Results: Correlates

24. 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

25. 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

26. 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

27. 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

28. 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

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

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

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

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

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

34. 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

35. 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

36. Results: 2007, Community SurveyRisk-Protective Factors • Good Neighbors: • Familiarity and influence of neighbors • Community activities and cooperation with neighbors • Common community values

37. 2007 O`ahu High School Survey: What Causes Fights?

38. 2007 O`ahu High School Survey: Attitudes Toward Fighting 66% 58%

39. Comparison to YRBS (2005)

40. 2007 One O`ahu High School Survey (Preliminary)

41. 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

42. 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.

43. Community Partnership and Mobilization High School Community A Community B School Complex

44. 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

45. 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

46. Work Groups at the High School Faculty & Staff Students: Safe School Task Force Counselors

47. Work Groups at the High School Students: Safe School Task Force • Health Fair • Research Development • Movie & a Message (M&M) Night 2007

48. Work Groups at the High School Counselors • Training in therapeutic techniques and programs • Counseling Groups

49. Work Groups at the High School Faculty & Staff • Freshman Jump Start • Movie & a Message (M&M) Night • Ethnic Studies • DOE PDERI Summer Course

50. 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)