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Victimization among African-American adolescents in substance abuse treatment.

Victimization victimization Social medicine The abuse of the disenfranchised–eg, those underage, elderly, ♀, mentally retarded, illegal aliens, or other, by coercing them into illegal activities–eg, drug trade, pornography, prostitution.  is the experience of direct or threatened harm, including physical violence, sexual violence, psychological or emotional abuse, and neglect (CDC See Control Data, century date change and Back Orifice.

CDC - Control Data Corporation
 2007). Victimization among adolescents is a recognized public health concern, which motivated an in-depth report by the Office of the US Surgeon General The U.S. Surgeon General is charged with the protection and advancement of health in the United States. Since the 1960s the surgeon general has become a highly visible federal public health official, speaking out against known health risks such as tobacco use, and promoting disease  (US DHHS DHHS Department of Health & Human Services (US government)
DHHS Dana Hills High School (Dana Point, California)
DHHS Deaf and Hard of Hearing Services
DHHS Deaf and Hard of Hearing Services
 1999). A national survey found that approximately 17% of adolescents have been physically assaulted and 39% have witnessed violence (NIJ Noun 1. NIJ - the law enforcement agency that is the research and development branch of the Department of Justice
National Institute of Justice

Department of Justice, DoJ, Justice Department, Justice - the United States federal department responsible for
 2003). Adolescents are twice as likely as adults to be victims of serious violent crimes (OJJDP OJJDP Office of Juvenile Justice and Delinquency Prevention (federal agency)  2000). Younger adolescents are also more likely to be both violently and nonviolently non·vi·o·lence  
n.
1. Lack of violence.

2. The doctrine, policy, or practice of rejecting violence in favor of peaceful tactics as a means of gaining political objectives.
 victimized than older adolescents (Van Dorn 2004).

Victimization occurs at a high rate among all adolescents, but the rate among African-American adolescents is especially alarming. For example, homicide is the third leading cause of death among White adolescents 15 to 19 years old, but it ranks first among their African-American counterparts (Anderson 2002). When compared to Latino and White adolescents, African-American adolescents are more likely to be involved in fights, to report knowing someone who has been a victim of violence, and to witness violent crimes (Paxton et al. 2004). Howard and colleagues (2002) reported that as many as 75% of urban African-American adolescents have witnessed at least one violent event in the past six months.

The rate of victimization among African-American adolescents can be explained, in part, by their broader social and environmental conditions. Approximately one-third of African-American adolescents live in economically depressed and socially marginalized neighborhoods, resulting in regular exposure to high rates of violence (Paxton et al. 2004). These are key factors that contribute to violence perpetration per·pe·trate  
tr.v. per·pe·trat·ed, per·pe·trat·ing, per·pe·trates
To be responsible for; commit: perpetrate a crime; perpetrate a practical joke.
 and victimization (McCart et al. 2005; Howard et al. 2002). Such conditions also give rise to using violence as a response to the ongoing pressures and threat of violence (Feigelman et al. 2000), which further complicates the problem of responding to and preventing victimization.

ASSOCIATIONS WITH VICTIMIZATION

The significance of victimization as a public health issue is further supported by its consistent relationships with various psychological and psychosocial problems. It is widely established that victimization can be a traumatic life event, challenging an individual's resources and negatively impacting developmental processes (Kaukinen 2002). A large body of research shows that victimization among adolescents is associated with higher degrees of depressive symptoms, substance use, PTSD PTSD posttraumatic stress disorder.

PTSD
abbr.
posttraumatic stress disorder


Post-traumatic stress disorder (PTSD) 
 symptoms, suicidality, physical aggression, and delinquent behavior (Goldstein et al. 2007; Sullivan, Farrell & Kliewer 2006; Champion et al. 2004; Moran, Vuchinich & Hall 2004; Funk et al. 2003; Grella & Joshi 2003; NIJ 2003; Liebschutz et al. 2002; Caviola & Schiff 2000; Cleary 2000; Fitzpatrick & Bolidizar 1993).

Factors related to severity, frequency and context of victimization, commonly referred to as traumagenic factors, can play an important role in how detrimental these experiences are to adolescent development. Traumagenic factors in victimized adolescents have been associated with more comorbid problems, including violence, internal mental distress Mental distress is a term used, both by some mental health practitioners and users of mental health services, to describe a range of symptoms and experiences of a person's internal life that are commonly held to be troubling, confusing or out of the ordinary. , and substance problems (Titus et al. 2003; NIJ 1997). Long-term consequences of victimization have also been described in the literature (Kaukinen 2002). For example, childhood physical abuse and exposure to parental violence is associated with the development of alcohol-related problems in adulthood (Caetano, Field & Nelson 2003).

The causal influences of victimization on mental health functioning and social development are further complicated by various gender differences. For example, early victimization among girls strongly influences the likelihood of delinquency, adult criminality, and violent criminal behavior, as well as entry into the juvenile justice system (Osofsky 2001). Victimization among adolescent males has been associated with increased involvement in violent lifestyles (Hawke, Jainchill & De Leon 2003).

High-risk behaviors, such as multiple sexual partners, substance use, fighting, and other types of violence perpetration, are also associated with victimization. However, the causal associations among these behaviors, especially substance use, are unclear. For example, while substance use may be a mechanism to cope with experiences of victimization (Hawke, Jainchill & De Leon 2000), substance use can also significantly reduce physical competence and decision-making in threatening or violent situations, thereby increasing the risk of victimization (Shepherd, Sutherland & Newcombe 2006). It is plausible that victimization is situated within a complex set of feedback relationships, whereby it influences and is influenced by substance use, mental health functioning, and other high-risk behaviors.

VICTIMIZATION AND SUBSTANCE ABUSE TREATMENT

Given the link between substance use and victimization, it is not surprising that rates of victimization are higher among adolescents in substance abuse treatment than those in the general population (Grella & Joshi 2003; Hawke, Jainchill & De Leon 2003; Titus et al. 2003). Accounting for victimization among adolescents in substance abuse treatment is important for numerous reasons. The existing evidence suggests that adolescents in drug treatment with a history of victimization have higher rates of psychological distress psychological distress The end result of factors–eg, psychogenic pain, internal conflicts, and external stress that prevent a person from self-actualization and connecting with 'significant others'. See Humanistic psychology.  (Caviola & Schiff 2000), which may negatively impact treatment engagement (Grella & Joshi 2003; Grella et al. 2001). Titus and colleagues (2003) found that high levels of victimization interact with treatment outcomes and subsequent violence. Consequently, victimization is taking a more prominent role in treatment planning In radiotherapy, Treatment Planning is the process in which a team consisting of radiation oncologists, medical radiation physicists and dosimetrists plan the appropriate external beam radiotherapy treatment technique for a patient with cancer. Typically, medical imaging (i.e. , especially level of care decisions (Funk et al. 2003).

RESEARCH OBJECTIVES

To date, the majority of knowledge on victimization among adolescents is based on school and community samples (Youngstrom, Weist & Albus 2003). Few studies of victimization have been conducted among adolescents in substance abuse treatment (Grella & Joshi 2003). As previously discussed, African-American adolescents tend to experience the highest rates of victimization. However, very little is known about the prevalence and associations of victimization among African-Americans in substance abuse treatment. Additional research in this area is needed to develop effective interventions to address the consequences of victimization (McCart et al. 2005) and prevent future occurrences among this population.

The purpose of this study is to help fill these gaps by pursuing three research objectives: (1) to examine the rate and different types of victimization among a sample of African-American adolescents in an urban substance abuse treatment program; (2) to test whether victimization is associated with increased levels of psychopathology psychopathology /psy·cho·pa·thol·o·gy/ (-pah-thol´ah-je)
1. the branch of medicine dealing with the causes and processes of mental disorders.

2. abnormal, maladaptive behavior or mental activity.
 and high-risk behaviors; and (3) to compare the rates and associations with those of existing studies of adolescent victimization.

METHODS

Participants

Data for this study were derived from a larger treatment outcome study of 288 adolescents admitted to outpatient or residential substance abuse treatment in a large Mid-western inner city between 2003 and 2006. This initiative was part of the Center for Substance Abuse Treatment The Center for Substance Abuse Treatment (CSAT) is an agency of the United States government. It is a part of the Substance Abuse and Mental Health Services Administration (SAMHSA), within the U.S. Department of Health and Human Services (DHHS).  Cooperative Agreement for Strengthening Communities for Youth (SCY SCY Security
SCY Short Course Yards (swimming) 
; TI13305). Adolescents completed at least two days of treatment. Following admission, treatment staff introduced the study to the adolescents and invited them to participate. Research staff obtained written informed consent from parents and written assent from interested participants. Adolescents who participated in the study were compensated $20. This study included 259 participants who self-identified as African-American, 90% of the total sample. A university Institutional Review Board approved this study.

Measures

All data were collected by treatment staff at intake using a standardized clinical assessment called the Global Appraisal of Individual Needs (GAIN; Dennis et al. 2006). The GAIN contains scales and survey items related to eight domains: demographics, substance use, physical health, risk behaviors, mental health, environment, legal, and vocational issues. Prior research on the psychometric psy·cho·met·rics  
n. (used with a sing. verb)
The branch of psychology that deals with the design, administration, and interpretation of quantitative tests for the measurement of psychological variables such as intelligence, aptitude, and
 properties of the GAIN revealed that it has good reliability and validity for both adolescents and adults (Dennis, Chan & Funk 2006; Dennis et al. 2004; Godley et al. 2002).

Victimization. Victimization was measured using the GAIN's General Victimization Scale (GVS (Global VideoPhone Standard) The technology behind AT&T's VideoPhones. GVS transmits at 10 frames per second, a third the rate of regular TV. The GVS technology is licensed to other manufacturers. ). The GVS is comprised of 15 dichotomously di·chot·o·mous  
adj.
1. Divided or dividing into two parts or classifications.

2. Characterized by dichotomy.



di·chot
 scored items. Four items ask whether respondents ever experienced four different types of victimization, including being physically abused, being attacked with a weapon, being forced to participate in sexual acts, and being emotionally abused. Four items reflect concern about future victimization--one item for each type of victimization. Seven items ask about traumagenic factors, which are the circumstances surrounding victimization (e.g., whether victimization occurred before the age of 18, whether victimization was perpetrated by a family member).

Items of the GVS are summed to produce an overall victimization score, ranging from 0 to 15 (Titus et al. 2003). The observed reliability of the GVS for this sample ([alpha] = .65) was consistent with prior research (Funk et al. 2003; Titus et al. 2003). Following the work of Titus and colleagues (2003), a cutoff score of four was used to dichotomize di·chot·o·mize  
v. di·chot·o·mized, di·chot·o·miz·ing, di·chot·o·miz·es

v.tr.
To separate into two parts or classifications.

v.intr.
To be or become divided into parts or branches; fork.
 this variable. Specifically, a score of three or less represented "low victimization," and a score of four or more represented "high victimization."

Participants were queried about their last episode of victimization using the following time frames: past two days, past week, one to four weeks ago, one to three months ago, four to 12 months ago, more than one year ago, or never. These responses were used to create lifetime and past 90-day measures of victimization. Participants were also queried about the age of their first victimization.

Mental health disorders. The GAIN includes items to measure DSM-IV mental health disorders. In this study, participants were classified as having major depressive disorder Major depressive disorder
A mood disorder characterized by profound feelings of sadness or despair.

Mentioned in: Conduct Disorder

major depressive disorder 
 (past year) if they reported depressed mood, irritability irritability /ir·ri·ta·bil·i·ty/ (ir?i-tah-bil´i-te) the quality of being irritable.

myotatic irritability  the ability of a muscle to contract in response to stretching.
, or loss of interest, and reported at least five of 13 symptoms of depression. Participants were classified as having generalized anxiety disorder Generalized Anxiety Disorder Definition

Generalized anxiety disorder is a condition characterized by "free floating" anxiety or apprehension not linked to a specific cause or situation.
 (past year) if they reported significant problems with anxiety, worry or panic, and problems controlling their worries, and also responded positively to at least two of seven other anxiety symptoms. They were classified as having traumatic stress Traumatic stress is recognized by the Diagnostic and Statistical Manual of Mental Disorders [1] as an acute emotional condition associated with reactive anxiety.  disorder (including post-traumatic stress disorder, acute stress disorder Acute Stress Disorder Definition

Acute stress disorder (ASD) is an anxiety disorder characterized by a cluster of dissociative and anxiety symptoms occurring within one month of a traumatic event.
 and disorder of extreme stress not otherwise specified; past year) if they reported at least five of 13 symptoms. They were classified as having conduct disorder Conduct Disorder Definition

Conduct disorder (CD) is a behavioral and emotional disorder of childhood and adolescence. Children with conduct disorder act inappropriately, infringe on the rights of others, and violate the behavioral expectations of
 (past 90 days) if they reported engaging in at least three of 15 negative behaviors at least two or more times and had problems due to breaking rules in the past 90 days. Prior research shows GAIN-based mental health diagnoses to match independent staff diagnoses for mood disorders (x = .85) and conduct disorder/oppositional defiant disorder (x = .82) (Shane, Jasiukaitis & Green 2003). Confirmatory factor analysis In statistics, confirmatory factor analysis (CFA) is a special form of factor analysis. It is used to assess the the number of factors and the loadings of variables.  of the measure of traumatic stress indicated acceptable factorial factorial

For any whole number, the product of all the counting numbers up to and including itself. It is indicated with an exclamation point: 4! (read “four factorial”) is 1 × 2 × 3 × 4 = 24.
 validity (Dennis, Chan & Funk 2006).

High-risk behaviors. High-risk behaviors in this study included general community behaviors and sex practices. High-risk community behaviors included past 90-day illegal activity and past-year gang involvement. High-risk sex practices included past 90-day unprotected sex Unprotected sex refers to any act of sexual intercourse in which the participants use no form of barrier contraception. Sexually transmitted infections
Specifically, unprotected sex
 and past 90-day multiple partners (i.e., two or more sex partners).

Analytic Strategy

Data were summarized using descriptive statistics descriptive statistics

see statistics.
. Bivariate bi·var·i·ate  
adj.
Mathematics Having two variables: bivariate binomial distribution.

Adj. 1.
 associations were tested using chi-square ([chi square chi square (kī),
n a nonparametric statistic used with discrete data in the form of frequency count (nominal data) or percentages or proportions that can be reduced to frequencies.
]) tests and t-tests. To discern the magnitude of the associations, effect sizes were also computed. These included phi-coefficients ([PHI]) and Pearson product-moment correlations (r), derived from the chi-square and t-tests, respectively. Following the rules of thumb proposed by Cohen cohen
 or kohen

(Hebrew: “priest”) Jewish priest descended from Zadok (a descendant of Aaron), priest at the First Temple of Jerusalem. The biblical priesthood was hereditary and male.
 (1988), .20 was regarded as a small effect size, .50 a moderate effect size, and .80 a strong effect size. Associations greater than or equal to .20 were considered to have clinical significance.

Very few missing values In statistics, missing values are a common occurrence. Several statistical methods have been developed to deal with this problem. Missing values mean that no data value is stored for the variable in the current observation.  were observed in the sample data. Eight variables had one missing value, and two variables had two missing values. Pair-wise deletion was used in the bivariate analyses.

RESULTS

Sample Description

Eighty-four percent (n = 218) of the sample was male, ranging in age from 12 to 17 years (Mean = 14.96, SD = 1.16). Sixty-three percent (n = 163) were admitted to outpatient treatment, and 37% were admitted to residential treatment. The majority of subjects had a marijuana use disorder (83.0%, n = 215) and 27% (n = 69) had an alcohol use disorder.

Approximately half the subjects met criteria for at least one mental health disorder (n = 129), and 30% (n = 77) of the sample met criteria for two or more mental health disorders. Conduct disorder was most prevalent (32%, n = 84), followed by major depressive disorder (20%, n = 56), traumatic stress disorder, 14%, n = 36), and generalized anxiety disorder (5%, n = 12).

About half the sample reported being involved in illegal activity during the past 90 days (n = 142). Twenty percent (n = 53) reported gang membership in the past year. One-fifth of the sample reported having unprotected sex in the past 90 days (n = 56), and approximately half of the sample reported having two or more sexual partners in the past 90 days (n = 126).

Rate and Types of Victimization

Table 1 provides a summary of the rate and types of victimization. Half the subjects reported lifetime victimization, and one-quarter reported victimization during the past 90 days. The age of first victimization ranged from four to 17 years (Mean = 12.3, SD = 2.48). The most common type of victimization was being attacked with a weapon (46%, n = 118). Twenty percent reported being struck or beaten, 15% reported emotional abuse, and 4% reported being forced into sexual acts. Twenty-seven percent (n = 70) reported at least one type of victimization, 20% (n = 51) reported two types, 5% reported three types (n = 12), and 1% (n=3) reported all four types. One percent (n = 3) of respondents did not provide a response to the survey question regarding type of victimization experienced.

Scores on the GVS ranged from 0 to 15 (Mean = 2.90, SD = 3.6). Among participants with a lifetime history of victimization, 77.6% (n = 108) met the criteria for high victimization (GVS score [greater than or equal to] 4). About a third of participants reported being victimized several times or over a long period of time, and about the same percent reported being victimized by more than one person.

Almost one-fifth reported victimization by a family member or trusted person. Of the total sample, about one-fifth reported they were currently worried about being victimized in the future. Among subjects who reported victimization, only 40% reported receiving help related to the experience of victimization.

Associations with Victimization

Table 2 presents cross-tabulations of victimization and the other study variables. The percentages reported in this table are column percentages. For example, the table shows that 84.9% (n = 118) of persons with lifetime victimization were male, and 83.3% (n = 100) of persons without lifetime victimization were male. To obtain percentages for females, each value is subtracted from 100. Thus, the cell percentages for females would be 15.1% (n = 21) and 16.7% (n = 20), respectively. As previously discussed, chi-square ([chi square]) tests were used to determine whether the observed differences were statistically significant, and phi-coefficients ([PHI]) were used to determine clinical significance (> .20). Thus, in the foregoing example, lifetime victimization did not exhibit either statistically or clinically significant associations with gender. It should also be noted that all clinically significant associations were also statistically significant.

Lifetime victimization. Lifetime victimization exhibited a small but clinically significant association with major depressive disorder ([PHI] = .21) and conduct disorder ({PHI] = .33). Generalized anxiety disorder and traumatic stress disorder were statistically associated with lifetime victimization. However, contrary to prior research, these relationships were not clinically significant ([PHI] = .13).

Lifetime victimization was also associated with past 90-day high-risk sex practices, although the effect sizes were small: unprotected sex ([PHI] = .26) and multiple sex partners ([PHI] = .20). Illegal activity (past 90-days) and gang involvement (past-year) exhibited larger effects sizes with respect to lifetime victimization ([PHI] = .29 and .32, respectively).

Past 90-day victimization. Recency of victimization, as indicated by a past 90-day episode, had clinically significant associations with three study variables: conduct disorder ([PHI] = .21), past 90-day illegal activity ([PHI] = .28), and past-year gang involvement ([PHI] = .20). Although some of the other study variables exhibited a statistically significant association with past 90-day victimization, these associations were not clinically significant.

Victimization severity. Victimization severity was associated with having a mental health disorder. Of these disorders, conduct disorder exhibited the strongest association ([PHI] = .37), followed by major depressive disorder ([PHI] = .26), traumatic stress disorder ([PHI] = .23), and generalized anxiety disorder ([PHI] = .22). Past 90-day illegal activity and past year gang involvement exhibited clinically significant associations with victimization severity ([PHI] = .25 and .27, respectively). Past 90-day unprotected sex also reached the threshold of clinical significance ([PHI] = .20).

DISCUSSION

This study presents findings on victimization prevalence and its association with mental health disorders and high-risk behaviors. The African-American adolescent sample provided an opportunity to report on an underrepresented un·der·rep·re·sent·ed  
adj.
Insufficiently or inadequately represented: the underrepresented minority groups, ignored by the government. 
 population in the service research literature. The rate of victimization for this substance abuse treatment sample (54%) was significantly higher than the national average, consistent with prior research showing a link between substance use and victimization (Shepherd, Sutherland & Newcombe 2006; Weiner et al. 2005). Approximately 43% of the overall sample and 85% of persons who reported victimization indicated a history of assault with a weapon. This suggests that the environment in which these adolescents live contains a high level of violence, and the use of substances creates further risks for being victimized.

Victimization and Mental Health

This study also revealed a high rate of comorbid mental health disorders. Severity of victimization was associated with having a psychiatric disorder, but associations with 90-day and lifetime victimization were inconsistent. These differential associations may be due to the time-based measures accounting for only the occurrence of victimization, whereas the measure of severity was based on traumagenic factors. Again, this is consistent with prior research suggesting that the severity and context of victimization have important consequences on mental health functioning (Titus et al. 2003). Treatment providers need to pay closer attention to traumagenic factors rather than recency of victimization. However, further research is needed regarding the stability of the effects of traumagenic factors over time.

While a link was observed between victimization and mental health functioning, all statistically significant relationships exhibited either small or small-to-moderate effect sizes. Generally speaking, prior research has not characterized the associations in terms of effect sizes, but the description of the associations suggests they are moderate to large. For example, Brown and colleagues (1999: 94) stated that exposure to trauma has been linked with "deleterious deleterious adj. harmful.  mental health outcomes," and Paxton and colleagues (2004: 283) stated that "exposure to violence makes significant contributions to the presence of post-traumatic stress symptomatology symptomatology /symp·to·ma·tol·o·gy/ (simp?to-mah-tol´ah-je)
1. the branch of medicine dealing with symptoms.

2. the combined symptoms of a disease.


symp·to·ma·tol·o·gy
n.
" [italics in both quotes added for emphasis]. In light of these examples and others (Lambert et al. 2005), the effect sizes observed in this study were smaller than expected. Three possible explanations for this unexpected finding are offered. First, victimization and mental health functioning are associated, but the strength of the association has not been clear as prior studies only focused on tests of statistical significance and p-values.

A second explanation is that the association between victimization and mental health functioning was attenuated Attenuated
Alive but weakened; an attenuated microorganism can no longer produce disease.

Mentioned in: Tuberculin Skin Test


attenuated

having undergone a process of attenuation.
 in this sample by an unmeasured mediating factor. Several studies examining the effects of exposure to crime or community violence on children and adolescents have found that protective factors inhibit the development of psychological difficulties, including post-traumatic stress disorder (e.g., Jones 2007; Youngstrom, Weist & Albus 2003; White et al. 1998). Moreover, it appears that protective factors interact with risk factors in their effects on adolescent well-being (Li, Nussbaum & Richards 2007; Ostaszewski & Zimmerman 2007). Even more specific to this study, unmeasured protective factors specific to African Americans including formal and extended kinship, spirituality, and collective coping may have been at play (e.g., Jones 2007; Utsey et al. 2007; Taylor, Casten & Flickinger 1993).

A third explanation may be bias in the sample due to service pathways. This was a substance abuse treatment sample, and adolescents with more severe co-occurring psychiatric disorders may have been diverted through the psychiatric or foster care systems. In the community from which this sample was drawn, adolescents with serious emotional disturbance This article requires authentication or verification by an expert.
Please assist in recruiting an expert or [ improve this article] yourself. See the talk page for details.
 are not necessarily referred to community substance abuse treatment. Depending on the history of victimization among these adolescents, the effect size between mental health and victimization may be larger than was observed in this study.

The foregoing interpretations on the association between victimization and mental health should be considered in the context of the study design. That is, because this was a cross-sectional study, the temporal relationship of victimization and mental health is unclear. Additional research is needed to determine how victimization and the onset or exacerbation of mental health problems are related. In addition to longitudinal studies that can help untangle the causal associations (e.g., Koenen et al. 2007; Giaconia et al. 2000), carefully designed retrospective accounts may also be important. Retrospective studies might involve a qualitative analysis Qualitative Analysis

Securities analysis that uses subjective judgment based on nonquantifiable information, such as management expertise, industry cycles, strength of research and development, and labor relations.
 to document the experiences of victimization, which could facilitate an understanding of how victims see their experiences to be related to mental health functioning. These results can generate new hypotheses, including other possible mediating factors.

Victimization and High-Risk Behaviors

Unlike associations with mental health disorders, victimization exhibited consistent relations with the lifetime measure of victimization. Gang membership and illegal activity exhibited the strongest associations. This is consistent with prior research that shows a high degree of overlap between victimization and violence perpetration (Hawke, Janichill & De Leon 2003; Howard et al. 2002; Feigelman et al. 2000). The effect size among victimization and high-risk sex behaviors reached the threshold of clinical significance. Engagement in these high-risk behaviors is most likely due to the lack of meaningful opportunities afforded to these adolescents.

The temporal ordering of victimization and high-risk behaviors is unclear; however, gaining knowledge on the temporal ordering of these relationships may not be as important as improving the conditions in which these adolescents live. That is, their decisions must be considered within the context of an environment with severely restricted social and economic opportunities, as well as a failing educational system. An effective treatment and prevention strategy will require a multifaceted effort that targets individuals and their broader social conditions.

Treatment and Prevention

Overall, this study documents a need for services related to treatment and prevention of victimization among African-American adolescents in substance abuse treatment. Sixty percent of subjects who were victimized reported that they had not received help for their experience of victimization, and 20% of the overall sample worried about future victimization.

A necessary step is improved access to and integration with the mental health service system. This can allow adolescents to be treated for the distress of mental disorders that may be due, in part, to victimization. Prior research has suggested that supportive relationships can help buffer against the effects of victimization (Youngstrom, Weist & Albus 2003). Treatment providers can explore the social network of the individuals and help identify ways of enhancing existing relationships.

Lambert and colleagues (2005: 44) stated that prevention efforts targeting urban adolescents "should attempt to increase youth vigilance of surroundings or awareness of danger as a means of reducing their risk for exposure to community violence by helping them avoid violent situations and involvement in violent activity." Nadel (1995) considered the modification of beliefs, attitudes and norms as fundamental to developing behaviors that can help prevent violence and victimization. Such prevention efforts can be included in substance abuse treatment through psychoeducation and cognitive behavioral groups. Service providers should assist adolescents in seeking out opportunities in the community that provide safe environments for structured activities and role models that discourage the use of substances.

Finally, it is unlikely that the problem of violence and victimization can be effectively addressed without improving the social and economic conditions of African-American adolescents living in urban settings. Thus, it is necessary to heighten the awareness of policy makers to promote meaningful social change.

Limitations and Future Directions

This study contributes to a developing area of research, focusing on an underrepresented group in services research. The contributions must be considered in the context of study limitations. First, as previously discussed, the cross-sectional design prevented any inferences regarding the temporal ordering of variables.

Second, the psychometrics psychometrics

Science of psychological measurement. Psychometricians design and administer psychological tests (see psychological testing), both to generate empirical data on mental processes and to refine their understanding of measurement techniques and the
 of the GAIN have not been thoroughly examined with African-American adolescents. African-American adolescents, especially those in urban environments, may have different conceptualizations of victimization due to their chronic exposure. Additional research is needed to understand how victimization can be effectively measured across different populations. Qualitative approaches can be an important method of research to help clarify these differences.

Third, the measure of victimization is based on assumptions that need to be validated. A summary score is derived by adding different experiences of victimization. This assumes that the items are additive and contribute equally to the final score. Future research should consider whether there are multiplicative effects of victimization and possible nonlinear associations with other variables.

Finally, the GAIN was administered at intake to substance abuse treatment. Clinical staff may not have had enough time to develop rapport with clients, which is a necessary condition for discussing sensitive topics such as victimization. It is possible that the true rate of victimization may be underestimated.

Summary

This study revealed a high rate of victimization in a sample of African-American adolescents in substance abuse treatment. The results contribute to existing evidence on the link between substance use and victimization. Severity of victimization was associated with having a mental disorder mental disorder

Any illness with a psychological origin, manifested either in symptoms of emotional distress or in abnormal behaviour. Most mental disorders can be broadly classified as either psychoses or neuroses (see neurosis; psychosis). Psychoses (e.g.
 (i.e., depression, generalized anxiety disorder, traumatic stress disorder, and conduct disorder). Lifetime victimization was associated with various high-risk behaviors (i.e., multiple sex partners, unprotected sex, gang membership, and illegal activity). Treatment and prevention of victimization will require strategies that address problems of the individual in addition to targeting broader social and economic conditions.

REFERENCES

Anderson, R.N. 2002. Deaths: Leading Causes for 2000. National Vital Statistics Report, Volume 50, No. 16. Hyattville, MD: National Center for Health Statistics.

Brown, T.L.; Henggeler, S.W.; Brondino, M.J. & Pickrel, S.G. 1999. Trauma exposure, protective factors, and mental health functioning of substance-abusing and dependent juvenile offenders. Journal of Emotional and Behavioral Disorders 7 (2): 94-102.

Caetano, R.; Field, C.A. & Nelson, S. 2003. Association between childhood physical abuse, exposure to parental violence, and alcohol problems in adulthood. Journal of Interpersonal Violence 18 (3): 240-57.

Caviola, A.A. & Schiff, M.M. 2000. Psychological distress in abused, chemically dependent adolescents. Journal of Child and Adolescent Substance Abuse 10 (2): 81-92.

Center for Disease Control (CDC). 2007. Victimization of Persons with Traumatic Brain Injury Traumatic brain injury (TBI), traumatic injuries to the brain, also called intracranial injury, or simply head injury, occurs when a sudden trauma causes brain damage. TBI can result from a closed head injury or a penetrating head injury and is one of two subsets of acquired brain  or Other Disabilities: A Fact Sheet for Professionals. Available at www.cdc.gov/ncipc/tbi/FactSheets/ VictimizationTBI_FactSheet4Professionals.htm

Champion, H.L.O.; Foley, K.L.; DuRant, R.H.; Hensberry, R.; Altman, D. & Wolfson, M. 2004. Adolescent sexual victimization, use of alcohol and other substances, and other health risk behaviors. Journal of Adolescent Health 35 (4): 321-28.

Cleary, S.D. 2000. Adolescent victimization and associated suicidal and violent behaviors. Adolescence 35 (Winter): 671-82.

Cohen, J. 1988. Statistical Power Analysis for the Behavioral Sciences. Second Ed. Hillsdale: Lawrence Erlbaum.

Dennis, M.L.; Chan, Y.-F. & Funk, R.R. 2006. Development and validation of the GAIN Short Screener (GSS (storage) GSS - Group-Sweeping Scheduling. ) for internalizing, externalizing and substance use disorders and crime/violence problems among adolescents and adults. American Journal on Addictions 15 (Suppl 1): 80-91.

Dennis, M.L.; White, M.; Titus, J.C & Unsicker, J. 2006. Global Appraisal of Individual Needs: Administration Guide for the GAIN and Related Measures. Bloomington: Chestnut Health System.

Dennis, M.L.; Funk, R.; Godley, S.H.; Godley, M.D. & Waldron, H. 2004. Cross-validation of the alcohol and cannabis use measures in the Global Appraisal of Individual Needs (GAIN) and Timeline Followback (TLFB TLFB Timeline Followback Method (alcoholism) ; Form 90) among adolescents in substance abuse treatment. Addiction 99 (Suppl 2): 120-28.

Feigelman, S.; Howard, D.E.; Li, X. & Cross, S.I. 2000. Psychosocial and environmental correlates of violence perpetration among African-American urban youth. Journal of Adolescent Health 27 (3): 202-09.

Fitzpatrick, K.M. & Bolidizar, J.P. 1993. The prevalence and consequences of exposure to violence among African-American youth. Journal of the American Academy of Child and Adolescent Psychiatry A branch of psychiatry that specialises in work with children, teenagers, and their families. History
An important antecedent to the specialty of child psychiatry was the social recognition of childhood as a special phase of life with its own developmental stages, starting with
 32 (2): 424-30.

Funk, R.R.; McDermeit, M.; Godley, S.H. & Adams, L. 2003. Maltreatment maltreatment Social medicine Any of a number of types of unreasonable interactions with another adult. See Child maltreatment, Cf Child abuse.  issues by level of adolescent substance abuse treatment: The extent of the problem at intake and relationship to early outcomes. Child Maltreatment child maltreatment '…intentional harm or threat of harm to a child by someone acting in the role of a caretaker, for even a short time…Categories Physical abuse, sexual abuse, emotional abuse, neglect…', the last being most common.  8 (1): 36-45.

Giaconia, R.M.; Reinherz, H.Z.; Hauf, A.C.; Paradis, A.D.; Wasserman, M.S. & Langhammer, D.M. 2000. Comorbidity of substance use and post-traumatic stress disorders in a community sample of adolescents. American Journal of Orthopsychiatry or·tho·psy·chi·a·try
n.
The psychiatric study, treatment, and prevention of emotional and behavioral problems, especially of those that arise during early development.
 70 (2): 253-62.

Godley, M.D.; Godley, S.H.; Dennis, M.L.; Funk, R. & Passetti, L.L. 2002. Preliminary outcomes from the assertive continuing care continuing care

a professional convention that a veterinarian who is treating an animal is obliged to continue treating that case unless an arrangement is made with its custodian to transfer the care to another practitioner or to a specialist.
 experiment for adolescents discharged from residential treatment. Journal of Substance Abuse Treatment 23 (1): 21-32.

Goldstein, A.L.; Walton, R.M.; Cunningham, M.A.; Trowbridge, M.J. & Maio, R.F. 2007. Violence and substance use as risk factors for depressive symptoms among adolescents in an urban emergency department. Journal of Adolescent Health 40 (3): 276-79.

Grella, C.E. & Joshi, J. 2003. Treatment processes and outcomes among adolescents with a history of abuse who are in drug treatment. Child Maltreatment 8 (1): 7-18.

Grella, C.E.; Hser, Y.; Joshi, V. & Rounds-Bryant, J. 2001. Drug treatment outcomes for adolescents with comorbid mental and substance use disorders. Journal of Nervous and Mental Disease The Journal of Nervous and Mental Disease is a scholarly journal on psychopathology.

Founded in 1874, it is the world's oldest independent scientific monthly in the field of human behavior.
 189 (6): 384-92.

Hawke, J.M.; Jainchill, N. & De Leon, G. 2003. Posttreatment victimization and violence among adolescents following residential drug treatment. Child Maltreatment 8 (1): 58-71.

Hawke, J.M.; Jainchill, N. & De Leon, G. 2000. The prevalence of sexual abuse and its impact on the onset of drug use among adolescent is the therapeutic community drug treatment. Journal of Child & Adolescent Substance Abuse 9 (3): 35-49.

Howard, D.E.; Feigelman, S.; Li, X.; Cross, S. & Rachuba, L. 2002. The relationship among violence victimization, witnessing violence, and youth distress. Journal of Adolescent Health 31 (6): 455-62.

Jones, J.M. 2007. Exposure to chronic community violence: Resilience in African American African American Multiculture A person having origins in any of the black racial groups of Africa. See Race.  children. Journal of Black Psychology 33 (2): 125-49.

Kaukinen, C. 2002. Adolescent victimization and problem drinking. Violence and Victims 17 (6): 669-89.

Koenen, K.C.; Moffitt, T.E.; Poulton, R.; Martin, J. & Caspi, A. 2007. Early childhood factors associated with the development of posttraumatic stress disorder Posttraumatic stress disorder

An anxiety disorder in some individuals who have experienced an event that poses a direct threat to the individual's or another person's life.
: Results from a longitudinal birth cohort. Psychological Medicine 37 (2): 181-92.

Lambert, S.F.; Ialongo, N.S.; Boyd, R.C. & Cooley, M.R. 2005. Risk factors for community violence exposure in adolescence. American Journal of Community Psychology 36 (1-2): 29-48.

Li, S.T.; Nussbaum, K.M. & Richards, M.H. 2007. Risk and protective factors for urban African American youth. American Journal of Community Psychology 39 (1-2): 21-35.

Liebschutz, J.; Savetsky, J.B.; Saitz, N.J.; Horton, R.; Lloyd-Travaglini, C. & Samet, J.H. 2002. The relationship between sexual and physical abuse and substance abuse consequences. Journal of Substance Abuse Treatment 22 (3): 121-28.

McCart, M.R.; Davies, W.H.; Harris, R.; Wincek, J.; Calhoun, A.D. & Melzer-Lange, M. 2005. Assessment of trauma symptoms among adolescent assault victims. Journal of Adolescent Health 36 (1): 70.e7-70.e13.

Moran, P.B.; Vuchinich, S. & Hall, N.K. 2004. Associations between types of maltreatment and substance use during adolescence. Child Abuse & Neglect 28 (5): 565-74.

Nadel, H.; Spellman, M.; Alvarez-Canino, T.; Lausell-Bryant, L. & Landsberg, G. 1995. The cycle of violence and victimization: A study of the school-based intervention of a multidisciplinary youth violence prevention program. American Journal of Preventive Medicine preventive medicine, branch of medicine dealing with the prevention of disease and the maintenance of good health practices. Until recently preventive medicine was largely the domain of the U.S.  12 (Suppl 5): 109-19.

National Institute of Justice (NIJ). 2003. Youth Victimization: Prevalence and Implications. Washington, DC: Department of Justice, Office of Justice Programs.

National Institute of Justice (NIJ). 1997. Research on Delinquency and Adult Criminality. Washington, DC: NIJ.

Office of Juvenile Justice and Delinquency Prevention The Office of Juvenile Justice and Delinquency Prevention (or OJJDP) is an office of the United States Department of Justice and a component of the Office of Justice Programs.  (OJJDP). 2000. Children as Victims. Washington, DC: OJJDP.

Osofsky, J.D. 2001. Addressing Youth Victimization. Coordinating Council on Juvenile Justice and Delinquency Prevention: Action Plan Update. Washington, DC: Department of Justice, Office of Justice Programs.

Ostaszewski, K. & Zimmerman, M.A. 2006. The effects of cumulative risks and promotive factors on urban adolescent alcohol and other drug use: A longitudinal study longitudinal study

a chronological study in epidemiology which attempts to establish a relationship between an antecedent cause and a subsequent effect. See also cohort study.
 of resiliency. American Journal of Community Psychology 38 (3-4): 237-49.

Paxton, K.C.; Robinson, W.L.; Shah, S. & Schoeny, M.E. 2004. Psychological distress for African-American adolescent males: Exposure to community violence and social support as factors. Child Psychiatry child psychiatry

Branch of medicine concerned with mental, emotional, and behavioral disorders of childhood. It arose as a separate field in the 1920s, largely because of the pioneering work of Anna Freud.
 and Human Development 34 (4): 281-95.

Shane, P.A.; Jasiukaitis, P. & Green, R. 2003. Treatment outcomes among adolescents with substance abuse problems: The relation-ship between comorbidities and post-treatment substance involvement. Evaluation and Program Planning 26 (4): 393-402.

Shepherd, J.P.; Sutherland, I. & Newcombe, R.G. 2006. Relations between alcohol, violence and victimization in adolescence. Journal of Adolescence 29 (4): 539-53.

Sullivan, T.N.; Farrell, A.D. & Kliewer, W. 2006. Peer victimization in early adolescence: Association between physical and relational victimization and drug use, aggression, and delinquent behaviors among urban middle school students. Developmental Psychopathology 18 (1): 119-37.

Taylor, R.D.; Casten, R. & Flickinger, S.M. 1993. The influence of kinship social support on the parenting experiences and psychosocial adjustment of African American adolescents. Developmental Psychology 29 (2): 382-88.

Titus, J.C.; Dennis, M.L.; Scott, C.K. & Funk, R.R. 2003. Gender differences in victimization severity and outcomes among adolescent treated for substance abuse. Child Maltreatment 8 (1): 19-35.

US Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979
Health and Human Services, HHS
 (US DHHS). 1999. Youth Violence: A Report of the Surgeon General. Washington, DC: USDHHS USDHHS,
n.pr See United States Department of Health and Human Services.
.

Utsey, S.O.; Bolden, M.A.; Lanier, Y. & Williams, O. 2007. Examining the role of culture-specific coping as a predictor of resilient outcomes in African Americans from high-risk urban communities. Journal of Black Psychology 33 (1): 75-93.

Van Dorn, R.A. 2004. Correlates of violent and nonviolent victimization in a sample of public high school students. Violence and Victims 19 (3): 303-20.

Weiner, M.D.; Sussman, S.; Sun, P. & Dent, C. 2005. Explaining the link between violence perpetration, victimization and drug use. Addictive Behaviors 30 (6): 1261-66.

White, K.S.; Bruce, S.E.; Farrell, A.D. & Kliewer, W. 1998. Impact of exposure to community violence on anxiety: A longitudinal study of family social support as a protective factor for urban children. Journal of Child and Family Studies 7 (2): 187-203.

Youngstrom, E.; Weist, M.D. & Albus, K.E. 2003. Exploring violence exposure, stress, protective factors and behavioral problems among inner-city youth. American Journal of Community Psychology 32 (1-2): 115-29.

([dagger]) Financial assistance for this study was provided by SAMHSA's Center for Substance Abuse Treatment (CSAT CSAT Center for Substance Abuse Treatment
CSAT Customer Satisfaction
CSAT Client Satisfaction
CSAT Certified Sexual Addiction Therapist
CSAT Combined Systems Acceptance Test
CSAT Civil Service Arbitration Tribunal (United Kingdom) 
) Grant No. TI13305.

Brian E. Perron Per´ron

n. 1. (Arch.) An out-of-door flight of steps, as in a garden, leading to a terrace or to an upper story; - usually applied to mediævel or later structures of some architectural pretensions.
, Ph.D., Assistant Professor, University of Michigan (body, education) University of Michigan - A large cosmopolitan university in the Midwest USA. Over 50000 students are enrolled at the University of Michigan's three campuses. The students come from 50 states and over 100 foreign countries.  School of Social Work, Ann Arbor Ann Arbor, city (1990 pop. 109,592), seat of Washtenaw co., S Mich., on the Huron River; inc. 1851. It is a research and educational center, with a large number of government and industrial research and development firms, many in high-technology fields such as , MI.

Heather J. Gotham, Senior Manager of Evaluation, Mid-America Addiction Technology Transfer Center, University of Missouri-Kansas City, Kansas City, Missouri Kansas City is the largest city in the state of Missouri. It encompasses parts of Jackson, Clay, Cass, and Platte counties and is the anchor city of the Kansas City Metropolitan Area, the second largest in Missouri, which includes counties in both Missouri and Kansas. .

Dong Cho, Associate Professor, Department of Psychiatry at Missouri Institute of Mental Health, School of Medicine, University of Missouri at Columbia.

Please address correspondence and reprint requests to Brian E. Perron, Ph.D., University of Michigan, School of Social Work, 1080 S. University Avenue, Ann Arbor MI 48109; email: beperron@umich.edu.
TABLE 1
Summary of Rate and Type of Victimization among Overall Study Sample

Study Variables                             N (Range)   % or Mean (SD)

Lifetime Victimization                       139        53.7
Past 90 Days Victimization                    60        23.2
Days Victimized (if Any) in Past 90 Days   (1-90)        6.88 (17.25)
Age of First Victimization                 (4-17)       12.3 (2.48)
Received Needed Help for Victimization
  (if Victimized) *                           55        39.6
Currently Worried About Being Victimized      56        21.6
Type of Victimization
  Attacked with Weapon                       118        45.6
  Hurt by Striking/Beating                    51        19.7
  Forced into Sexual Acts                     11         4.2
  Abused Emotionally                          40        15.4
Traumagenic Factors
  Victimized Several Times or for a
    Long Time                                 85        32.8
  With More Than One Person Involved          92        35.5
  Was Person Family Member/Trusted One        43        16.6
  Where You Afraid for Life or Injury         36        14.0
  Result in Oral, Vaginal, or Anal Sex        11         4.2
  People You Told did not Believe or
    Help You                                  28        10.8
High Victimization **                        108        41.7

* Among subjects who reported a history of victimization (N = 139).

** Score of 4 or greater on GVS.

TABLE 2
Summary of Associations Among Victimization and Study Variables

                                  Lifetime Victimization

Study                    Yes         No       [chi square]   [PHI]
Variable              (n = 139)   (n = 120)

Male                    84.9%       83.3%        .12          .02
Clinical Disorders
  Major Depressive      29.5%       12.5%      10.98 ***      .21
  Generalized
    Anxiety              7.9%        0.8%       7.31 **       .17
  Traumatic Stress      18.0%        9.2%       4.18 *        .13
  Conduct               46.8%       15.8%      28.11 ***      .33
High-Risk
    Behaviors
  Illegal Activity      68.3%       39.2%      22.14 ***      .29
  Gang Membership       32.4%        6.7%      26.15 ***      .32
  Unprotected Sex       31.9%       10.1%      17.82 ***      .26
  Multiple Sex
    Partners            58.3%       37.8%      10.74 ***      .20

                                 Past 90-day Victimization

Study                    Yes        No       [chi square]       [PHI]
Variable               n = 60)   (n = 199)

Male                     85.0       83.9       .04               .01
Clinical Disorders
  Major Depressive      33.3%      18.1%      6.32               .16
  Generalized
    Anxiety              6.7%       4.0%       .48 ([dagger])    .00
  Traumatic Stress      15.0%      13.6%       .08               .02
  Conduct               50.0%      27.1%     11.00 ***           .21
High-Risk
    Behaviors
  Illegal Activity      80.0%      47.2%     19.98 ***           .28
  Gang Membership       35.0%      16.1%     10.14 ***           .20
  Unprotected Sex       33.3%      18.3%      6.12 *             .15
  Multiple Sex
    Partners            58.3%      46.9%      2.82               .10

                               High Severity Victimization

Study                    Yes         No       [chi square]   [PHI]
Variable              (n = 108)   (n = 151)

Male                    81.5       86.1          1.00         .06
Clinical Disorders
  Major Depressive      34.3%      12.6%        17.46 ***     .26
  Generalized
    Anxiety             10.2%       0.7%        12.92 ***     .22
  Traumatic Stress      23.1%       7.3%        13.24 ***     .23
  Conduct               52.8%      17.9%        35.00 ***     .37
High-Risk
    Behaviors
  Illegal Activity      69.4%      44.4%        15.98 ***     .25
  Gang Membership       33.3%      11.3%        18.85 ***     .27
  Unprotected Sex       31.8%      14.7%        10.73 ***     .20
  Multiple Sex
    Partners            54.6%      44.7%         2.94         .10

Note: * p < .05, ** p < .01, *** p < .001. Phi-coefficients ([PHI])
[greater than or equal to] .20 are in bold, indicating a clinically
significant association.

([dagger]) Cross-tabulation did not meet assumption of chi-square
([chi square]) test due to low cell counts; thus, Fisher's exact test
was used and reported.
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Author:Perron, Brian E.; Gotham, Heather J.; Cho, Dong
Publication:Journal of Psychoactive Drugs
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Date:Mar 1, 2008
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