Supportive Family Connections Decrease Odds of Violence Exposure

Youth in urban environments often are plagued by high levels of exposure to community violence. They have few safe spaces to spend time and face complex economic and social pressures. Exposure to violence is associated with long-term psychological and physiologic changes that impact behavior and health, and often the same youth who have witnessed or experienced violence are at risk for one day perpetuating the cycle of violence.

For the past three decades, homicide has been the No. 1 cause of death among African-American adolescents in the U.S. and is the second most common cause of death among all U.S. adolescents. From 2007 to 2013, 5,051 young Philadelphians ages 14 to 24 were shot or killed.

As an adolescent medicine physician at The Children’s Hospital of Philadelphia, Alison Culyba, MD, MPH, encounters youth every day who have been exposed to violence within their families, peer groups, or neighborhoods. These experiences motivated her to pursue research to better understand the factors that may be protective against interpersonal violence and find ways to help support youth in urban environments. One of the factors that she has explored is the effect of supportive adult familial connections.

“We know that adult connections are deeply protective to kids across a range of behaviors. However, some people may think that in the midst of certain circumstances, such as violence in urban environments, relationships might not make that much of a difference,” said Dr. Culyba, who is a fellow in the Craig-Dalsimer Division of Adolescent Medicine. “Our goal was to better understand the role of supportive family relationships in protecting youth from violence in urban contexts.”

In a study of 283 males ages 10 to 24 in Philadelphia, 98 percent of whom were African-American, Dr. Culyba and colleagues conducted interviews using a structured questionnaire that assessed participants’ previous violence exposure. Thirty-three percent reported high levels of violence involvement, which included violence perpetration or violence victimization. Thirty percent reported high levels of witnessing violence, and 17 percent reported high levels of both violence involvement and witnessing.

Next, the participants answered questions that characterized the nature of their relationships with family members who they felt played an important role in their lives. The study team analyzed those family trees and identified three overarching categories of relationships: supportive, unsupportive, and mixed features of supportive and unsupportive.

The results showed that 68 percent of participants identified at least one supportive relationship with an adult family member. Those youth with at least one supportive adult relationship were less likely to report both violence involvement and witnessing violence. They most commonly identified mothers as supportive adults in their lives (60 percent), but they also listed fathers (27 percent) and a host of other family members including maternal grandmothers, aunts, uncles, and parents’ significant others.

“This is really great news,” Dr. Culyba said. “Although there are many things on a societal level that still need to be addressed in order to affect youth violence, every family and community should understand that they have a direct and profound impact on protecting youth and young adults. These relationships are really critical as people transition to independence.”

In her future research efforts, Dr. Culyba would like to focus on identifying the specific dynamics within those supportive adult relationships that help to safeguard youth. For example, is there a certain parenting style or conflict resolution approach that parents practice that could reduce the odds that youth will be involved with violence? “If there are things that we can learn from and help teach parents that would be helpful in their ability to protect their children, I think that would be incredibly important,” Dr. Culyba said.

Dr. Culyba, who also is a PhD student in epidemiology at the Perelman School of Medicine at the University of Pennsylvania, presented an abstract about her study at the Pediatric Academic Societies annual meeting held in San Diego. Dr. Culyba is also an adolescent medicine consultant to the Violence Intervention Program, which provides intensive case management services for youth presenting to the CHOP Emergency Department with injuries due to interpersonal violence.

Learn more about the efforts under way at CHOP to interrupt the cycle of youth violence by visiting the Violence Prevention Initiative.