Growing Up in Violent Contexts: Differential Effects of Community, Family, and School Violence on Child Adjustment

Although different than in war-torn areas, violence affects children even in the most economically developed countries. In this chapter we review the empirical evidence supporting the detrimental effects of early violence exposure on a wide range of developmental outcomes. We also provide an examination of mechanisms linking violence exposure to negative developmental outcomes, as well as the predisposing and precipitating factors that intervene in these complex relationships. We conclude that the problem of exposure to violence in children is often underestimated and discuss the implications for child welfare policy and preventive interventions.


Introduction
Violence is pervasive in the world, even among those who live in the most economically developed countries. In many Western industrialized cities, one in two children every year is denied his/her fundamental right to be protected from violence and to grow up in healthy and safe homes, schools, and communities, with early exposure to violence likely to be especially detrimental to the child's wellbeing (Margolin & Gordis, 2000).
Although it takes different forms than in war-torn areas, violence pervading Western societies affects child development and psychological functioning in many similar ways. A basic postulate is that violence breeds violence. Indeed, children exposed to a violent environment are often more aggressive and more involved in antisocial behavior than children who are not. Furthermore, children exposed to violence are more at risk for anxiety and depression, mainly due to the perception of danger in the context where they live. A violent context negatively influences also the capability of children to solve social problems and shapes a conception of the social world as hostile and dangerous. Lastly, a sudden or a chronic exposure to violence can result in post-traumatic stress disorder (PTSD) symptoms (Margolin, Vickerman, Oliver, & Gordis, 2010), such as intrusive and involuntary reexperiencing of a traumatic event, high emotional arousal, and avoidance of situations that are reminders of the event.
In this chapter we first define exposure to violence and then (a) present data from international surveys on the prevalence of violence exposure, showing that being exposed to violence is a common experience for many children in industrialized countries, and (b) discuss the main consequences associated with violence exposure, in all its forms and across contexts. Next, we will focus on the specific issue of community violence in the Neapolitan context, in the South of Italy, evidencing (c) some mechanisms through which violence might affect child development and (d) the risk and protective factors that are known to increase or reduce the likelihood of impaired child development.

Defining Exposure to Violence
One of the main difficulties when addressing the problem of violence lies in the lack of universal notions of what is acceptable and unacceptable in terms of behavior and what could be considered "harmful" over and above culture-specific social norms. In general, the World Health Organization defines violence (1996) as "the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury or death, as well as in psychological harm, maldevelopment or deprivation." Within this broad definition, all forms of violence against people under 18 years old are considered "violence against children." It encompasses a wide range of possible perpetrators and settings, such as parents or other caregivers in the family context, peers in the school environment and the more general peer group, or strangers while walking the streets.
Children may experience violence in multiple, sometimes overlapping, settings. In addition, the problem is complex as children may be victims ("happens to them," primary victimization) or witnesses of violence ("saw it happens to someone else," secondary victimization) within their daily life contexts. A large body of literature, especially concerning the investigation of community violence, has focused on the study of the effects related to being a victim or a witness of violence. In general, findings show that witnessing violence is linked to the acquisition of deviant social information patterns, such as selective attention to hostile peer cues, attributions that others are being hostile toward the self, rapid accessing of aggressive responses, and positive evaluations of aggressive responses, which in turn increase the likelihood of aggressive behavior (Crick & Dodge, 1994). In contrast, victimization appears to be more strongly associated with the development of internalizing symptoms (Cooley-Quille, Boyd, Frantz, & Walsh, 2001) mediated through emotional self-regulation that compromise the more general ability of individual's adaptive behavior (Schwartz & Proctor, 2000).
Although the distinction between being a victim and a witness seems to be conceptually reasonable, it is not yet clear if it always applies in reality. Understanding whether victimization and witnessing reflect two specific domains of experience, which can occur independently or co-jointly, remains an open question for future research to address.

Violence Exposure aAcross Multiple Contexts: Prevalence Estimates and Differential Effects
Violence is ever-present in the lives of children and adolescents worldwide, taking many forms and across several contexts (UNICEF; United Nations Children's Fund, 2017). Consistent with data reported in the scientific literature (Finkelhor, Ormrod, & Turner, 2007), the statistics provided by UNICEF revealed that about three in four children worldwide experience violent discipline by their caregivers on a regular basis. In terms of witnessing violence, one in four children under age five lives with a mother who is a victim of intimate partner violence. Slightly more than one in three students between the ages of 13 and 15 experience bullying. In 2015 alone, collective violence took the lives of around 82,000 adolescents worldwide. Similarly, the results from "The Multi-Country Study on the Drivers of Violence Affecting Children," led by the UNICEF Office of Research -Innocenti and involving Italy, Peru, Viet Nam, and Zimbabwe, have confirmed that physical, sexual, and emotional violence affecting children is prevalent in all societies (Maternowska, Potts, & Fry, 2016). It is also in light of these alarmingly high numbers that considerable progress has been made on the scientific investigation of violence exposure in childhood and adolescence. An important insight offered by research over the last decades concerns the need to consider the interconnectedness of multiple contexts of violence exposure (Margolin et al., 2010) within an ecological-transactional model of development (see Lynch & Cicchetti, 1998), according to which individuals are part of multiple nested levels of environment (i.e., ecological contexts) that independently and in interaction with each other shape individual development and adaptation.
One of the major comprehensive national surveys addressing the assessment of children's exposure to multiple forms of violence is the National Survey of Children's Exposure to Violence (NatSCEV; Finkelhor, Turner, Shattuck, Hamby, & Kracke, 2015), sponsored by the US Department of Justice (DOJ) and the Centers for Disease Control and Prevention (CDC). According to the last published bulletin (Office of Juvenile Justice and Delinquency Prevention; Finkelhor et al., 2015), among all children and youth surveyed, nearly half (48.4 percent) had experienced more than one specific victimization type involving direct or witnessed victimization (out of 50 possible types), nearly one in six (15.1 percent) experienced six or more types, and nearly one in 20 (4.9 percent) had been exposed to 10 or more different forms of victimization.
Both within and outside the NatSCEV, a consistent amount of research has showed that victimization within a context may increase vulnerability to other forms and/or contexts of victimization, through mechanisms that include, but are not limited to, lowered self-esteem, distorted cognitive schemas, and lack of social support (Turner, Shattuck, Finkelhor, & Hamby, 2016). Perry, Hodges, and Egan (2001), for example, found that cognitive schemas acquired in families with aggressive interactional styles made children more susceptible to violence outside the family and, consequently, more likely to be exposed to the risk of further opportunities for victimization. Episodes of violence within the family context have been found to be associated with high levels of violence in the neighborhood (Margolin et al., 2010) or to increase child's vulnerability to school victimization (Schwartz & Proctor, 2000). In a study by Affuso, Bacchini, Aquilar, De Angelis, and Miranda (2014), Italian adolescents who scored high on family violence reported levels of violence exposure in the neighborhood and in the school as high as in the family.
Against this background, researchers have examined links between being exposed to multiple violent contexts and children's adjustment problems, hypothesizing that a cumulative experience of violent contexts increases the likelihood of developing adjustment problems. Findings have provided some support for this hypothesis, revealing that violence exposure at home, at school, and in the community is a stronger predictor of adolescents' concurrent internalizing and externalizing problems than exposure in any single setting (Mrug & Windle, 2010). Poly-victimization also seems to be a powerful predictor of current (Turner et al., 2016) and subsequent (Finkelhor et al., 2007) internalizing symptoms in children and adolescents. The results of the abovementioned study of Affuso et al. (2014) showed a similar pattern on a sample of adolescents living in the metropolitan area of Naples, indicating that the higher the number of contexts to which adolescents were exposed (ranging from 1 to 7), the higher were the levels of PTS symptoms reported by adolescents ( Fig. 10.1).
Analogous to the results by Affuso et al. (2014), we found that levels of antisocial behavior and anxiety-depression increased along with the number of violent contexts to which adolescents were exposed. Furthermore, no difference due to adolescent gender has been found ( Fig. 10.2).
Other hypotheses that emerging research is exploring concern the idea that some violent contexts could be more detrimental for child adjustment than others (i.e., differential effects) or the possibility that different contexts of violence may interact  Affuso et al., 2014) with one another to amplify or attenuate their individual effects (i.e., interactive effects). In general, studies seem to suggest a sort of equifinality of violence exposure across different contexts; that is, different contexts eventuate in the same outcome. However, they also emphasize a stronger impact of exposure to microsystem violence (e.g., family and school contexts) on a wide range of developmental outcomes. This is perhaps due to the differential proximity to the child within the hierarchically ordered social ecology. Comparing violence exposure at home, at school, and in the neighborhood, for example, Mrug and Windle (2010) found that violence exposure at home and school (both witnessing and victimization) was a more robust predictor of adjustment problems (anxiety, depression, and aggression) than exposure to community violence. More specifically, witnessing violence in the community only predicted higher levels of delinquency, whereas victimization in the community was not independently predictive of any outcomes. Nonetheless, the results from Bacchini, Affuso, and Aquilar (2015) showed that witnessing neighborhood and school violence had a stronger concurrent association with antisocial behavior than witnessing violence at home. Overall, we can draw two important conclusions, albeit partial, from the results so far reported. First, although family plays a crucial role, the development of adolescents' behavior problems seems to be particularly affected also by contexts outside the family. Second, these problems are more likely to occur when adolescents experience violence as witnesses and not as direct victims, suggesting that witnessed violence does provide behavioral models for deviant and antisocial behavior, increasing the tendency to believe that such behavior is acceptable or even expected and perhaps desensitizing young people to the emotional effects of violence (Mrug & Windle, 2009). However, it is important to note that the short-and long-term consequences of poly-victimization are not completely understood because most of the studies examining poly-victimization and its consequences are based on cross-sectional data.
Other interesting issues for discussion come from the study of interaction effects between different contexts of violence. There are only a few studies addressing this question. Noteworthy is that by Mrug and Windle (2010), in which witnessing community violence attenuated the impact of witnessing domestic violence on anxiety, aggression, and delinquency. As the authors argued, the interpretation one could give is that witnessing community violence may desensitize youths to the effects of violence occurring at home, such that witnessing domestic violence had no impact on adolescents' anxiety, depression, and delinquency when youth witnessed community violence (Cooley-Quille et al., 2001). Furthermore, violence in the community may set norms or expectations for violence in other settings, so that adolescents exposed to community violence may perceive domestic violence as "normative" and be less affected by it. Regardless of these speculations, future research is needed to clarify how different contexts of violence interact with each other and what their interactions implicate in terms of consequences on child adjustment.

Youth Exposure to Community Violence: The Case of Naples
In the next paragraphs we will present some studies (published and not) based on several rounds of data collection, starting from 2006 and involving approximately 1700 adolescents. Participants aged from 10-11 to 18-19 and were drawn from several middle and high schools located in the metropolitan area of Naples. Among those, about 800 adolescents are still involved in an ongoing longitudinal research project, which is now entering its sixth year. The measure of youth exposure to community violence through witnessing and victimization has been adapted from Schwartz and Proctor (2000), where children are asked to report violent incidents that had occurred during the last year and instructed to report only serious real-life events from their neighborhoods and their communities (e.g., being or seeing someone being physically assaulted, being or seeing someone being threated, etc.).

Why Do We Work on Youth Community Violence in Naples?
The first thing popping up into people's head when someone says "Naples" is not the beauty of the city. Instead, people recall the stories told by the newspapers all over the world about the Neapolitan Mafia, so-called Camorra, pickpockets, drug dealing, etc. We do not know whether Naples is more dangerous and violent than other cities in Italy and in the world, but certainly violent behavior and unemployment and school dropout rates in this geographic area are among the highest in Italy (CNEL ISTAT, 2016), sounding a serious social alarm. As reported in a recent cross-cultural study comparing the perception of neighborhood danger in nine different countries (Italy, China, Kenya, Philippines, Sweden, United States, Colombia, Jordan, and Thailand) and including data collected in the metropolitan areas of Naples and Rome as representative of Italy, Neapolitan adolescents (10-11 years old) and their parents exhibited the highest scores (Skinner et al., 2014). The fact that Neapolitan adolescents are massively exposed to violence in their everyday life is shown also in the study of Affuso et al. (2014), in which 76% reported that they had witnessed violence or had been victims of violence in the neighborhood (assault, robbery, threats) at least one time in the last year, whereas 15% of the sample claimed to have been involved, at least once, in all contexts of violence considered in the study, that is, community, school, family, and media violence. In addition, serious concerns have been raised by the phenomena of Naples' youth gangs since 2013, approximately. Overall, our data show a consistent rate of 35-40% of adolescents reporting that they have been chased by youth gangs at least once in a year, whereas 65-70% report having seen somebody else get chased by gangs. While the problem was originally considered closely linked to the presence of organized crime, as widely chronicled in Roberto Saviano's "La paranza dei bambini" (2016), the news reported by media between 2017 and 2018 have brought to light a grave social emergency, beyond the criminal emergency. These episodes involve very young kids, not teenage "camorristi," who commit violence against other kids or adults apparently for no reason. In the wake of these events, we acknowledge the importance of deepening the possible mechanisms linking violence exposure in the community and youth gang involvement, examining how repeated exposure to violence may lead youth to be involved in delinquent peer networks, such as gangs, and/or how, vice versa, those peer associations might tend to increase exposure to community violence. The criminology literature, and in particular Gottfredson and Hirschi's "self-control theory" (1990), may represent a useful starting point for further considerations.

Exposure to Community Violence and the Role of Effortful Control
According to the criminology literature, self-regulating abilities seem to play an important role in adolescent involvement in violent contexts (Gottfredson & Hirschi, 1990). What we know about self-regulation in adolescence is that young people are characterized by an easily aroused reward system, which inclines adolescents toward sensation seeking, and a low ability of self-control, which limits their capacity to resist these inclinations (see Steinberg's "dual system" model, 2008). At around age 15, self-regulatory abilities may reach adultlike levels in relatively less arousing, "cool" contexts (Casey, 2015), but when tasks become more demanding or emotionally arousing, adultlike performance may not be reached until closer to the mid-20s (Shulman et al., 2016).
These considerations are fundamental when trying to explain which factors amplify the risk of adolescent exposure to community violence. As suggested by Gottfredson and Hirschi in their "self-control theory of crime" (1990, p. 157), youth with low self-control "gravitate to the street." Compared to youth with higher levels of self-control, they tend to gravitate toward activities that bring short-term pleasure and do not consider the long-term consequences of their behavior (Gibson, 2011); hence, they are more likely to put themselves in situations in which violence is likely, high-risk situations, to engage in delinquent behavior or to associate with other delinquent youth, and then to become direct victims of violence (Schreck, Stewart, & Fisher, 2006). Over the last decade, the criminology literature has encouraged researchers to incorporate neurogenetic or brain-based temperament traits (DeLisi, 2014) as an explanation of antisocial and deviant behavior (Bridgett, Burt, Edwards, & Deater-Deckard, 2015), including the tendency to be involved in violent contexts. Against this background, we recently tested a temperament-based theory of involvement in violent contexts and engagement in aggressive behavior in adolescence, specifically by examining the cross-lagged associations between temperamental effortful control, exposure to community violence (as a witness and as a victim), and aggressive behavior across four time points (Esposito, Bacchini, Eisenberg, & Affuso, 2017). The results of this study were encouraging, providing support for the hypothesis that temperamental effortful control plays a complex role in the development of violence: first, by increasing adolescents' tendency to engage in acts of aggression and externalizing behavior and, second, by increasing the likelihood that adolescents put themselves in violent contexts, both as a witness and as a victim, but only through the mediation of engagement in aggressive behavior. Overall, we concluded that the substantial relations among self-regulation abilities with aggressive behavior combined with exposure to violence within the community underscore the importance of considering interventions that target the early stages in the development of self-regulation in order to reduce juvenile aggression (DeLisi & Vaughn, 2014).

The Paradigm of Pathologic Adaptation to Community Violence
Repeated exposure of community violence versus one-time exposure could lead to differential outcomes. We know that community violence is linked to youths' psychological adjustment according to a dose-response mechanism, which means that as experiences of violence exposure accumulate over time, more severe psychological symptoms develop (e.g., Kennedy, Bybee, Sullivan, & Greeson, 2010). However, the impact of exposure to community violence on youths' well-being becomes more complex when considering the chronicity, or persistence, of violence exposure over time (Garbarino, 1999). Indeed, it seems reasonable to assume that witnessing or being a victim of violence repeatedly over time may have a greater or different impact than having one isolated experience of witnessing or victimization, but the research examining how repeated experiences of community violence are longitudinally associated with psychological outcomes and how this pattern of exposure may be differentially related to outcomes from one-time exposure is still needed (Foster & Brooks-Gunn, 2009). One theory that may account for differential outcomes of repeated exposure of community violence versus one-time exposure is that youth become desensitized to violence over time. As pointed out by Huesmann (1998), children who are repeatedly exposed to violence during childhood inhabit it and experience it as less adverse. Over time, desensitization would account for a weaker association between violence exposure and emotional symptoms, such as depression, but a stronger link between violence and aggressive behaviors, indicating a greater acceptance of the use of violence as a normative problem-solving strategy (Ng-Mak, Salzinger, Feldman, & Stueve, 2004). However, less is understood about the mechanism through which desensitization develops. In their first theoretical model that they called "pathologic adaptation to violence," Ng-Mak, Salzinger, Feldman, and Stueve (2002) identified the crucial mechanism in moral disengagement processes (Bandura, Barbaranelli, Caprara, & Pastorelli, 1996): That is, chronic exposure to violence leads to a normalization of violence through moral disengagement, which in turn promotes an active engagement in future episodes of violence. However, to the best of our knowledge, no study has systematically examined how being exposed to community violence influences the development of moral disengagement. Wilkinson and Carr (2008) tried to raise this point using qualitative data from male violent offenders. They noted that individuals respond to exposure to violence in many ways, some of which are consistent with traditional concepts of moral disengagement, but also argued that those processes are not sufficient for behaving aggressively and that aspects of contingencies and configurations of situational and interpersonal factors play a powerful role in violent behavior. Thus, in a still unpublished study, we have sought to address this issue by investigating how exposure to community violence is associated with specific longitudinal trajectories of moral cognitive distortions (Gibbs, Potter, Barriga, & Liau, 1996) in a sample of 745 adolescents. Albeit partial and still processing, our findings suggest that growing up in a violent neighborhood undermines the normative process of moral development, causing delays that consolidate into self-serving cognitive distortions. Furthermore, when examining the association of trajectories of moral cognitive distortions with later aggressive behavior, the results seem to suggest that a crystallization of disengaging mechanisms and self-serving distortions legitimatizes and reinforces the recourse to aggressive and violent behaviors (Arsenio & Lemerise, 2004;Bandura et al., 1996). Based on these preliminary findings, we conclude that research on relevant environmental variables that could influence individual behaviors at several levels is necessary, both for expanding knowledge about the development and persistence of aggressive and violent outcomes and in order to design appropriate interventions aimed at preventing maladjustment in adolescence.

The Role of Parental Monitoring in Violent Neighborhoods
The role of parents in buffering the effects of violence exposure is well recognized in the literature. In their ecological-transactional model of community violence, Lynch and Cicchetti (1998) categorized exposure to violence in the community as an enduring distal stressor that may influence, through dynamic and mutually reinforcing exchanges, behavior and relationships within children's proximal family context; similarly, parenting and family characteristics may influence the degree to which distal stressors have an impact on children's developmental outcomes. Within this framework, many studies have focused on the moderating role of positive family characteristics, such as a supportive family environment, in buffering the negative impact of community violence exposure on poor child outcomes. An extensive review of these studies is reported in Proctor (2006), where the author points out two different moderating roles that positive family characteristics play in the relationship between exposure to community violence and negative developmental outcomes. The former is a protective-stabilizing effect, in which a factor exerts a positive effect on children's outcomes even in the presence of increasing risk, while the latter is a protective-reactive effect, in which a factor exerts a generally positive effect on an outcome, but less so at higher levels of risk (Luthar, Cicchetti, & Becker, 2000). One of the most important family-related factors able to protect adolescents against psychological and social risk is parental monitoring. To date, researchers have found that high exposure to violence annuls the protective effects of parental monitoring not only against antisocial behavior (Miller, Wasserman, Neugebauer, Gorman-Smith, & Kamboukos, 1999) but also against symptoms of anxiety and depression (Gorman-Smith & Tolan, 1998). Based on these findings, we tested the moderating role of parental monitoring in the association of community violence, both as a victim and as a witness, with antisocial behavior and anxiety-depression symptoms in a sample of 489 adolescents (Bacchini, Miranda, & Affuso, 2011). The study showed impressive results, suggesting that different outcomes involve different mechanisms through which parental monitoring does act, or not act, as a buffer against the negative impact of violence exposure. As shown in Fig. 10.3, the linear regression analysis with parental monitoring as a moderating variable indicated that parental monitoring had a "protective-reactive" effect when the outcome was antisocial behavior, such that high parental monitoring could substantially reduce antisocial behavior only when violence exposure was low, not when it was high. Adolescents who exhibit antisocial behavior are generally also those who are more likely involved in high-risk environments, maybe due to individual factors, such as low self-control, that totally "overwhelms" the protective effect of parental monitoring. In contrast, a "protective-stabilizing" effect was found when considering anxiety-depression as an outcome, where high parental monitoring produced a reduction in depression, even when exposure to violence was high. We argue that, in this case, talking about these experiences with their parents, and expressing their fears, makes young people feel protected and reduces feelings of isolation and danger.

Implications for Policy and Practice
Years of research have improved our understanding of the consequences of youth violence exposure and increased our knowledge of how risk and protective factors contribute to or buffer against violence exposure. The challenge is now to develop policies that ensure the right of every child to live in a safe and nonviolent society.
We know that violence affecting youth development has many sources, and addressing this issue requires attention at all levels of the social ecology. Based on decades of experience, UNICEF (2014) has identified six key strategies to prevent violence exposure, which involve a wide range of government agencies working in the areas of education, finance, health, home affairs, justice, labor, as well as academic agencies. Those strategies include (1) helping parents to develop positive parenting skills, (2) giving children and adolescents the skills to cope and manage risks without the use of violence, (3) changing attitudes and social norms that encourage violence and discrimination, (4) providing high-quality support services for children who are victims of violence, (5) implementing and enforcing laws and policies that protect children from violence, and (6) carrying out data collection and research to plan and design intervention strategies, as well as to monitor progress and end violence.
Other preventive approaches that have been demonstrated to have a great public health impact have been promoted by the Centers for Disease Control and Prevention in USA. These programs target both youth skill development and relationships with parents, peers, and other caring adults but also use strategies influencing school and community environments (see, e.g., the program "Striving To Reduce Youth Violence Everywhere", or STRYVE; David-Ferdon et al., 2016).
However, we acknowledge that programs targeting multiple levels of the child's ecology, although optimal, require economic resources that are not always avail-  Bacchini et al., 2011) able, especially in low-income countries. In such cases, school-based programs could provide ample opportunity to reduce the costs of preventive intervention, targeting relevant factors at different levels of the child's functioning and environment, simultaneously. For example, programs like the Coping Power Universal (Lochman, Wells, & Murray, 2007) as well as the Equipping Youth to Help One Another (EQUIP; Gibbs, Potter, & Goldstein, 1995) could be easily implemented in the school setting in order to prevent violence exposure or its effects, strengthening children's moral cognition, self-regulation, and skills for social problem-solving. Further, all these abilities would promote, in the long term, the development of a nonviolent and law-abiding culture, which represents the crucial condition to ensure success in preventing and reducing children's exposure to violence.

Conclusions
Although different than in war-torn areas, violence affects children even in the most economically developed countries, breaking into their family, school, or neighborhood daily life. The reasons are complex and strictly interrelated: among all, social injustices and organized crime are two relevant contributors.
In this chapter we reviewed the empirical evidence supporting the detrimental effects of early violence exposure on a wide range of developmental outcomes. Overall, the research suggests a sort of equifinality of violence exposure across different contexts. Research indicates that, fundamentally, children need to feel safe in their daily life contexts. If they do not feel safe, they are at risk of developing internalized symptoms or eventually becoming perpetrators of violence themselves. Nevertheless, still many holes remain in our knowledge of mechanisms linking violence exposure to negative developmental outcomes, as well as of predisposing and precipitating factors that intervene in these complex relationships. Because the investment of economic, political, and social resources in deterrent strategies has been demonstrated to be not effective in reducing violence in the way that was hoped, the challenge for research in this field is to inform policies aimed at reducing the number of risk factors that, at different ecological levels, might lead children to poor developmental outcomes.
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