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Witnessing Violence Among Inner-city Children of Substance-Abusing and Non–Substance-Abusing Women
Maureen E. Schuler, PhD;
Prasanna Nair, MD, MPH
Arch Pediatr Adolesc Med. 2001;155:342-346.
ABSTRACT
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Objectives To determine if children of substance-abusing mothers witness more violence
than children of non–substance-abusing (control) mothers, and to determine
if children who witness violence have more behavioral problems and higher
stress scores than children who do not witness violence.
Design Cross-sectional research design comparing exposure to violence among
children of substance-abusing mothers and control mothers of low socioeconomic
status.
Setting An inner-city pediatric clinic.
Participants Forty substance-abusing mothers and their children, and 40 non–substance-abusing
mothers and their children, examined when the children were 6 years old.
Main Outcome Measures Maternal report of children's exposure to violence was assessed using
the Exposure to Violence Interview and the Conflict Tactics Scale. Maternal
report of children's behavior was assessed using the Child Behavior Checklist
and the Children's Response to Stress Inventory.
Results Children of substance-abusing mothers did not witness more violence
than the control children (P>.05). However, 6-year-old
inner-city children in the present study witnessed a high rate of violence:
43% had seen someone beaten up, 13% had seen someone threatened with a knife,
and 7% had seen someone stabbed or shot. Children witnessing violence had
significantly higher aggressive, delinquent, anxious/depressed, withdrawn,
attention, and social problems (P<.05) on the
Child Behavior Checklist, and higher stress scores (P
= .05) on the Children's Response to Stress Inventory.
Conclusions More than half of the 6-year-old inner-city children in the present
study witnessed some form of violence. Witnessing violence was associated
with more behavioral problems and higher stress scores as assessed through
maternal report. Subsequent research should examine the long-term effects
of this exposure to violence among young children.
INTRODUCTION
YOUNG INNER-CITY children are witnessing violence at high rates. One
study on the prevalence of witnessing violence among inner-city preschool
children found that 10% had witnessed a stabbing or shooting, 18% had witnessed
a beating, and 47% had heard gunshots by the age of 5 years.1
Research with older children found that more than one fourth of urban school-aged
children had witnessed a shooting or stabbing2, 3, 4, 5
or seen someone killed.5, 6 Compared
with older urban children, younger children witness less severe forms of violence,
such as beatings,7and are more likely to witness
community violence than to be victims.8, 9
Exposure to violence has a negative effect on the behavior of young
children. Children exposed to violence suffer from symptoms associated with
posttraumatic stress disorder (PTSD), which include mentally reexperiencing
the traumatic event, avoidance, and numbing of responsiveness.8, 10
Other behaviors associated with exposure to violence include increased depression,
distress, aggression, anxiety, sleep problems, delinquent behavior, stress,
and regression to earlier behaviors.4, 11, 12, 13, 14, 15, 16, 17, 18
Substance abuse in women is frequently associated with violence against
these women, including physical abuse and rape.19, 20, 21
What is not clear from this research is if the children of substance-abusing
women are more likely to witness violence than children of non–substance-abusing
(control) women; this was the primary aim of our study. The second aim was
to determine if witnessing violence was associated with more behavioral problems
and higher stress among 6-year-old inner-city children.
SUBJECTS AND METHODS
SUBJECTS
The substance-abusing families in the present study are a subset of
families who are part of an ongoing longitudinal cohort study. These families
have been followed since the children were born. The recruitment procedures
for these families have been reported previously22
but are summarized here for clarity. The substance-abusing women and their
infants were recruited from a university hospital that serves a largely inner-city
African American population. Women were eligible for recruitment if they or
their infants had a positive urine toxicology screen at birth or if a history
of recent drug use was noted in the medical records. Infants who were not
discharged into the care of their mothers or who had serious developmental
or congenital problems were not eligible for recruitment.
The non–drug-exposed (control) children were identified through
medical records and recruited from the same inner-city pediatric clinic where
many of the children of the substance-abusing women received care. Control
families were eligible for recruitment if they had a 6-year-old child who
was born at the same university hospital, was still in the care of its biological
mother, had no serious developmental or congenital problems, was full-term
(gestational age >36 weeks), and had no indications from birth records or
the pediatric clinic charts of drug exposure. Letters explaining the study
were sent to all eligible control families (N = 91). The first 40 control
families recruited into the study were matched to 40 of the substance-abusing
families by child's date of birth, child's sex, and maternal education. All
children in both groups were currently living with their biological mothers.
INSTRUMENTS
The children's exposure to violence outside the home was assessed using
the Modified Exposure to Violence Interview (Betsy Groves, MSW, written communication,
1997). The Exposure to Violence Interview has been used with a similar inner-city
population.1 The interview consists of 42 forced-choice
and open-ended questions. Mothers were asked how frequently in the last year
their child had seen the following types of violence: yelling, beating (kicking,
punching, or slapping), someone being threatened with a knife, stabbing, shooting,
rape, or other. The frequency of each type of violence was rated on a 5-point
scale, from never (0) to more than 5 times (4). If the child had witnessed
an act of violence, the mothers were asked for more information about the
act. First, mothers were asked the relationship between the people engaged
in the violent act (mother, father, aunt, uncle, neighbor, stranger, etc)
and the study child. Second, the mothers rated the degree of injury to the
people involved in each violent act on a 4-point scale, from no injury (0)
to death (3). Third, the mothers rated behavioral changes in the child after
he or she witnessed the violent act on an 8-point scale, from no changes (0)
to clinging to the mother (7). Finally, the mothers rated how witnessing the
violent act affected their child on a 5-point scale, from not at all (0) to
severely (4).
Violence in the home was assessed using the Conflict Tactics Scales
(CTS).23 The CTS is a 19-item standardized
questionnaire that assesses methods used by the mother and her partner during
the last year to settle problems. Each item is rated on a 5-point scale, from
never (0) to more than 5 times (4). The CTS is composed of 4 subscales for
both the mother and her partner: verbal reasoning, verbal aggression, minor
violence, and major violence. Because this research was concerned with violence,
only the minor and major violence data are presented here. The minor violence
subscale includes throwing an object, pushing or shoving, and slapping. The
major violence subscale includes kicking or hitting with fists, hitting with
an object, beating up, choking, threatening with a knife or gun, and using
a knife or gun.
Child behavior was assessed using the Child Behavior Checklist (CBCL).24 The CBCL is a 113-item questionnaire used to assess
children's behavioral and emotional problems. Each item is rated on a 3-point
scale, from not true (0) to sometimes true (1) to often true (2). The behaviors
are summed to form 7 subscales: aggressive behavior, delinquent behavior,
somatic problems, withdrawn, anxious/depressed, thought problems, and social
problems. Each subscale score was then converted to a T score (mean = 50,
SD = 10). Higher scores on each subscale mean worse behavior.
Child stress was assessed using the Children's Response to Stress Inventory:
Interview With Parents (Linda Mayes, MD, written communication, 1995). The
Children's Response to Stress Inventory is a 28-item questionnaire that assesses
stress-related behaviors. The mother rates each behavior as not true (0),
maybe (1), or true (2). The items are summed to create a total stress score;
higher scores mean more stress.
A general questionnaire was used to obtain demographic data, socioeconomic
data, and number and ages of other children in the household. Finally, drug
use was assessed with a form that asked the mothers about both their current
and past use of cigarettes, alcohol, heroin, cocaine, marijuana, amphetamines,
barbiturates, tranquilizers, and hallucinogens.
PROCEDURE
Mothers who agreed to participate in the present study signed a consent
form approved by the Institutional Review Board of the University of Maryland
in Baltimore. Research assistants who were unaware of the group status of
the mothers (drug or control) conducted the evaluation visit in a pediatric
clinic. As part of the 6-year clinic evaluation, the mothers completed measures
on the child's exposure to violence, child behavior, and child stress. Demographic
data and maternal report of drug use were also collected at the visit. To
control for differences in reading ability, all questions were read to the
mother. Mothers were paid on completion of the clinic evaluation visit and
given bus tokens to get home. Only data relevant to this article are reported
here.
STATISTICAL ANALYSIS
All data analyses were conducted with SPSS 10.0 for Windows (SPSS Inc,
Chicago, Ill). Demographic data were compared with analysis of variance (ANOVA)
and the c2 test. Data on maternal report of drug use and children's
exposure to violence were also compared using the  2 test.
Because there was a significant group difference in maternal age at the birth
of the target child, it was used as a covariate when child behavior and stress
variables were examined. Multivariate analysis of covariance (MANCOVA) was
used to analyze group differences on the CBCL. Analysis of covariance (ANCOVA)
was used to analyze group differences in the stress score from the Children's
Response to Stress Inventory.
RESULTS
A total of 80 mothers (40 substance-abusing, 40 control) and their 6-year-old
children participated in this study. Five control mothers reported heroin
or cocaine use sometime after the target child was born; therefore, their
data were dropped before the analyses were done. Demographic data for the
control and substance-abusing families are presented in Table 1. Substance-abusing mothers were significantly older at the
birth of the target child (P<.01) and had significantly
more children (P = .02) than control mothers. Most
mothers in both groups were single, African American, and receiving public
assistance.
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Table 1. Demographic Data on the Study Population
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Maternal report of drug use for both groups is presented in Table 2. Significantly more mothers in
the drug group reported using cigarettes (P<.01),
alcohol (P = .05), and marijuana (P<.01) in their lifetime than control mothers.
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Table 2. Maternal Report of Drug Use in Lifetime*
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The percentage of children in both groups who witnessed violence outside
the home is presented in Table 3.
Two control children heard a shooting but did not see it. One child heard
multiple shootings; the other child heard a friend get shot. Although these
children were not included in the group of children who witnessed a shooting,
they were included as children who witnessed violence, because they had seen
other violent acts. Children of substance-abusing mothers were not more likely
to see violence outside the home than children of control mothers. Almost
38% of the children in both groups witnessed someone being beaten up, 9% witnessed
someone being threatened with a knife, and 7% witnessed someone being stabbed
or shot outside the home.
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Table 3. Percentage of Children Witnessing Violence Outside the Home*
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The data from the CTS are presented in Table 4. Five drug-abusing mothers and 5 control mothers had not
been involved in a relationship for more than a year; therefore, their data
were not included in the analyses. There were no significant differences between
substance-abusing women and control women in their use of violence. There
were no significant differences between partners of substance-abusing women
and partners of control women in their use of violence. Regardless of drug
use, 40% of the mothers had used minor violence and 25% had used major violence
against their partners during the last year. In addition, 28% of the partners
had used minor violence and 23% had used major violence against the mothers
during the last year.
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Table 4. Percentage of Mothers and Their Partners Using Violence Inside
the Home
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Finally, some of the children witnessed violence that could not be placed
in the previous categories. One drug-exposed child witnessed multiple episodes
of organized dogfights in which the animals were hurt. A control child witnessed
a neighbor jumping naked out the second-story window with her infant in her
arms when drug dealers burst into her house.
To determine which children had witnessed violence, data from both the
Exposure to Violence Interview and the CTS were examined. If mothers reported
on the Exposure to Violence Interview that their child had witnessed violence
(beating, threatening with a knife, stabbing, shooting, rape, or other violence)
or on the CTS that minor violence (throwing objects, pushing, or slapping)
or major violence (kicking, hitting with objects, beating, choking, threatening
with a knife or gun, stabbing, or shooting) had occurred between the mother
and her partner, the children were placed in the "witnessing violence" group.
If on both measures the mothers reported that the child had not witnessed
violence, they were placed in the "no violence" group.
A MANCOVA was conducted to examine the effects of witnessing violence
on child behavior. Maternal age at the target child's birth was used as a
covariate. The overall MANCOVA was significant (P
= .05). Data from the CBCL are presented in Table 5. Children who witnessed violence had significantly higher
aggressive, delinquent, withdrawn, anxious/depressed, attention, and social
problems (P<.05 for all) than children who did
not witness violence. An ANCOVA was run to examine the effects of witnessing
violence on child stress. Data from the Children's Response to Stress Inventory
are also presented in Table 5.
Children who witnessed violence had significantly higher stress scores (P = .04) than children who did not.
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Table 5. Group Means and SDs for Child Behavior Checklist and Stress
Scores
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COMMENT
The data in the present study indicate that children of substance-abusing
mothers were not more likely to witness violence than children of control
mothers. Regardless of maternal substance abuse, 38% of the 6-year-old children
had witnessed someone getting beaten up, 9% had witnessed someone being threatened
with a knife, and 7% had witnessed a stabbing or shooting in the neighborhood.
These results are similar to those of other studies9
in which exposure to violence is reported separately for younger and older
children. Many studies on children's exposure to violence group all children
together regardless of age.2, 3
The data in the present study indicate a high level of violence between
adults in the home. Twenty-five percent of the mothers reported using major
violence and 40% reported using minor violence against their partners. This
supports previous research9 that found a similar
rate of minor and major violence among an inner-city population. Subsequent
research needs to determine if violence witnessed in the home has different
behavioral effects on young children than violence witnessed in the community.
Among the 6-year-old children in the present study, witnessing violence
was associated with more behavioral problems and stress. Similar to other
studies,6, 13, 15, 17
children who witnessed violence had significantly higher aggressive, delinquent,
anxious/depressed, withdrawn, and stress scores than children who did not
witness violence. Thus, witnessing violence had a detrimental effect on the
young children's behavior.
The results in the present study must be interpreted with caution. First,
the sample size was small. However, the percentage of children witnessing
violence was similar to other studies. Second, only 42% of the control families
who were mailed letters participated in the study. Thus, the sample of control
families may not be representative of all non–drug-abusing inner-city
families. Third, exposure to violence was based on maternal report. Previous
research indicates discrepancies in reporting between parents and their young
children8; parents may report lower rates than
their children. There have also been questions about how truthful young children
are and whether they discriminate between violent acts they have actually
witnessed and those that they have only heard about.
Another limitation was the use of the CBCL to measure behavior in a
sample that included drug-exposed children. Previous research indicates that
school-aged children exposed to drugs in utero have more behavioral problems
as measured by the CBCL than control children.25
However, analyses in the present study indicated no significant differences
between drug-exposed and control children on any CBCL scale or on the total
stress score. Finally, half of the drug-exposed children (n = 20) were involved
in an intervention during the first 2 years of life. Among the drug-exposed
children, analyses revealed no significant differences on the CBCL and Stress
Inventory between children who received the intervention and those who did
not.
In summary, more than 60% of the 6-year-old inner-city children in the
present study had seen someone beaten up, threatened with a knife, stabbed,
or shot. Witnessing violence was associated with more behavior problems and
higher stress among the children. More longitudinal research is needed to
examine the long-term effects of witnessing violence at such a young age.
AUTHOR INFORMATION
Accepted for publication November 16, 2000.
This research was supported by a grant from the Thomas Wilson Sanitarium
for Children, Baltimore City, Md, and grant DAO7432 from the National Institute
on Drug Abuse, Bethesda, Md.
Presented at the annual meeting of the Ambulatory Pediatric Association,
Boston, Mass, May 14, 2000.
From the Department of Pediatrics, University of Maryland School of
Medicine, Baltimore.
Corresponding author and reprints: Maureen E. Schuler, PhD, Department
of Pediatrics, University of Maryland School of Medicine, 655 W Lombard St,
Suite 311, Baltimore, MD 21201-1091 (e-mail: mschuler{at}peds.umaryland.edu).
REFERENCES
| |
1. Taylor L, Zuckerman B, Harik V, Groves BM. Witnessing violence by young children and their mothers. J Dev Behav Pediatr. 1994;15:120-123.
ISI
| PUBMED
2. Bell CC, Jenkins EJ. Community violence and children on Chicago's southside. Psychiatry. 1993;56:46-54.
ISI
| PUBMED
3. Sheehan K, DiCara JA, LeBailly S, Christoffel KK. Children's exposure to violence in an urban setting. Arch Pediatr Adolesc Med. 1997;151:502-504.
FREE FULL TEXT
4. Schwab-Stone ME, Ayers TS, Kasprow W, et al. No safe haven: a study of violence exposure in an urban community. J Am Acad Child Adolesc Psychiatry. 1995;34:1343-1352.
FULL TEXT
|
ISI
| PUBMED
5. Campbell C, Schwarz DF. Prevalence and impact of exposure to interpersonal violence among suburban
and urban middle school students. Pediatrics. 1996;98:396-402.
FREE FULL TEXT
6. Miller LS, Wasserman GA, Neugebauer R, Gorman-Smith D, Kamboukos D. Witnessed community violence and antisocial behavior in high-risk,
urban boys. J Clin Child Psychol. 1999;28:2-11.
FULL TEXT
|
ISI
| PUBMED
7. Farrell AD, Bruce SE. Impact of exposure to community violence on violent behavior and emotional
distress among urban adolescents. J Clin Child Psychol. 1997;26:2-14.
FULL TEXT
|
ISI
| PUBMED
8. Fitzpatrick KM, Boldizar JP. The prevalence and consequences of exposure to violence among African-American
youth. J Am Acad Child Adolesc Psychiatry. 1993;32:424-430.
ISI
| PUBMED
9. Richters JE, Martinez P. The NIMH community violence project: children as victims of and witnesses
to violence. Psychiatry. 1993;56:7-21.
ISI
| PUBMED
10. Berman SL, Kurtines WM, Silverman WK, Serafini LT. The impact of exposure to crime and violence on urban youth. Am J Orthopsychiatry. 1996;66:329-336.
ISI
| PUBMED
11. Eth S, Pynoos RS. Children who witness the homicide of a parent. Psychiatry. 1994;57:287-306.
ISI
| PUBMED
12. Fantuzzo JW, DePaola LM, Lambert L, Martino T, Anderson G, Sutton S. Effects of interparental violence on the psychological adjustment and
competencies of young children. J Consult Clin Psychol. 1991;59:258-265.
FULL TEXT
|
ISI
| PUBMED
13. Hughes H. Psychological and behavioral correlates of family violence in child
witnesses and victims. Am J Orthopsychiatry. 1988;58:77-90.
ISI
| PUBMED
14. Hurley DJ, Jaffe P. Children's observations of violence: clinical implications for children's
mental health professionals. Can J Psychiatry. 1990;35:471-476.
ISI
| PUBMED
15. Jaffe P, Wolfe D, Wilson S, Zak L. Similarities in behavioral and social maladjustment among child victims
and witnesses to family violence. Am J Orthopsychiatry. 1986;56:142-146.
ISI
| PUBMED
16. Martinez P, Richters J. The NIMH community violence project, II: children's distress symptoms
associated with violence exposure. Psychiatry. 1993;56:22-35.
ISI
| PUBMED
17. Singer MI, Anglin TM, Song LY, Lunghofer L. Adolescents' exposure to violence and associated symptoms of psychological
trauma. JAMA. 1995;273:477-482.
FREE FULL TEXT
18. Freeman LN, Mokros H, Poznanski EO. Violent events reported by normal urban school-aged children: characteristics
and depression correlates. J Am Acad Child Adolesc Psychiatry. 1993;32:419-423.
ISI
| PUBMED
19. Amaro H, Fried E, Cabral H, Zuckerman B. Violence during pregnancy and substance use. Am J Public Health. 1990;80:575-579.
FREE FULL TEXT
20. Regan D, Ehrlich S, Finnegan L. Infants of drug addicts: at risk for child abuse, neglect, and placement
in foster care. Neurotoxicol Teratol. 1987;9:315-319.
FULL TEXT
|
ISI
| PUBMED
21. Wasserman DR, Leventhal JM. Maltreatment of children born to cocaine-dependent mothers. Am J Dis Child. 1993;147:1324-1328.
FREE FULL TEXT
22. Schuler ME, Nair P, Black MM, Kettinger L. Mother-infant interaction: effects of a home intervention and ongoing
maternal drug use. J Clin Child Psychol. 2000;29:424-431.
FULL TEXT
|
ISI
| PUBMED
23. Straus M. Measuring intrafamily conflict and violence: the Conflict Tactics Scales. J Marriage Fam. 1979;41:75-88.
FULL TEXT
|
ISI
24. Achenbach T. Manual for the Child Behavior Checklist/4-18 and
1991 Profile. Burlington: University of Vermont Department of Psychiatry; 1991.
25. Chasnoff IJ, Anson A, Hatcher R, Stenson H, Iaukea K, Randolph LA. Prenatal exposure to cocaine and other drugs: outcome at four and six
years. Ann N Y Acad Sci. 1998;846:314-328.
FULL TEXT
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ISI
| PUBMED
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