Adolescents in Public Housing: Addressing Psychological and Behavioral Health

ADOLESCENT DEVELOPMENT ENCOMPASSES MULTIPLE AND sometimes interacting personal, social, economic, cultural, and environmental factors (Bronfenbrenner 1979; Compas & Millstein 1993; Knopf, Park, & Mulye 2008; Rowling 2006; World Health Organization 2004). Bronfenbrenner (1979) underscored the important role of an adolescent’s environment in understanding their development. Indeed, the surroundings within which children or adolescents develop can serve to either promote or inhibit favorable and negative outcomes.

The urban environment may play a unique and at times critical role in shaping minority adolescent development. Researchers have surmised, for example, that the developmental outcomes of African American adolescents may be indubitably affected by the distinctive experience of the urban context, such as the public housing neighborhood, and that this experience is unshared by nonminority youth (Coll et al. 1996; Jarrett 2003; Nebbitt & Lombe 2007). These suppositions undergird the importance of exploring the relationship between environmental factors and developmental outcomes for urban minority youth.

Although African American adolescents on the whole navigate the developmental stages of adolescence successfully, they may be at higher risk for adverse behavioral health outcomes, such as depression, compared to other racial/ethnic minority youth (Roberts, Roberts, & Chen 1997; U.S. Department of Health and Human Services [USDHHS] 2001). Additionally, negative characteristics of the urban environment, such as community violence, poverty, and deviant peer groups, may further contribute to adverse outcomes for African American adolescents, particularly those living in public housing settings (Garbarino 1992; Jenkins & Bell 1997). Exposure to community violence, for example, is related to antisocial behavior, such as the use of violence (DuRant et al. 2000) and increased aggressive behavior (Gorman-Smith, Henry, & Tolan 2004). Furthermore, exposure to delinquent peers is related to greater participation in delinquent behaviors (Nebbitt, Lombe, & Williams 2008) and depressive symptoms (Nebbitt & Lombe 2007) for urban youth living in public housing settings.

Chapter 3 identified a vital need in the research literature for theories that help to understand the processes influencing child and adolescent development within the urban environmental context, specifically within urban public housing settings. In particular, chapter 3 elucidated factors, including protective factors, that are potentially related to differences in developmental outcomes for youth living in public housing. The chapter examined factors that may prevent negative outcomes, as well as factors that promote positive ones.

The Integrated Model of Adolescent Development in Public Housing Neighborhoods is presented in depth in chapter 3. Generally, it purports that distal factors, such as residential segregation, mediated through processes such as discrimination and isolation, potentially influence adolescent developmental outcomes. Additionally, proximal factors and processes including promotive (e.g., fictive kinship networks) and inhibiting (e.g., community violence) aspects of the public housing environment may have direct and at times interacting effects on both positive and negative youth adaptations and development. Understanding the influence of both distal and proximal factors on developmental outcomes of youth in public housing is imperative to the development of prevention and treatment interventions consonant with the needs and experiences of this population.

The findings from the studies discussed in this book support existing research and provide new knowledge about the influence of developmental factors and health-related outcomes inherent to the public housing setting for African American adolescents. Sections of the Integrated Model of Adolescent Development in Public Housing Neighborhoods in chapter 3 were tested through empirical studies in this volume, which examined the impact of selected promoting and inhibiting aspects of the public housing neighborhood on both internalizing symptoms and externalizing behaviors among African American adolescents in this setting. Specifically, researchers examined individual, family, community, and neighborhood risk and protective factors as direct and/or indirect influences on depression, substance use, and antisocial, delinquent, and health-risk behaviors among African American youth in public housing. The studies also examined factors such as adultification, community cohesion, and social context as possible moderators of the explored relationships. Both adultification and community cohesion were viewed in this volume as positive adjustments made by adolescents to enduring life in harsh urban environments (chapter 8).

The authors found some support for the suppositions of the model. In chapter 5, the promoting aspects of the public housing environment, such as fictive kin (defined as adults considered close but unrelated) and maternal encouragement, were found to positively influence adolescent attitudes and beliefs, which together function as a protective factor against negative youth behaviors and lower emotional well-being in adolescents. As predicted, inhibiting aspects of the public housing environment, such as community violence, delinquent peer affiliation, and perceptions of neighborhood disorder, were directly and indirectly related to depressive symptoms and engagement in health-risk behaviors (chapters 6–8). Additionally, adultification was directly related to less depressive symptoms, lower susceptibility to neighborhood risk, and fewer exposure to deviant peers (chapter 8). Furthermore, community cohesion emerged as a potential protective influence mitigating the impact of community and neighborhood risk factors on depression and substance use in this population (chapters 6 and 8).

Although the primary focus of the research was not to explore gender differences in outcomes, the presence of externalizing and internalizing symptoms was also found to vary, at times, by gender. Chapter 6, for example, found greater prevalence of posttraumatic stress disorder (PTSD) in females, while males exhibited higher substance use and delinquent behavior, as well as experienced greater exposure to household conflict (chapters 6–8).

Generally, the empirical studies support the postulations of the integrated model that individual, family, community, and neighborhood factors either directly or indirectly influence both positive and negative developmental outcomes in adolescents. The research supports the importance of examining factors that promote well-being and protect against negative behaviors within the population of African American adolescents residing in public housing. The research also evinced that community cohesion served as a critical protective function between neighborhood risk factors and both substance use and depression. The findings also highlighted differences in certain behaviors and symptoms based on gender. Taken together, the results suggest several factors that could inform the development or implementation of interventions targeted to this group.

Grounded in the developmental perspective, a central idea of prevention is that early intervention (proximal) will prevent a later (distal) negative outcome (Kellam, Koretz, & Moscicki 1999). Generally, prevention research focuses on the exploration of the precursors of health or disease that influence the developmental process. It also highlights a risk and protective framework such that protective mechanisms interact with risk factors to mitigate the effect of the risk when present (Coie et al. 1993; Kellam, Koretz, & Moscicki 1999; Luster, Bates, & Johnson 2006). Risk factors can be broadly defined as circumstances, attributes, and events that increase the probability of negative outcomes (Carbonell et al. 2002). Protective factors can be defined as factors, both internal and external, that potentially guard against or alleviate risk (Kirby & Fraser 1997). Subsequently, prevention interventions are geared towards mitigating risk factors and promoting the development of protective factors, thereby reducing incidence of maladjustment and promoting optimal functioning in individuals (Coie et al. 1993; Gordon 1983; Kazdin 1993; Kellam, Koretz, & Moscicki 1999). Garmezy (1985) identified three general classes of factors that can be considered protective: factors inherent to individuals, factors that create a supportive family setting, and factors outside of the individual and family that support the positive development of the child. These factors in operation may serve to protect an individual from the development of a problem, diminish or mitigate the impact of a risk factor, and/or strengthen an individual’s ability to cope in the presence of a risk (Carbonell et al. 2002). Protective factors have also been highlighted as one aspect of promoting resilience (Rutter 2006) that potentially have a cumulative or combined impact on outcomes (Kirby & Fraser 1997).

Results from the empirical research in this text support the facilitation of interventions that focus on promoting positive family- and community-level factors in an effort to foster positive adolescent development and protect against risk factors inherent to the public housing setting. Chapter 5 reported, for example, that family factors influence adolescents’ attitudes towards deviance and efficacious beliefs, which, in turn, protect against negative youth behaviors and lower emotional well-being. Family has been indicated as the primary socialization agent and a key form of social capital for children and adolescents. Additionally, families in low-income settings, such as public housing, may leverage relationships with extended family, including fictive kin, in an effort to develop and strengthen social support networks (chapter 3). Subsequently, adolescents in these settings may benefit from the tangible and intangible resources and emotional support provided by these networks. Within a prevention framework, the findings would support the implementation of interventions that target the family, school, and community environments within which the adolescent lives. Specifically, both individual and group interventions could incorporate strategies to work with the adolescent’s family to foster maternal encouragement and promote positive relationships with adults considered close but unrelated (fictive kin) in an effort to reduce antisocial behavior and engagement with delinquent peers and promote better emotional well-being (e.g., less depression).

Additionally, chapters 6 and 8 found that community cohesion served a protective function, reducing the effect of inhibiting aspects of the public housing environment on both substance use and depression, respectively. In chapter 6, community cohesion was conceptualized as supportive relationships outside of an adolescent’s primary home environment (Gutman, Sameroff, & Eccles 2002). The literature on effective programs for adolescents showed that facilitating positive relationships with peers, family, and other adults were beneficial to youth and helped to allay engagement in risk behavior (Nation et al. 2003). The current findings suggest that interventions designed to produce better outcomes in this population would benefit from the inclusion of opportunities for youth to develop positive relationships with others in school and other community settings as a protective mechanism against negative developmental outcomes.

In chapter 8, adultification, conceptualized as the process by which adolescents adopt behavior and roles that are normally adult (Jarrett 2003), was found to be related to fewer depressive symptoms among adolescents in the public housing environment. This unique finding suggests the significance of place, or neighborhood, and the consideration of youths’ adaptations to their particular environment in the development of interventions that are relevant to this population. Individual- or group-level interventions, for example, designed to address or protect against negative outcomes in this population, could consider the role(s) that an adolescent plays in the family or household and how those roles may have a positive impact on the adolescent’s emotional well-being.

The research findings from this volume also identify inhibiting aspects of the public housing environment that have a detrimental effect on developmental outcomes in adolescents’ lives. These factors should also be considered in the development of interventions targeted to address negative developmental outcomes in this group. Community violence, domestic violence, exposure to delinquent peers, delinquent behavior, symptoms of PTSD, depressive symptoms, and neighborhood disorder, for example, were directly and indirectly related to greater substance use (chapters 6 and 7). Chapter 8 found that delinquent behavior, exposure to deviant peers, and neighborhood risk were all positively related to depression. Individual or group-level interventions designed to address depression and/or substance among this population of urban youth can incorporate multiple components, such as developing better decision-making skills, dealing with violence, and cognitive behavioral therapy to reduce the risk of these various factors on negative developmental outcomes.

Additionally, interventions can target the individual problem behavior, as well as the multiple environmental contexts of the adolescent. Chapter 7 reported that adolescent perceptions of disorder in their neighborhoods influenced high-risk sexual behaviors. Individual- and group-level interventions that incorporate strategies to help adolescents manage their perceptions of neighborhood disorder and that target the reduction of neighborhood risk may also, in turn, affect a decrease in the high-risk behavior. Additionally, previous research has suggested that substance abuse treatment programs incorporate the exploration of risk and protective factors in various settings, such as the family, peer group, and school (Hawkins, Catalano, & Miller, 1992). Additionally, Komro et al. (2008) and Diamond et al. (2009) described interventions, adapted for use with an urban youth population, to impact factors associated with alcohol and drug use. The interventions targeted change in factors associated with substance use within multiple environmental contexts of the adolescent, including school, home, peers, and community. Similarly, because the findings in this book found to impact negative youth developmental outcomes traverse various environmental contexts (e.g., domestic violence, neighborhood disorder), interventions should be explored that are multilevel, addressing family, school, peer, and community settings. Generally, the research findings regarding both the promotive and inhibitive aspects of the housing environment contribute to the design of interventions that target the individual, family, peer, and community levels.

The literature suggests that adolescent development takes place within the transactions that occur between the adolescent and his or her environment (e.g., Coll et al. 1996). The uniqueness of an adolescent’s experience within the public housing environment can significantly impact developmental outcomes in this group. The research in this volume evinced various individual, family, community, and neighborhood level factors that either directly or indirectly influence both positive and negative developmental outcomes in adolescents and have implications for the development of interventions that promote well-being and protect against negative behaviors within the population of African American adolescents residing in public housing. The distinctive culture of the urban environment, along with the unique experiences of minority adolescents within that environment, also support the implementation of interventions that consider the protective influence of family and community as well as the possible deleterious impact of place and neighborhood. These interventions can be facilitated at multiple levels (e.g., family, school) to target the various social contexts of the adolescent, with the ultimate goal of promoting better mental and behavioral health outcomes for adolescents in public housing neighborhoods.