A study published in JAMA Network Open Pediatrics found that the co-occurrence of violence-related risk and protective behaviors differs significantly in adolescent males with vs without adult support, providing evidence that social context matters in relation to adolescent violence.1

Violence disproportionately affects male youth in urban areas. In 2014, the Centers for Disease Control and Prevention released a report, Connecting the DOTS: An Overview of the Links Among Multiple Forms of Violence, which highlighted the need for epidemiologic and prevention studies of violence among youth.2

Alison J. Culyba, MD, PhD, MPH, of the University of Pittsburgh Medical Center Children’s Hospital in Pennsylvania, and colleagues explored patterns of violence among adolescent males and their association with individual and social factors. They gauged protective factors such as social support and school engagement, as well as risk factors such as a history of exposure to violence and substance use.  The investigators used a cross-sectional design and data from a cluster randomized trial that included 866 male adolescents between the ages of 13 and 19 years from urban neighborhoods.

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The mean age of the study population was 15.5±1.6 years and 77.5% identified as black. The investigators identified 7 clusters of risk and protective behaviors: school engagement; career and future aspirations; substance use and bullying exposure; exposure to violence and related adversities, sexual violence exposure, peer delinquency, and gang involvement; sexual violence, youth violence, and bullying perpetration; dating abuse perpetration; and physical or sexual partner violence perpetration.

The strongest association occurred in the sexual violence perpetration cluster. Youth with high social support were significantly less likely to engage in any of 40 risk behaviors (95% CI, 0.63-2.64; P =.004), while both social support and natural mentoring were inversely associated with gang involvement (social support: odds ratio [OR], 0.39; 95% CI, 0.22-0.71; and natural mentoring: OR, 0.44; 95% CI, 0.25-0.76) and sexual violence exposure (social support: OR, 0.39; 95% CI, 0.24-0.64; and natural mentoring: OR, 0.61; 95% CI, 0.39-0.98). Youths who had a positive future orientation and strong career aspirations were not likely to perpetrate sexual or weapon-related violence. Youths who perpetrated one form of violence were more likely to engage in other forms.

The study was limited by the self-reported nature of the data and the use of a single urban youth population.

In an accompanying commentary in JAMA, Matthew C. Aalsma, PhD, Adolescent Behavioral Health Research Program, department of pediatrics, Indiana University School of Medicine, Indianapolis, noted that the work supports the important role of natural mentors within the community for ensuring the health of adolescents.3

Disclosure: Dr. Culyba reported receiving grants from Centers for Disease Control and Prevention and grants from National Institutes of Health during the conduct of the study. No other disclosures were reported.


1. Culyba AJ, Miller E, Albert SM, Abebe KZ. Co-occurrence of violence-related risk and protective behaviors and adult support among male youth in urban neighborhoods. JAMA Network Open. 2019;2(9):e1911375.

2. Connecting the DOTS: An Overview of the Links Among Multiple Forms of Violence. Centers for Disease Control and Prevention (CDC) website. www.cdc.gov/violenceprevention/pdf/connecting_the_dots-a.pdf. Published July 2014. Accessed October 10, 2019.

3. Aalsma MC. The importance of connection and context in adolescent violence. JAMA Network Open. 2019;2(9):e1911374.