Journal of Urban Health

, Volume 91, Issue 2, pp 335–354 | Cite as

Witnessing a Violent Death and Smoking, Alcohol Consumption, and Marijuana Use among Adolescents

  • Roman PabayoEmail author
  • Beth E. Molnar
  • Ichiro Kawachi


Witnessing violence has been linked to maladaptive coping behaviors such as smoking, alcohol consumption, and marijuana use. However, more research is required to identify mechanisms in which witnessing violence leads to these behaviors. The objectives of this investigation were to examine the association between witnessing a violent death and smoking, alcohol consumption, and marijuana use among adolescents, to identify whether exhibiting depressive symptoms was a mediator within this relationship, and to determine if those who had adult support in school were less likely to engage in risky health behaviors. Data were collected from a sample of 1,878 urban students, from 18 public high schools participating in the 2008 Boston Youth Survey. In 2012, we used multilevel log-binomial regression models and propensity score matching to estimate the association between witnessing a violent death and smoking, alcohol consumption, and marijuana use. Analyses indicated that girls who witnessed a violent death were more likely to use marijuana (relative risk (RR) = 1.09, 95 % confidence interval (CI) = 1.02, 1.17), and tended towards a higher likelihood to smoke (RR = 1.06, 95 % CI = 1.00, 1.13) and consume alcohol (RR = 1.07, 95 % CI = 0.97, 1.18). Among boys, those who witnessed a violent death were significantly more likely to smoke (RR = 1.20, 95 % CI = 1.11, 1.29), consume alcohol (RR = 1.30, 95 % CI = 1.17, 1.45) and use marijuana (RR = 1.33, 95 % CI = 1.21, 1.46). When exhibiting depressive symptoms was included, estimates were not attenuated. However, among girls who witnessed a violent death, having an adult at school for support was protective against alcohol consumption. When we used propensity score matching, findings were consistent with the main analyses among boys only. This study adds insight into how witnessing violence can lead to adoption of adverse health behaviors.


Adolescents Violence Coping Smoking Alcohol Consumption Marijuana Use 



Socioeconomic Status



The Boston Youth Survey (BYS) was conducted in collaboration with the Boston Public Health Commission (Barbara Ferrer, Director), Boston’s Office of Human Services (Larry Mayes, Chief), Boston Public Schools (Carol Johnson, Superintendent), and the Office of The Honorable Mayor Thomas M. Menino. The survey would not have been possible without the participation of the faculty, staff, administrators, and students of Boston Public Schools. This work was supported by a grant from the Center for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control (NCIPC) (U49CE00740) to the Harvard Youth Violence Prevention Center (David Hemenway, Principal Investigator). Roman Pabayo is a Canadian Institutes of Health Research postdoctoral fellowship recipient.


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Copyright information

© The New York Academy of Medicine 2013

Authors and Affiliations

  1. 1.Department of Social and Behavioral SciencesHarvard School of Public HealthBostonUSA
  2. 2.Bouvé College of Health SciencesNortheastern UniversityBostonUSA

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