KANSAS ALCOHOL AND DRUG ABUSE SERVICES - DEPARTMENT OF SOCIAL AND REHABILITATION SERVICES
The public health model addresses the multiple interrelated causes of alcohol and other drug abuse: the agent (alcohol and drugs); the host (consumer of alcohol and other drugs); and the environment (settings in which hosts and agents are found). This model contributes to a shift from primarily focusing upon individual consumption and subsequent problems to a much broader perspective addressing community norms and conditions which contribute to risk.
Just as medical researchers have found risk factors for heart attacks such as diets high in fats, lack of exercise, and smoking, research has defined a set of risk factors for drug abuse. We know that the more risk factors of heart disease present, the greater the likelihood a person will suffer a heart attack. This is true with risk factors for drug abuse.
Risk-focused prevention is based on a simple premise: to prevent a problem from happening, we need to identify the factors that increase the rild of that problem developing and then find ways to reduce the risks. Risk-focused prevention is based on the work of I. David Hawkins, Ph.D.; Richard F. Catalano, Ph.D.; and a team of researchers at the University of Washington in Seattle. In the early 1980's, they conducted a review of thirty years of youth substance abuse and delinquency research and identified risk factors for adolescent drug abuse and delinquency. They have continually updated this review. Other researchers, including Joy Dryfoos, Robert Slavin, and Richard Jessor, have reviewed the literature on behavior problems, such as school dropout and teen pregnancy, and identified risk factors of these problems. Not surprisingly, there is an interrelationship between adolescent drug abuse, delinquency, school dropout, teen pregnancy, and violence and identified risk factors for these problems. Young people who are seriously involved in either juvenile delinquency, substance abuse, school dropout, teenage pregnancy, or violence are more likely to engage in one or more of the other problem behaviors. Furthermore, all of these teen problems share many common risk factors.
Before looking at the risk factors and the problems they predict, it is important to establish a working definition of the terms delinquency and violence. For our purposes, delinquency is defined as "crimes committed by juveniles under 18." Violence is defined as "acts against a person that involve physical harm or the threat of physical harm."
Utilizing the research and program development work of Dr. J. David Hawkins and Dr. Richard Catalano, the University of Washington, Developmental Research and Programs, Inc., this issue of DIRECTIONS is dedicated to Kansas' risk and protective factor approach to prevention.
Research has shown that there are a number of risk factors that increase the chances of adolescents developing health and behavior problems. Equally important is the evidence that certain protective factors can help shield youngsters from problems. If we can reduce risks which increase protection throughout the course of young people's development, we can prevent these problems and promote healthy, pro-social growth.
- Availability of Firearms (Delinquency and Violence)
Firearm availability and firearm homicide have increased together since the late l950's. If a gun is present in the home, it is much more likely to be used against a relative or friend than an intruder or stranger. Also, when a firearm is used in a crime or assault instead of another weapon or no weapon, the outcome is much more likely to be fatal. While a few studies report no association between firearm availability and violence, more studies show a positive relationship. Given the lethality of firearms, the increase in the likelihood of conflict escalating into homicide when guns are present, and the strong association between availability of guns and homicide rates, firearm availability is included as a risk factor.
- Community laws and norms favorable toward drug use, firearms and crime (Substance Abuse, Delinquency and Violence)
Community norms-the attitudes and policies a community holds about drug use and crime-are communicated in a variety of ways: through laws and written policies, through informal social practices. and throuch the expectations parents and other members of the ccmmumv nave or young people.
One example of a community law affecting drug use is the taxation above alcoholic beverages. Higher rates of taxation decrease the rate of alcohol use at every level of use.
When laws, tax rates and community standards are favorable toward substance use or crime, or even it they are just unclear, children are at higher risk.
Another concern is when there are conflicting messages about alcohol/drugs from key social institutions. An example of conflicting messages about substance abuse can be found in the acceptance of alcohol use as a social activity within the community. The "Beer Gardens" popular at street fairs and community festivals frequented by young people are in contrast to the "Just Say No" messages that schools and parents may be promoting. These conflicting messages make it difficult for children to decide which norms to follow,
Laws regulating the sale of firearms have had small effects on violent crime that usually diminish after the law has been in effect for multiple years. In addition, laws regulating the penalties for violating licensing laws or using a firearm in the commission of a crime have also been related to reductions in the amount of violent crime, especially involving firearms. A number of studies suggest that the small and diminishing effect is due to two factors the availability of firearms from other jurisdictions without legal prohibitions on sales or illegal access, and community norms which include lack of proactive monitoring or enforcement of the laws.
- Media Portrayal of Violence (Violence)
The role of media violence on the behavior of viewers (especially vo ung viewers) has been debated for over three decades. Research over that time period has shown a clear correlation between media violence and the development of aggressive and violent behavior. Exposure to media violence appears to impact children in several ways. First, children learn from watching actors model violent behavior, as well as learning violent problem-solving strategies. Second, media violence appears to alter children's attitudes and sensitivity to violence.
- Transitions and Mobility (Substance Abuse, Delinquency, and School Dropout)
Even normal school transitions predict increases in problem behaviors. When children move from elementary school to middle school or from middle school to high school, significant increases in the rate of dru~ use, school misbehavior, and delinquency result. When communities are characterized by frequent non-scheduled transition rates, there is an increase in problem behaviors.
Communities with high rates of mobility appear to be linked to an increased risk of drug and crime problems. The more often people in a community move, the greater the risk of both criminal behavior and drug-related problems in families. While some people find buffers acainst the negative effects of mobility by making connections in new communities, others are less likely to have the resources to deal with the effects of frequent moves, and are more likely to have problems.
- Low neighborhood attachment and community disorganization. (Substance Abuse, Delinquency, and Violence)
Higher rates of drug problems, juvenile delinquency, and violence occur in communities or neighborhoods where people have little attachment to the community, and where the rates of vandalism are high and where there is low surveillance of public places. These conditions are not limited low-income neighborhoods; they can also he found in wealthier hborhoods.
The less homogeneous a community in terms of race, class, and religion, the less connected residents may feel to the overall community, and the more difficult it is to establish clear community goals and identity. The challenge of creating neighborhood attachment and organization is greater in these neighborhoods.
Perhaps the most significant issue affecting community attachment is whether residents feel they can make a difference in their lives.
If the key players in the neighborhood -- such as merchants, teachers, police, human and social services personnel -- live outside the neighborhood, residents' sense of commitment will be less. Lower rates of voter participation and parental involvement in schools also indicate lower attachment to the community.
- Extreme Economic Deprivation (Substance Abuse, Delinquency, Violence, Teen Pregnancy, and School Dropout)
Children who live in deteriorating and crime-ridden neighborhoods characterized by extreme poverty are more likely to develop problems with delinquency, teen pregnancy, school dropout, and violence. Children who live in these areas -- and have behavior and adjustment problems early in life -- are also more likely to have problems with drugs later on.
- Family Management Problems (Substance Abuse, Delinquency, Violence, Teen Pregnancy, and School Dropout)
This risk factor has been shown to increase the risk of drug abuse, delinquency, teen pregnancy, school dropout and violence. Poor family management practices include lack of clear expectations for behavior, failure of parents to monitor their children (knowing where they are and who they're with), and excessively severe or inconsistent punishment.
- Family Conflict (Substance Abuse, Delia quencN, Violence, Teen Pregnancy, and School Dropout)
Persistent, serious conflict between primary caregivers or between caregivers and children appears to enhance risk for children raised in these families. Conflict between family members appears to be more important than family structure. Whether the family is headed by two biological parents, a single parent, or some other primary caregiver, children raised in families high in conflict appear to be at risk for all of the problem behaviors. For example, domestic violence in a family increases the likelihood that young people will engage in delinquent behaviors and substance abuse as well as become pregnant or drop out of school.
- Parental Attitudes and Involvement in Drug Use, Crime and
Violence (Substance Abuse and Delinquency)
Parental attitudes and behavior toward drugs, crime and violence influence the attitudes and behavior of their children. Parental approval of young people's moderate drinking, even under parental supervision, increases the risk of the young person s using marijuana. Similarly, children of parents who excuse their children for breaking the law are more likely to develop problems with juvenile delinquency. In families where parents display violent behavior towards those outside or inside the family, there is an increase in the risk that a child will become violent.
Further, in families where parents involve children in their own drug or alcohol behavior -- for example, asking the child to light the parent's cigarette or get the parent a beer from the refrigerator -- there is an increased likelihood that their children will become drug abusers in adolescence.
This risk factor also includes persistent antisocial behavior in early adolescence, like misbehaving in school, skipping school, and getting into fights with other children. Young people, both girls and boys, who engage in these behaviors during early adolescence are at increased risk for drug abuse, juvenile delinquency, violence. school dropout and teen pregnancy.
- Academic failure in elementary school (Substance Abuse,
Delinquency, Violence, Teen Pregnancy, and School Dropout)
Beginning in the late elementary grades, academic failure increases the risk of drug abuse, delinquency, violence, pregnancy and school dropout. Children fail for many reasons. It appears that be the experience of failure-- not necessarily ability -- increases the risk of problem behaviors.
This is particularly troubling because, in many school districts, African American, Native American, and Hispanic students have disproportionately higher rates of academic failure compared to white students. Consequently, school improvement and reducing academic failure are particularly important prevention strategies for communities of color.
- Lack of commitment to school (Substance Abuse, Delinquency, Teen Pregnancs, and School Dropout)
Low commitment to school means the young person has ceased to see the role of student has a viable one. Young people who have lost this commitment to school are at higher risk for all four problem behaviors.
In many communities of color, education is seen as a "way out," similar to the way early immigrants viewed education. Other subgroups in the same community may view education and school as a form of negative acculturation. In essence, if you get education, you have "sold out" to the majority culture. Young people who adopt this view are likely to be at higher risk for health and behavior problems.
- Alienation/rebelliousness and lack of bonding to society (Substance Abuse, Delinquency, and School Dropout)
Young people who feel they are not part of society, are not bound by rules, don't believe in trying to be successful or responsible, or who take an active rebellious stance toward society, are at higher risk of drug abuse, delinquency, violence and school dropout.
Alienation and rebelliousness may be an especially significant risk for young people of color. Children who are consistently discriminated against may respond by removing themselves from the dominant culture and rebelling against it. On the other hand, many communities of color are experiencing significant cultural change due to integration. The conflicting emotions about family and friends working, sociali:ing or marrying outside of the culture, may well interfere with a young person's development of a clear and positive racial identity.
- Friends who engage in the problem behavior (Substance Abuse, Delinquency. Violence. Teen Preg-nancy. and School Dropout) Young people who associate with peers who engage in problem hehavior -- delinquency, substance abuse, violent activity, sexual activity or school dropout -- are much more likely to engage in the same problem behavior. This is one of the most consistent predictors that research has identified. Even when young people come from well-managed families and do not experience other risk factors, just hanging out with friends who engage in problem behavior greatly increase the child's risk of that problem. However, young people who experience a low number of risk factors are less likely to associate with friends who are involved in problem behavior.
- Favorable attitudes touard the problem behavior (Substance Abuse, Delinquency, Teen Pregnancy, and School Dropout)
During the elementary school years, children usually express anti-drug, anti-crime, pro-social attitudes. They have difficulty imagining why people use drugs, commit crimes and drop out of school. However, in middle school, has others they know participate in such activities, their attitudes often shift toward greater acceptance of these behaviors. This acceptance places them at higher risk.
- Early initiation of the problem behavior (Substance Abuse, Delinquency, Violence, Teen Pregnancy, and School Dropout)
The earlier young people begin using drugs, committing crimes, engaging in violent activity, dropping out of school and becoming sexually active, the greater the likelihood that they will have problems with these behaviors later on. For example, research shows that young people who initiate drug use before the age of fifteen are at twice the risk of having drug problems as those who wait until after the age of nineteen.
- Constitutional factors (Substance Abuse, Delinquency, and Violence)
Constitutional factors are factors that may have a biological or physiological basis. These factors are often seen in young people with behaviors such as sensation-seeking, low harm-avoidance and lack of impulse control. These factors appear to increase the risk of young people abusing drugs, engaging in delinquent behavior, and/or committing violent acts.
- The more risk factors present, the greater the risk
While exposure to one risk factor does not condemn a child to problems later in life, exposure to a greater number of risk factors increases a young person s risk exponentially. Even if a community cannot eliminate all the risk factors that are present, reducing or eliminating even a few risk factors may significantly decrease risk for young people in that community.
- Common risk factors predict diverse behavior problems
Since many individual risk factors predict multiple problems, the reduction of risk factors is likely to affect a number of different problems in the community.
- Risk factors show much consistency in effects across different races, cultures and classes
While levels of risk may vary in different racial, cultural or socioeconomic groups, the way in which these risk factors work does not appear to vary. One implication for community prevention is to prioritize prevention efforts for groups with higher levels of risk exposure.
- Protective factors may buffer exposure to risk Knowledge of risk factors can help communities know what to focus on to reduce health and behavior problems. Communities must know how to reduce risk. Protective factors are conditions that buffer young people from the negative consequences of exposure to risks by either reducing the impact of the risk or changing the way a person responds to the risk.
Some youngsters who are exposed to multiple risk factors do not become substance abusers, juvenile delinquents, school dropouts, or teen parents. Balancing the risk factors are protective factors -- aspects of people's lives that counter or buffer risk. Research has identified protective factors that fall into three basic categories: individual characteristics; bonding; and healthy beliefs and clear standards.
- Individual characteristics
Research has identified four individual characteristics as protective factors. These are characteristics children are born with and are difficult to change: gender, a resilient temperament, a positive social orientation, and intelligence. Intelligence, however, does not protect against substance abuse.
Positive bonding makes up for many other disadvantages caused by other risk factors or environmental characteristics. Children who are attached to positive families, friends, school and committed to achieving the goals valued by these groups are less likely to develop problems in adolescence. Studies of successful children who live in high risk neighborhoods or situations indicate that strong bonds with a caregiver can keep children from getting into trouble.
To build bonding, three conditions are necessary: opportunities, skills and recognition. Children must be provided with opportunities to contribute to their community, family, peers and school. The challenge is to provide children with meaningful, challenging opportunities that help them feel responsible and significant.
Children must be taught the skills necessary to effectively take advantage of the opportunities they are provided. If they don't have the necessary skills to be successful, they experience frustration and/or failure. Children must also be recognized and a knowledge for their efforts. This gives them the incentive to contribute, and reinforces their skillful performance.
- Healthy beliefs and clear standards
The people that young people are bonded to need to have clear, positive standards for behavior. The content of these standards is what protects young people. When parents, teachers and communities set clear standards for children's behavior, when they are widely and consistently supported, and when the consequences for not following the standards are consistent, young people are more likely to follow the standards.
Research supports the importance of a community focus.
- Risk and protective factors are lodged in all aspects of the community: schools, families, individuals and the community. Community efforts can affect the entire local environment, including community norms, values and policies.
- Because substance abuse is a phenomenon influenced by multiple risk factors, its prevention may be most effectively accomplished with a combination of interventions.
- A community-wide approach promotes the development of strong bonds to family, community and the school.
- Because community approaches are likely to involve a wide spectrum of individuals, groups and organizations, they create a base of support for behavior change. The firm support of community leaders and their involvement in a prevention effort are likely to lead to long-term behavior change. This reallocation of resources to reduce risk factors becomes feasible with support from community leaders.
- Programs and strategies gradually become integrated into the regular services and activities of local organizations and institutions. The community-wide focus creates a synergy; the whole is more powerful than all of its parts would be, working separately.
- Because many attempts to change families, schools and other institutions have operated in isolation, they have had limited success. For meaningful change to occur, multiple, interconnected forces of the community must begin to share a common vision and agenda.
- Focus on Known Risk Eactors
- Address Risk Factors at Appropriate Developmental Stages
- Intervene Early, Before the Behavior Stabilizes
- Include those at Hi~h-Risk
- Target High-Risk Individuals and High-Risk Community Areas
- Address Multiple Risks with Multiple Strategies
- Reach All Diverse Groups in Your Community
- Change Community Norms, Values and Policies
- Promote Conditions for Community-Wide Bonding
- Build a Greater Base üf Support for Behavior Change
- Integrate Programs and Strategies into Existing Services, Organizations and Institutions
(Communities That Care. 1993. Hawkins and Catalano and the Search Institute. 1993.)