Paul Boxer, Ph.D. - US grants

DESCRIPTION (provided by applicant): The goal of this R03 proposed investigation is to identify prospectively the individual and contextual factors that predict and can ultimately prevent extreme aggression exhibited by youth during institutional treatment. The proposed study uses existing data archives to address this broad goal by 1) Accessing and coding individual, contextual, and behavioral data from archived sources (intake/treatment records and a critical incident database) in an inpatient youth psychiatric facility; and 2) Testing a model of aggressive behavior occurring during institutionalized care by examining the prediction of self- and other-directed aggressive behaviors and related critical incidents (i.e., seclusions and restraints) from individual and contextual variables. This investigation is guided by several specific aims. First, to identify the individual biopsychological characteristics and contextual socializing influences that are associated with the occurrence of self-directed and other-directed aggression during institutional treatment. This involves identifying factors in a very high-risk sample of youth that discriminate those who engage in serious aggression during institutional treatment from those who do not. Second, to examine the extent to which individual and contextual factors predict the patterns and persistence of aggression throughout institutional treatment. This involves the study of how individual-contextual factors lead to increases, decreases, or non-linear trends in aggression during treatment. Information about individual-contextual predictors of self- and other-directed aggressive behaviors derived through the two sets of analyses will be used to develop assessment measures suitable for research and practice on the development and treatment of aggression in very high-risk youth. This instrument will be designed to serve as the basis for a larger scale longitudinal study of aggression in that population, and also will be directly applicable to treatment planning for individual youth. A critical focus of this investigation also is to specify a model of aggression in very high-risk youth that can be used to facilitate the dissemination of findings and spur additional research. Results from the proposed study will have implications for the host facility as well as to the larger audience of scientists and practitioners invested in the reduction and prevention of assaultive and self-injurious behaviors among high-risk children and adolescents.

DESCRIPTION (provided by applicant): Despite national trends showing declines in violent crime, studies show that violence remains alarmingly high in some communities as well as in homes, schools, and the media. The goal of this proposed R21 project is twofold: To develop a multi-informant, multi-method assessment of youths'exposure to violence in the social environment, anchored to youths'mental health;and to set a foundation for launching new research into the reduction and prevention of the deleterious mental health consequences of youth violence exposure. Our novel approach to assessment is driven by a four-dimensional conception of violence exposure based on the context (setting), content (impact), channel (mode of exposure), and chronicity (frequency of exposure) of specific acts of violence. Our measurement is tied to a comprehensive assessment of mental health (externalizing, internalizing, and traumatic stress disorders) to provide an overall assessment of the burden of violence exposure based on current theory in developmental psychopathology. This investigation will be conducted in socio-economically distressed urban neighborhoods comprising a range of projected risk for exposure to violence in a major metropolitan area of the Northeast. Our study population will be families with children between the ages of 11 and 14 inclusive;we will sample caregiver-youth pairs (dyadic N = 200) for a comprehensive protocol integrating information from the pairs directly with information from data sources across all levels of the social ecology. Our investigation is guided by five aims: 1) Develop and implement a cross-informant, mixed-method protocol for assessing youths'exposure to violence in the social environment;2) Utilize our novel four-dimensional conception of violence exposure to evaluate the psychometric properties of the new individualized protocol and establish internal validity;3) Apply a dual pathway model of how exposure to violence affects mental health outcomes to evaluate the criterion validity of the new protocol;4) Employ multivariate modeling to analyze patterns of exposure and associated outcomes across meaningful subpopulations (e.g., low and high risk for exposure) to assess the generalizability of the new protocol;and 5) Analyze various combinations of reports in order to finalize a protocol for field testing in clinical research settings. Our investigation will provide information critical to understanding how violence exposure leads to negative health outcomes. Ultimately this knowledge will be essential to efforts at reducing the negative impact of exposure to violence. Our approach to measuring youths'exposure to violence is essential for formulating individualized assessment and intervention strategies for ameliorating the negative sequelae of exposure among children and adolescents. Further, the proposed investigation represents a necessary step in expanding our knowledge of how violence in the social ecology impacts individual mental health via biopsychosocial mechanisms. PUBLIC HEALTH RELEVANCE: Although a large body of research confirms detrimental effects of youths'exposure to violence in multiple social contexts on their mental health status, there have been no systematic efforts to develop a theoretically informed measure of exposure to violence across settings. Properly assessing exposure to violence along key dimensions including context as well as severity, frequency, and mode of exposure is an essential step in advancing our understanding of how violence affects youths'mental health outcomes. Better measurement of exposure also will translate into more precise and ultimately more effective intervention strategies. The proposed project aims to develop a new protocol for assessing youths'exposure to violence and exploring how different profiles of exposure account for different patterns of psychopathology.

According to the Bureau of Justice Statistics, 11.6 million people were admitted to jail from 2011-2012;
yet, there has been relatively little research examining the impact of short-term incarceration on offender
adjustment. Two opposing theories have typically been provided to explain how inmates adapt to the
incarceration environment. The importation model suggests that inmates bring a host of pre-incarceration
experiences and characteristics with them into the incarceration environment that account for how
inmates adapt and behave. Conversely, the deprivation model posits the oppressive incarceration
environment is responsible for inmate adaptation. Research has found support for both models.
However, these theories have not been tested longitudinally in jail. This project will test these theories
throughout a stay in jail and into the community to update and expand these models. The study will test
the overarching hypothesis that traumatic experiences with violence encountered before, during, and after
jail are related to increased mental health difficulties and recidivism.

Two hundred male and female inmates will be recruited to participate in the present study. Subjects will
complete surveys approximately once a month for four months, starting from the initial point of
incarceration and ending a month after release from jail. The subjects will self-report psychosocial
problems including symptoms of anxiety, post-traumatic stress, depression, antisocial behavior,
aggression, and substance use. Recidivism data will also be collected for released subjects. The
researchers will use self-report data on violence exposure prior, during, and after incarceration, to explain
the development of psychopathology and predict mental/behavioral outcomes, as well as identify risk
factors for recidivism.

The current study is the first longitudinal examination to assess developmental changes in mental and
behavioral health throughout jail and in the community. This project will identify risk and protective
factors that can be used to create interventions and programs, reducing the risk of recidivism. By learning
more about the context in which offenders must adapt, researchers can provide informed
recommendations to policy makers and increase safety in communities and jails.

We are submitting this application in response to RFA CE-20-006, ?Research Grants to Prevent Firearm- Related Violence and Injuries,? with specific regard to Objective One, ?research to help inform the development of innovative and promising opportunities to enhance safety and prevent firearm-related injuries, deaths, and crime.? We are applying for Funding Option A, ?research projects that rely on existing data.? Firearm violence in the United States is a serious public health concern, with 21,789 intentional violence- related firearm deaths in 2017, one third of whom are in the 15-29 year old age range; and the rates are much higher among African American and Hispanic compared to white youth. We collected longitudinal data from two urban samples at high risk for weapons crimes: Flint, MI (5 waves of data collection on a predominantly African American sample of 426 participants from three starting grade cohorts in 2007 of 2nd, 4th, and 9th graders, with the last assessment in 2019 at ages 20, 22, and 27, respectively) and Jersey City, NJ (4 annual waves of data collection on an ethnically diverse sample of 200 participants starting as high school sophomores in 2016-2017). We used similar measures in both studies (e.g., violence/weapon exposure in the neighborhood, family, and media, social cognitions about violence and weapon exposure, violent and weapon- related behavior), and we used a multi-wave, multi-source methodology (e.g., self-, parent-, and teacher- reports; geospatial crime coding of participants' neighborhoods). By calibrating and integrating data across the two studies, we can now use a robust approach to data analysis to address four specific aims: 1) assess developmental patterns of exposure to violent behavior with weapons (in the neighborhood, family, and violent media), of one's own firearms and other weapon use, and of social cognitions about violence, firearms, and weapons use?with nearly every age between 7 and 27 covered in the combined samples, and the relations among these three trajectories; 2) investigate how social cognitions about violence and weapon use mediate the longitudinal relation between exposure to weapon violence and subsequent engagement in weapon violence; 3) examine whether self-reports of neighborhood firearm crime and geospatial calculations of the same differentially or cumulatively predict trajectories of social cognitions about weapon violence, and in turn, actual self-reported use of guns and other weapons; and 4) investigate how personal risk and protective factors (e.g., sex, cognitive achievement, emotional reactivity to violence) and family or extra-familial contextual factors (e.g., parenting, neighborhood qualities) might moderate the relations. By testing key theoretical propositions concerning mediating cognitive and emotional processes, as well as protective factors, our findings can inform the development of multi-layered community interventions to reduce gun violence among urban youth. Our proposed study is thus directly in line with the broad community-wide violence prevention agenda of the Centers for Disease Control.