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Cover of Preventing Violence and Related Health-Risking Social Behaviors in Adolescents

Preventing Violence and Related Health-Risking Social Behaviors in Adolescents

Evidence Reports/Technology Assessments, No. 107

Investigators: , PhD, , PhD, , MPH, , MPH, , MD, , MD, MPH, and , MD.

Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 04-E032-2ISBN-10: 1-58763-168-7

Structured Abstract


The overarching goal of this review is to identify the highest quality research findings in the field of youth violence. In preparation for a state-of-the-science conference in the fall of 2004, the Office of Medical Applications of Research (OMAR) and the National Institute of Mental Health (NIMH) nominated and supported the topic for an Agency for Healthcare Research and Quality (AHRQ)-sponsored systematic review and analysis of the evidence on individual, family, school, community, and peer level influences as well as research to evaluate prevention intervention effectiveness. AHRQ awarded the Task Order to the Southern California Evidence-Based Practice Center (SC-EPC) and its partner, Childrens Hospital Los Angeles, to conduct the review.


The evidence review was conducted to address six key questions mandated in the Task Order: (1) What are the factors that contribute to violence and associated adverse health outcomes in childhood and adolescence? (2) What are the patterns of co-occurrence of these factors? (3) What evidence exists on the safety and effectiveness of interventions for violence? (4) Where evidence of safety and effectiveness exists, are there other outcomes beyond reducing violence? If so, what is known about effectiveness by age, sex, and race/ethnicity? (5) What are commonalties of the interventions that are effective and those that are ineffective? (6) What are the priorities for future research?

Data Sources:

We used data reported in published articles retrieved from any of four electronic databases—MEDLINE®, PsychINFO, SocioAbstracts, and ERIC. A systematic search of each database was performed in April/May of 2003, and then again in October/November of 2003.

Study Selection:

Published articles were eligible for inclusion if they were peer-reviewed, were published in 1990 or thereafter, reported on research conducted in the United States, and specifically examined either risk/protective factors associated with youth violence perpetration or the effectiveness of a violence prevention intervention designed to reduce violence among adolescents, ages 12 through 17 years. Excluded were case reports, editorials, letters, reviews, practice guidelines, non-English language publications, and papers from which no data could be abstracted. To evaluate the literature related to risk factors, we limited our analysis to studies that used a prospective longitudinal cohort design, and to evaluate the literature related to intervention effectiveness, we limited our analysis to randomized or nonrandomized controlled trials in which a control group was used either concurrently or prospectively. Given these parameters, we screened a total of 11,196 titles and abstracts; reviewed 1,612 full-length articles; abstracted data from 265 articles onto evidence tables and ultimately analyzed evidence abstracted from 67 studies.

Data Extraction:

All citations were screened by two independent researchers and discrepancies resolved by consensus. Data were abstracted and recorded onto evidence tables by a team member and then checked by a senior researcher. All screening and data abstraction used pre-established criteria and guidelines.

Data Synthesis:

To identify risk factors contributing to youth violence, we reviewed findings that were reported in two or more cohort studies, and we reported a finding as consistently associated with violence if at least 75 percent of the articles reported the same finding (i.e., 75 percent of articles reported a statistically significant association between a specific risk factor and a violence-related outcome). A finding was considered statistically significant if the article reported a p-value less than 0.05. To evaluate the effectiveness of prevention interventions, we considered an intervention to be effective if one or more violent outcome indicators was reported to be significantly different at the p less than 0.05 level. If none of the violent outcome indicators were reported to be significantly different at the p<0.05 level, we characterized those interventions as having no reported evidence of effectiveness.

Main Results:

Across all studies, only one risk factor, male gender, was consistently reported to be significantly associated with youth violence perpetration. Low family socioeconomic status (SES) was consistently reported not to be an independent risk factor associated with youth violence. Co-occurrence of family SES with other risk factors could be associated with youth violence. Reported significance and non-significance showed very little consistency for all other risk factors. Moreover, few studies examined a comparable set of risk factors (i.e., risk factors were often examined only by a single study) limiting our ability to make conclusions based on the available evidence. Among studies that specifically focused on adolescent males, we identified a consistent significant association between violence and anger, cigarette smoking, and non-violent delinquency. For adolescent females, we identified a consistent significant association between violence and non-violent delinquency. For research conducted with at-risk youth populations, we found a consistent significant association between being Latino and repeat physical aggression among adolescent males; no consistency was observed for the findings of research conducted with at-risk adolescent females. With respect to the review of the effectiveness of prevention interventions, the number of studies was too small for the detection of any systematic differences among programs with different characteristics.


We found little agreement with respect to the definitions used to measure youth violence and ways in which risk/protective factors are conceptualized, operationally defined, measured, analyzed, and reported, despite the severe restrictions that limited the number and quality of studies reviewed. As a result, little consistency was observed in findings across individual studies and the literature does not appear to be growing in a cumulative nature. We recommend that researchers nationwide initiate efforts to develop comparable approaches to defining, measuring, analyzing, and publishing research data related to youth violence, and that new initiatives be funded to facilitate the collection of comparable data across multiple sites and with multiple youth populations. Furthermore, we recommend that future research consider the use of an “individual-level-data-meta-analysis” method to identify sequential and simultaneous co-occurrences of contributing factors to youth violence. We recommend that social scientists studying youth violence increase the rigor of their research, including the use of control populations and extended follow-up to evaluate the sustained effectiveness of youth violence prevention interventions.


Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0003. Prepared by: Southern California Evidence-based Practice Center, Los Angeles, CA.

Suggested citation:

Chan LS, Kipke MD, Schneir A, Iverson E, Warf C, Limbos MA, Shekelle P. Preventing Violence and Related Health-Risking Social Behaviors In Adolescents. Evidence Report/Technology Assessment No. 107 (Prepared by the Southern California Evidence-based Practice Center under Contract No. 290-02-2003.) AHRQ Publication No. 04-E032-2. Rockville, MD: Agency for Healthcare Research and Quality. October 2004

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers—patients and clinicians, health system leaders, and policymakers—make more informed decisions and improve the quality of health care services.

The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.


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Bookshelf ID: NBK37490


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