MICHAEL G. VAUGHN, MARGARET LOMBE, STEPHEN TRIPODI, AND VON E. NEBBITTOVERVIEW OF THE ISSUE
ADOLESCENCE IS A STAGE OF development when young people strive for group identity and subsequently explore the larger social world (Erikson 1950; Giordano 2003). Accordingly, exposure to a variety of risks, such as violence and substance use, tends to increase during adolescence compared to childhood. For example, from 1993 through 2003, juveniles ages 12 to 17 years were approximately 2.5 times more likely than adults (i.e., ages 18 and older) to be victims of nonfatal violence (Lawrence & Hemmens 2008; Snyder & Sickmund 2006). Rates of exposure to community violence are far higher for African American adolescents than other racial and ethnic groups (Myers & Thompson 2000; Vaughn et al. 2008). This is exacerbated by the fact that African Americans reside in areas experiencing profound concentrated disadvantage, as exemplified by their overrepresentation in urban public housing developments marked by violence (community and domestic), gangs, substance abuse, and alternative market activity (e.g., drug trafficking).
Although a growing body of research has highlighted the associations among mental health symptoms and health-risk behaviors in African American adolescents living in urban public housing neighborhoods (see, e.g., DuRant et al. 2000; Nebbitt & Lombe 2007), research that has examined various ecological correlates of adolescents’ alcohol and other drug use is notably absent. Important questions regarding the extent to which these relationships are mitigated by community cohesion remain largely unanswered. Using a sample of 663 African American adolescents living in urban public housing, our study addresses this gap in knowledge by assessing how community cohesion buffers the relationship between multiple risk factors and adolescents’ alcohol, tobacco, and marijuana use.
Exposure to Violence and Substance Use
Much is known about the prevalence of adolescent exposure to violence (Cooley-Quille et al. 2001; Gorman-Smith, Henry, & Tolan 2004; Myers & Thompson 2000). Research has emerged that links exposure to community violence, either as witness or victim, to a variety of emotional and behavioral problems (Gorman-Smith, Henry, & Tolan 2004; Myers & Thompson 2000; Oravecz et al. 2011; Schwartz & Gorman 2003). Documented emotional and behavioral consequences of violence exposure among both urban and rural youth include increased risk for symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD; see, e.g., DuRant et al. 2000; Fitzpatrick & Boldizar 1993). These emotional and behavioral problems are intertwined with substance use.
Scholars also link exposure to community violence to drug initiation, use, and dependence (Cooley-Quille et al. 2001; DuRant et al. 2000). More specifically, DuRant et al. (2000), using a sample of African American youth living in public housing, found that exposure to violence was related to the frequency of use of cigarettes, alcohol, and other substances. Likewise, Clark, Lesnick, and Hegedus (1997) found an association between alcohol dependence in adolescence and childhood histories of violence exposure. One mechanism that explains these linkages is the proposition that alcohol and other drug use may be a form of coping behavior used to medicate or assuage difficult feelings related to traumatic memories (Kilpatrick et al. 2003).
Family and household conflict (e.g., domestic violence), which are often embedded within communities, are positively associated with adolescent problem behaviors, including psychological distress (e.g., Jacobson & Crockett 2000; Saltzman, Holden, & Holahan 2005). Studies have also indicated that exposure to violence in the home is a predictor of depression and PTSD among youth (Folsom et al. 2003; Voisin & Hong 2012) and is also associated with lower self-esteem and increased cognitive dysfunction (Saltzman, Holden, & Holahan 2005). Finally, living in a violent home and experiencing harsh parental discipline can also put youth at risk for both current and future substance abuse (Hawkins, Catalano, & Miller 1992; Kilpatrick et al. 2003; Sloboda & David 1997).
DEVIANT PEERS AND SUBSTANCE USE
The developmental period of adolescence involves individualization from family and identification with a peer group (Brown & Klute 2006). As a result of this change, peers exert relatively greater influence and form an important behavioral reference for an adolescent. Findings indicate similarities in levels of risk behavior among adolescents within the same peer group (Henrich et al. 2000). In fact, affiliation with delinquent peers is one of the most consistent and strongest predictors of delinquent behavior (Keenan et al. 1995; Nebbitt, Lombe, & Williams 2008; Warr 2003).
Moreover, research has reported a link between affiliating with delinquent peers and a variety of emotional problems in adolescents (Brendgen, Vitaro, & Bukowski 2000; Fergusson & Woodward 2002). For example, youth who affiliated with delinquent peers reported more depressive feelings and suicidal behaviors compared to those who affiliated with nondelinquent peers (Brendgen, Vitaro, & Bykowksi 2000; Nebbitt & Lambert 2009; Nebbitt & Lombe 2007). One way to view these relationships is that psychological distress (e.g., depressive symptoms, anxiety) among youth residing in harsh urban communities serves as a mediator between exposure to environmental stressors and substance use (Sanders-Phillips 2001). This relationship, however, has not been fully explored among African American adolescents living in urban public housing communities; hence, there is a need for further empirical examination within this vulnerable population.
Still, research has established a direct relationship between exposure to delinquent peers and substance use in adolescents (Kilpatrick et al. 2000; Vaughn, Beaver, & DeLisi 2009). A peer environment perceived to be accepting of substance use may be inviting to an adolescent who is struggling to cope with the stresses associated with the urban environment.
DELINQUENT BEHAVIOR AND SUBSTANCE USE
Convergent findings across studies of delinquent youth indicate significant overlap between problem behaviors and substance misuse (Thompson et al. 1996; Tripodi, Springer, & Corcoran 2007). Research by Vaughn et al. (2007) has shown that substance use severity and serious delinquency go hand in hand, clustering together along a severity-based gradient. Essentially, youth who use the most drugs have the most extensive criminal histories. Furthermore, early initiation of substance use is an important predictor of later delinquency (Lipsey & Derzon 1998). However, does substance use possess an independent effect, irrespective of delinquent offending? A 30-year prospective study by Odgers et al. (2008) showed that early initiation of substance use was a risk factor for maladaptive problems, irrespective of delinquent behavior and conduct disorder. Studies are needed to elucidate the effects of social-ecological contextual variables on the intertwined nature of delinquency and substance use.
CO-OCCURRENCE OF PTSD AND SUBSTANCE USE
Studies have shown a strong association between PTSD and substance abuse problems. Specifically, in a study assessing risk factors for PTSD, Deykin and Buka (1997) identified substance use disorders as potential risk factors. As previously mentioned, the mechanism hypothesized is that the use of alcohol and other drugs may be a coping behavior to assuage painful feelings and memories (DuRant et al. 2000). Indeed, it has been postulated that exposure to stress heightens the predisposition for drug initiation and use (Piazza & Moal 1996; Volkow & Fowler 2000). The underlying biologically based tendency to abuse and become dependent on substances is partly expressed by exposure to environmental stress (Sinha 2009). This form of explanation is consistent with viewing these dynamic relations as a gene–environment interaction (e.g., Rutter 2007).
COMMUNITY COHESION AS A MODERATING FACTOR
Youth residing in harsh environments often rely on various social factors to help them overcome the harmful effects stemming from their adverse life circumstances. One such factor is community cohesion, perceived as supportive relationships beyond a youth’s immediate home environment (Gutman, Sameroff, & Eccles 2002). Social support generally consists of a network of peers and caring adults within a youth’s community and is evaluated on the basis of people’s perceptions of how community members relate to each other (Garbarino & Kostelny 1992; Rountree & Warner 1999).
Some evidence suggests that supportive relationships outside a youth’s immediate family buffer environmental challenges by providing youth with an avenue to process their experiences with peers or caring adults within their communities (Garbarino & Kostelny 1992). Furthermore, adolescents are more likely to avoid risky behaviors when they perceive themselves to be socially integrated and exposed to a variety of prosocial community assets, including social support (Benson et al. 2006; Hawkins et al. 2007).
Empirical evidence on exposure to community violence vis-à-vis a youth’s emotional and behavioral well-being is mixed. Some scholars have found positive adaptations after exposure to community violence among youth who perceived high rates of social cohesion (Aneshensel & Sucoff 1996; Zimmerman et al. 2000), whereas others reported that social cohesion is only associated with fewer internalizing symptoms (Kliewer et al. 2004). Nebbitt (2009) found higher community cohesion to be associated with higher generalized self-efficacy, which was associated with lower alcohol and other drug use in adolescents.
Greater research attention has been afforded to understanding the effects of community cohesion on psychological (internalizing) functioning in urban youth (Aneshensel & Sucoff 1996; Zimmerman et al. 2000) compared to empirical evidence assessing the relationships between community cohesion and a youth’s externalizing behavior (e.g., substance abuse). Rigorous examination of this relationship may have important implications for promoting resilience and health predispositions among African American youth in urban public housing communities. The goal of this chapter is to address this gap in knowledge by examining the direct effect of individual and community correlates on substance use and assessing how these relationships may be moderated by community cohesion.
THEORETICAL ORIENTATION
This chapter tests the component of the Integrated Model of Adolescent Development in Public Housing Neighborhoods, which postulates that negative aspects of public housing environments (e.g., exposure to delinquent peers, domestic conflict, exposure to community violence), in addition to an adolescent’s mental health symptoms, directly influence adolescents’ substance use. This chapter also assesses whether the direct effects of delinquent peers, domestic conflict, and community violence are moderated by community cohesion.
This chapter advances two questions:
1. How are the patterns of relations among exposures to community and domestic violence, community cohesion, delinquent peers, symptoms of PTSD, and delinquent behavior related to substance use in African American adolescents living in public housing?
2. Is there evidence that community cohesion moderates the relationship, if any, between external risk factors (e.g., domestic violence, delinquent peers) and substance use?
METHODS
Research Settings
This paper uses data from youth in Washington DC, New York City, and Philadelphia. These were the cities with complete data available on all substance use/abuse variables.
Measures
Measures used included the following:
1. Alcohol, tobacco, and marijuana use was assessed using the Centers for Disease Control and Prevention’s Youth Risk Behavior Survey (2011).
2. Exposure to delinquent peers was assessed using the Self-Reported Exposure to Deviant Peers Scale (Eliot 1987).
3. Delinquent behavior was assessed using the Self-Reported Delinquency Scale (Elliot 1987).
4. PTSD symptoms were measured using the Impact of Event Scale (Horowitz, Wilner, & Alvarez 1979).
5. Domestic violence was assessed using the Family Conflict Scale (Barbarin, Richter, & deWet 2001).
6. Social cohesion was assessed using the Subjective Neighborhood Scale (Aneshensel and Sucoff 1996).
7. Exposure to community violence was assessed using the Survey of Exposure to Community Violence: Self-Report Version (Richter & Martinez 1990).
The primary analytic procedure included a six-step sequential regression analysis. Controls (e.g., age, gender, research site) were entered in the first step. The second step included individual level correlates (e.g., symptoms of PTSD, annual prevalence of delinquency). Exposure to delinquent peers was entered in the third step. The fourth step included domestic conflict, while exposure to community violence and social cohesion were entered in the fifth step. The sixth step included six two-way interaction terms (e.g., social cohesion by annual prevalence of delinquency, social cohesion by PTSD, social cohesion by exposure to delinquent peers, social cohesion by domestic conflict, social cohesion by witnessing community violence, and social cohesion by victimization by community violence). In addition to sequential regression analysis, results from descriptive statistics (means and standard deviations), t-tests, bivariate correlations, and one-way analysis of variance are reported.
Prior to the analyses, data were evaluated for missing observations, outliers, normality, multicollinearity, and homoscedasticity. Maximum missing scores, on selected observations, were less than 3 percent. Listwise deletion was employed. No departures from normality were observed for study variables. Regression diagnostics (e.g., scatter plot of the standardized residual and the standardized predictors, variance inflation factors, and tolerance values) indicated that the assumptions of regression were met. All variables were centered to reduce entering multicollinearity into the model when assessing interaction effects.
RESULTS
Sample Characteristics
This chapter uses a sample of 663 youth: 167 from Washington DC, 347 from New York, and 149 from Philadelphia. The age range of the sample was from 13 to 19 years, with a mean age of 15.4 years and a standard deviation of 2.4 years. Females were 48 percent of the sample.
Bivariate Analyses
Males reported a significantly higher prevalence of substance use, delinquent behavior, and exposure to household conflict. Females, on the other hand, reported a significantly higher prevalence of PTSD symptoms. Direct and indirect exposure to community violence did not differ by gender (table 6.1).
Substance use had a significant positive bivariate relationship with age, symptoms of PTSD, delinquent behavior, exposure to delinquent peers, exposure to household conflict, and direct and indirect exposure to community violence. The annual prevalence of substance use was unrelated to community cohesion at the bivariate level (table 6.2).
TABLE 6.1 Ranges, Means, and Standard Deviations for Sample and T-Test Statistics by Gender
NS, not significant; *p < .05, **p < .01, ***p < .000.
TABLE 6.2 Bivariate Correlation Coefficients for Study Variables
*p < .05, **p < .01, ***p < .000.
Multivariate Analysis
Results show that the overall regression model was significant, explaining 26 percent of the variance in substance use [F(14,645) = 17.37; R2 = 25.9; p < .001]. Controls (age, gender, and research city) uniquely accounted for 15 percent of the variation in substance use [F(3,652) = 39.97; R2 = 15.5; p < .001]. Coefficient estimates indicate that being male and older is associated with increased substance use. Symptoms of PTSD and delinquent behavior contributed a significant and independent 7 percent of the variance in substance use [F(change) = 29.06; 
R2 = .069, p < .001]. Coefficient estimates suggest that symptoms of PTSD and delinquent behavior are both positively related to substance use.
Peers’ delinquent behavior explained a statistically significant and unique 1 percent of the variance in the model [F(change) = 8.34; R2= .011; p < .01]. Coefficient estimates indicate that greater exposure to delinquent behaviors is associated with increased substance use. Household conflict also reached statistical significance and uniquely contributed 1 percent of the variance in substance use [F(change) = 9.14; R2 = .011; p < .01]. Neighborhood correlates (witnessing and victimization by community violence and community cohesion) explained 1 percent of the variance in substance use [F(change) = 3.79; R2 = .013; p < .01]. Coefficient estimates indicate that witnessing community violence is positively related to substance use, while community cohesion is inversely related to substance use. Victimization by community violence was unrelated to adolescents’ substance use.
The interaction terms explained a significant and unique 1 percent of the variance in the model [F(change) = 3.71; R2 = .017; p < .01]. Coefficient estimates suggest that the positive relationship between exposure to delinquent peers and substance abuse becomes significantly weaker as community cohesion increases. Furthermore, the positive relationship between witnessing community violence and substance abuse becomes significantly weaker when community cohesion increases. The relationships between household conflict and victimization by community violence and substance abuse did not depend on levels of community cohesion (table 6.3).
TABLE 6.3 Sequential Regression: Criterion Variable ATOD
ATOD, alcohol, tobacco and other drugs; SE, standard error; *p < .05, **p < .01, *** p < .000.
Various contextual and behavioral domains tend to influence substance use in this sample of vulnerable youth. More specifically, in our study, males reported a significantly higher prevalence of both substance use and delinquent behavior than females. On the other hand, females accounted for significantly greater symptoms of PTSD than males, despite the fact that males were exposed to greater household conflict. These observations are consistent with previous research on youth in public housing (DuRant et al. 2000). Also, male gender and older age were predictors of increased substance use. Furthermore, symptoms of PTSD and delinquent behavior were both positively related to substance use. Similarly, greater exposure to delinquent peers was associated with an increase in substance use. These findings have, in fact, been reported in prior research (Silverman et al. 2001; Vaughn, Beaver, & DeLisi 2009). We also noted that household conflict and witnessing community violence were positively related to substance use, whereas community cohesion was negatively related to alcohol, tobacco, and marijuana use. These findings provide further support for the proposition that use of alcohol and other drugs may be a coping mechanism used to manage difficult feelings and memories of trauma (Cooley-Quille et al. 2001; DuRant et al. 2000).
Importantly, we found that the relationship between exposure to delinquent peers and substance abuse was moderated by increases in community cohesion; this is consistent with previous research suggesting that community cohesion has the potential to cushion negative behavioral effects (Hawkins et al. 2007). In addition, a positive relationship between witnessing community violence and substance use was also moderated by increases in community cohesion. This observation may have important implications for youth in urban public housing, and it points to the role that community cohesion plays in facilitating a youth’s positive adaptation. Other scholars have made similar observations (Aneshensel & Sucoff 1996; Zimmerman et al. 2000). Importantly, these findings complement treatment research on the effectiveness of individual and family interventions for reducing alcohol and cannabis use among adolescents (Bender et al. 2011; Tripodi et al. 2010; Vaughn & Howard 2004).
Community cohesion served as a moderating influence in this study, pointing to the need to include this in conceptual models on adolescent development in adverse environments, such as public housing. The integrated model that guides this research posits that ultimate macrolevel factors (isolation and segregation) give rise to both promotive and inhibiting environments for youth and that community cohesion is one prosocial source that can blunt maladaptive behaviors. Drug trafficking, incivility, community and domestic violence, dilapidation, deviant peer groups, deviant adult males, and further isolation have direct effects on provoking anxiety and depression in youth who are perhaps biologically predisposed for these internalizing disorders. In turn, substance use is one coping mechanism that is employed by youth to counteract the emotional turmoil and trauma in their lives. This not only sets many youth on a pathway toward addiction but also exposes them to further risk (D’Amico et al. 2008). Larger contextual effects, such as community cohesion, can possibly reduce the deleterious effects of substance use for these youth by enhancing caregiver or adult monitoring of behavior (Piko & Kovacs 2010). This form of biosocial theorizing, which involves successive levels of context, is gaining momentum as researchers realize that transdisciplinary approaches are necessary for solving complex social problems (Vaughn 2007).
Limitations
Our study findings need to be interpreted within the context of several limitations. First, convenience sampling (e.g., voluntary participation) was employed. Second, there were minor variations in data collection sites. For example, data collection at sites 1 and 3 occurred in community centers, whereas data collection at site 2 occurred in a social service agency located in the housing development. The cross-sectional approach used in the study limits its ability to establish temporal ordering of variables necessary to infer causation. Thus, subjective appraisals of community cohesion may influence, and in turn be influenced by, adolescents’ substance use. Furthermore, an adolescent’s subjective appraisal of community cohesion may be influenced by his or her family’s tenure and status in the housing development. That is, families with intergenerational tenure may have higher status and more elaborate social networks, which may contribute to higher perceived community cohesion among youth in these families. It should be noted that other predictors (not included in this analysis) such as depression, sensation-seeking temperament, attitudes toward drug use, and access to drugs might also influence substance use. Furthermore, the accuracy of the data is limited by the accuracy to which youth recall and self-report their perceptions, feelings, and behaviors.
Conclusions from this study are based on a sample of youths from public housing developments in three large cities. Generalizing these findings to youths from other public housing types (e.g., rural housing developments, Section 8, and HOPE IV communities) should be done with caution. These limitations notwithstanding, it should be noted that the characteristics of the sample have many similarities to other studies on youth in public housing using random sampling techniques (DuRant et al. 2000).
Implications
Several implications emerge that are important for providing insight to guide policy decisions and the development of interventions to support positive adaptations among youth in urban public housing. Although, as noted by Sampson (2003), the science of urban ecology in relation to individual outcomes is relatively young, several suggestions can be proffered. A full discussion of the policy and practice implications of this chapter is provided in part 3 of this book.
