This paper brings a cross-national perspective to the previously observed relationship between exposure to interpersonal violence in the community during adolescence and later manifestation of psychological distress. Exposure to community interpersonal violence has been recognized as a serious public health problem throughout the world (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). Youth have been documented to be by far the most frequent victims of interpersonal violence in the U.S. (Bastian, 1992; Rennison, 2002, 2003; U.S. Department of Health and Human Services, 2001) as well as in other parts of the world such as the Caribbean (Mansingh & Ramphal, 1993; Mercy, Krug, Dahlberg, & Zwi, 2003; Moser & Holland, 1997). Concern about exposure to community interpersonal violence focuses not only on the physical trauma, but also on the psychological trauma that may be a consequence of such exposure (McCann, Sakheim, & Abrahamson, 1988; Rosenthal, 2000). A considerable amount of empirical research on the relationship between exposure to community violence and psychological distress has been carried out within the United States, but no studies of this phenomenon outside the U.S. have been found. Before delving into cross-national and cross-cultural differences in the psychological response to exposure to community violence, however, one should place the phenomenon in a conceptual context.
A meta analysis of the set of 37 independent samples reported in 27 studies published in the U.S. in the 1990s (Wilson & Rosenthal, 2003) established that, in the U.S., exposure to interpersonal community violence during adolescence is moderately related to level of psychological distress manifested later. The analysis also found that the set of 37 independent samples was not homogeneous in terms of the size of the correlations between exposure and distress; that is, some samples produced statistically significantly larger correlations between exposure and distress than did others. The sources of this differential impact of exposure on distress could not be determined from the data available.
This phenomenon of differences in the degree of manifestation of psychological symptoms consequent to exposure to adverse environmental circumstances has been discussed in developmental psychology in terms of the concepts of vulnerability and protective factors (Cowen & Work, 1988; Garmezy, 1991; Howard, 1996; Rutter, 1987). Some individuals may be more sensitive or vulnerable to the effects of exposure to adverse environmental circumstances while others may have characteristics that protect them from the impact. If one pole of a variable is a "protective factor," the other pole of the variable may be considered a "vulnerability factor" (Roosa, Wolchik, & Sandler, 1997). Variables that embody a protective factor at one pole and a vulnerability factor at the other pole are referred to as moderator variables (Baron & Kenny, 1986; Holmbeck, 1997); the presence of the moderator variable moderates or changes the relationship between two other variables depending upon the value of the moderator. Thus, the issue of potential differences between groups in the relationship between exposure to community violence and psychological distress depending upon the characteristics of the group may be framed in terms of protective-vulnerability variables or moderating variables. Differences in levels of psychological distress deriving from exposure to an adverse environmental circumstance may be attributable either to differences in the level of exposure or differences in vulnerability to the adverse circumstance. The contribution of differential level of exposure would be empirically demonstrated by showing that groups that differ in level of exposure also differ in levels of distress. The contribution of differential vulnerability would be empirically demonstrated by showing that one group of individuals had a larger correlation between exposure to a stressor and distress than did another group of individuals. Thus, if one wants to understand the impact of a social stressor one must consider both exposure and vulnerability. This view represents a conceptual and methodological shift from considering only group differences in scores on a variable to considering group differences in the patterns of relationship among variables (Steinberg & Fletcher, 1998).
In searching for variables that moderate the effects of exposure to adverse environmental circumstances, it is widely assumed that the effect of a moderating variable is general across a range of types of social stressors, and that a moderator variable identified in the context of one social stressor may also moderate the effects of other social stressors (Coie et al., 1993; Masten & Coatsworth, 1998; Roosa et al., 1997). "Culture" is among the many variables touted as potential moderating variables (Cohler, Stott, & Musick, 1995; Gibbs & Huang, 1998; Gonzales & Kim, 1997; Marsella, Friedman, & Spain, 1996; Mirowsky & Ross, 1980; Ogbu, 1990). In this context culture refers to shared symbolic constructions of reality embodied in language that guide the meaning of and interpretation of events in life (Cohler et al., 1995; Ogbu, 1990). The case for "culture" as a moderator of the relationship between adverse environmental circumstances and psychological distress, however, is essentially based on intuition and the conjectural interpretation of observations made of single individual cultural groups; but the need for cross-cultural empirical studies in this area is now beginning to be recognized (Gonzales & Kim, 1997; Marsella, Friedman, & Spain, 1996; Phinney & Landin, 1998; Steinberg & Fletcher, 1998).
THE PRESENT STUDY
This study is concerned with exposure to community violence as a social stressor and psychological distress as a response to that stressor; it compares two nations, the United States and Jamaica, in terms of the response of psychological distress to exposure to community violence. However, in order to understand variation in psychological distress in response to exposure to community violence, one must consider both the level of exposure and the degree of vulnerability to exposure (Ulbrich, Warheit, & Zimmerman, 1989). That is, different levels of psychological distress may be due to different levels of exposure or they may be due to different levels of vulnerability. Therefore, in a cross-national comparison of exposure to community violence and psychological distress, one must consider differences in both the levels of exposure and the level of vulnerability to exposure, not just levels of exposure.
Informal observation suggests that individuals in Jamaican society compared to individuals in the U.S. have a higher level of exposure to community interpersonal assault, and that individuals in the Jamaican culture may have a lower vulnerability to the effects of exposure to interpersonal violence. With regard to exposure, informed social critics in Jamaica perceive Jamaica to have a higher level of interpersonal violence than the U.S. (Meeks-Gardner, Powell, & Grantham-McGregor, 2000; Moser & Holland, 1997; Williams, 1999). Although this opinion is based on informal observation, it seems reasonable in view of official statistics indicating that Jamaica has a homicide rate four times as high as does the United States (Buvinic, Morrison & Shifter, 1999). It is assumed that the level of exposure to community violence on the part of individuals in a community is positively related to the level of violence in the community. With regard to potential psychological response of Jamaicans to violence, two facts may be noted. First, the history of Jamaica has been steeped in violence, beginning with the conquistadores, followed by slavery and then colonialism, resulting in a cultural tradition of using violence for both resisting oppression and establishing order when informal civic norms are disrupted (Moser & Holland, 1997; Phillips & Wedderburn, 1988; Williams, 1999); this cultural tradition is thought to have legitimized violence as a potential mode of interpersonally relating in all arenas of social interaction within the Jamaican culture (Moser & Holland, 1997; Phillips & Wedderburn, 1988; Williams, 1999). Second, the use of corporal punishment in child rearing is almost universal in Jamaican culture (Lambert et al., 1999; Roopnarine & Shin, 2003; Smith & Mosby, 2003). One may assume that these two characteristics, culturally legitimized interpersonal violence and use of corporal punishment, may result in a somewhat different meaning for interpersonal violence in the Jamaican culture and some desensitization of psychological response to interpersonal violence among individuals in the Jamaican culture. The above analysis leads to two hypotheses:
Cross-national hypothesis: Adolescents living in Jamaica have a higher level of exposure to interpersonal community violence than do adolescents living in the U.S.
Cross-cultural hypothesis: Adolescents developing within the Jamaican culture have a lower level of psychological response (less vulnerability) to exposure to community violence than do adolescents developing within the non-Jamaican U.S. culture.
Culture and nation of residence tend to be relatively tightly bound together, except, of course, in the case of immigrants. Immigrants typically not only move from one geographical location to another, they often move to a geographical location in which the local set of mores is different from the one in the location that they leave. It is widely thought that this process of immigrating is also a stressful situation, and it has been conceptualized in terms of acculturative stress (Berry, 1997; Ward, 1996). The effects of acculturative stress on individuals would be in addition to the impact of stress from exposure to community violence and the moderating effects of culture on the relationship between exposure and distress. Applying these concepts to the situation of cross-national and cross-cultural comparisons between Jamaica and the U.S., one arrives at a third hypothesis:
Acculturative stress hypothesis: Immigrant adolescents have a higher level of psychological distress than either adolescents native to the nation of residence or adolescents living in the nation of the immigrants' origin.
This study compares three groups [African Americans living in New York City, Jamaican Americans living in New York City, and Jamaicans living in Jamaica, West Indies (WI)] in terms of exposure to community interpersonal violence, level of psychological distress, and the relationship between exposure and distress.
The research uses a cross-sectional correlational design, which compares three groups of individuals on each of three variables. One group comprises African Americans living in the United States; the second group comprises Jamaican immigrants living in the United States; the third group comprises Jamaicans living in Jamaica, WI. The three dependent variables are: one, level of exposure to community violence during the three previous years (while in high school); two, level of manifesting psychological distress symptoms; and three, the correlation between exposure to community violence and psychological distress.
The three-group design allows testing of both the cross-national and cross-cultural hypotheses independently of each other, as well as the testing of the acculturative stress hypothesis. The cross-national comparison involves those living in the United States (African Americans and Jamaican Americans) versus those living in Jamaica; the cross-cultural comparison involves third-generation African Americans versus those of Jamaican cultural background (Jamaican Americans and Jamaicans); and the acculturative stress hypothesis involves comparing immigrants (Jamaican Americans) with non-immigrants (African Americans in the U.S. and Jamaicans living in Jamaica, WI).
The internal validity of a correlational design may be strengthened by making the comparison groups similar on several variables that potentially may contaminate the results. The three groups in the present study were similar in terms of race (all participants were descendants of the African Diaspora to the New World), age, gender, educational status (all were first-year students in college), and living in a large urban center.
Data on U.S. students were collected as part of an ongoing research project. Data on Jamaican students were collected by the research staff of the U.S. project with the cooperation of the administration and faculty at a university in Jamaica.
Data were collected using self-report questionnaires administered during class in classroom settings. Participation was voluntary and data were collected anonymously; approximately 95% of the students in attendance at class at the time of data collection completed the questionnaires. Students at the university in New York City were enrolled in courses that are often taken by beginning students; students at the university in Jamaica were enrolled in courses that are typically taken by first-year students. Only first-year students in these courses were included in the present study.
The study sample comprised older adolescents attending college in two countries: first-year undergraduate students in a four-year nonresidential public university in New York City (African Americans and Jamaican Americans) and first-year undergraduate students in a government-sponsored university in the large city of Kingston, Jamaica, WI.
A total of 617 first-year college students, ranging in age from 16-20 years, participated in this study: 179 non-Jamaican African Americans living in New York City, 137 Jamaican Americans living in New York City, and 301 students living in the Kingston metropolitan area in Jamaica. Data collection for New York City participants occurred in the interval 2000-2003 [this data collection period includes the occurrence of the World Trade Center attack in New York City, but the impact of this event on the population of the present study was minimal (Wilson & Rosenthal, 2004)]; data collection for the Jamaican, WI, participants occurred during January, 2002. Only individuals who had attended high school in the U.S. were included in the African American and Jamaican American samples; only Jamaican nationals were included in the Jamaica, WI, sample. The three groups had similar distributions on gender: African Americans, 79% female; Jamaican Americans, 75% female; and Jamaicans, 80% female. The Jamaicans from the university in Jamaica were slightly older than the students in the U.S., because the data were collected during the fall semester in the U.S. but the data were collected at the beginning of the spring semester in Jamaica. The mean ages for the three groups were: African Americans, 18.4 years; Jamaican Americans, 18.3 years; and Jamaicans, 18.7 years.
Exposure to community violence. Community violence is also referred to in the literature as "street violence," "chronic community violence," and "recurring community violence." It is concerned with violence that is interpersonal; occurs outside the home (non-domestic); is non-sexual; involves "commonplace" events such as shootings, knifings, muggings, beatings, and threats of physical assault, rather than singular events such as sniper attacks or mass bombings; and is experienced firsthand rather than vicariously (reading about, seeing on TV or in the movies, or hearing about from others).
The measure of community violence used in this study comprises 18 items adapted from the Survey of Exposure to Community Violence developed by the National Institute of Mental Health (Richters & Saltzman, 1990): 7 items are concerned with the individual's own experience of being a victim and 11 items are concerned with the individual's witnessing someone else being a victim. The victimization items inquire about how often the individual was chased, threatened with serious physical harm, punched, mugged, robbed using force, stabbed or shot during the past three years before coming to college. The witnessing items inquire about how often the individual, during the past three years before coming to college, had seen others being: chased, threatened with serious physical harm, punched, mugged, arrested, wounded, stabbed, shot, killed, seeing others carrying a gun, and seeing a dead person. The response alternatives were "never," "once or twice," "several times," and "very often." Responses were weighted from 1 to 4 and summed over the 18 items to produce a single common factor scale that is quasi-interval; possible scores range from 18 to 72. Each item was given the same weight; although the items differ in apparent severity of trauma, the apparent severity does not correlate with distress (Rosenthal & Wilson, 2003). The scale had very good reliability (alpha = .89) with previous samples of older adolescents (Rosenthal & Wilson, 2001; Wilson, Rosenthal, & Austin, 2005), and also does so with the present sample (alpha = .88). The face content validity of the scale is good in that the items reflect the conceptualization of the variable presented above.
Psychological distress. The psychological distress scale comprises 25 items from the dysphoria domain of the Trauma Symptom Inventory (Briere, 1995). The Trauma Symptom Inventory is a standardized inventory measuring several domains of psychological sequelae to traumatic experience. It was standardized on a large nationally representative sample aged 18 years and older in the U.S. The dysphoria domain includes anger, anxiety, and depression. The scale asks the individual to report the frequency of experiencing each of 25 dysphoric feelings during the past two months. Examples of feelings are: "trouble controlling your temper," "feeling jumpy," and "feeling depressed." The scale uses four response alternatives, "never," "seldom," "sometimes," and "often"; these responses are weighted from 1 to 4 and the weighted responses are summed over the 25 items to produce a single common factor scale that is quasi-interval, with possible scores ranging from 25 to 100. The scale has excellent reliability (Cronbach's alpha = .95) when used with older adolescents in the U.S. (Rosenthal & Wilson, 2002) and had alpha = .93 with the present cross-national sample. The psychological distress scale has criterion validity in that it correlates with similar scales in the Derogatis Brief Symptom Inventory as well as differentiating between psychiatric patients and the norm sample with a large effect size (Briere, 1995).
Differences among group means were tested using one-way analysis of variance. Differences among three correlation coefficients were tested using a test of heterogeneity based on Chi Squared described by Johnson and Jackson (1959) and more recently by Rosenthal (1991). Power analysis (Cohen, 1988) reveals that the size of the sample used in the present study would detect a difference among means indicating a small effect size 95% of the time using a criterion of [alpha] = .01 for rejecting the null hypothesis; and would detect a difference among correlations indicating a small to medium effect size 79% of the time using a criterion of .05 for rejecting the null hypothesis.
Exposure to Community Violence
For the total sample, the mean exposure score, 27.4, is equivalent to never having experienced half the items in the past three years and having experienced the other half of the items "once or twice" during this time. This exposure to community violence is similar to the level of exposure of other samples of New York City adolescents in recent years (Rosenthal & Wilson, 2001, 2003).
Jamaican adolescents living in Jamaica have statistically significantly lower levels of exposure to community violence than do Jamaican American and African American adolescents living in New York City (see Table 1). This difference due to nation of residence is approximately equivalent to r = .24 and is generally considered a medium effect size (Cohen, 1988). Thus, there are cross-national differences in level of exposure to community violence--but these differences are not in the direction implied by the conceptual analysis above.
The mean level of psychological distress for the total sample, 51.1 (equivalent to experiencing each of the distress symptoms "seldom" in the past two months), is similar to the mean level for the representative standardization sample of adults aged 18 and over living in the continental U.S. (Briere, 1995) and for other samples of older adolescents living in New York City in recent years (Rosenthal & Wilson, 2001, 2003).
Jamaican American adolescents living in New York City report statistically significantly higher levels of psychological distress than do African Americans living in New York City and Jamaicans living in Jamaica (see Table 1). This difference is approximately equivalent to r = .12 and is generally considered a small effect size (Cohen, 1988). Hypothesis Three was confirmed--immigrants have a higher level of distress than do non-immigrants.
Relationship between Exposure and Distress
The correlation between exposure to community violence and psychological distress for the total sample, r = .33 (a medium effect size) (Cohen, 1988), was similar to that found in other samples of older adolescents living in New York City in recent years (Rosenthal & Wilson, 2001, 2003). No statistically significant differences were found among the three groups in terms of the relationship between exposure to community violence and manifesting psychological distress (see Table 1). Thus, Hypothesis Two was not confirmed--culture does not moderate the impact of exposure to community violence on psychological distress among older adolescents.
The finding that older adolescents living in Jamaica (which has a considerably higher rate of homicide than the U.S. and which has a cultural tradition of violence in interpersonal relations) report a lower level of exposure to community violence than do adolescents living in New York City is counter-intuitive: one might expect that individuals living in places with more violence would have higher levels of exposure to violence. Nevertheless, in New York City, the level of older adolescents' exposure to community violence is not related to the rate of violent crime in neighborhoods in which they live (Rosenthal, 2000; Rosenthal & Wilson, 2003). The authors speculate that in New York City older adolescents are highly geographically mobile and routinely travel to neighborhoods with different violent crime rates. Jamaican informants have suggested that in Jamaica, socioeconomic status of community is highly associated with crime rate, residential segregation by socioeconomic status is much more rigid than in the U.S., residents of upper socioeconomic communities seldom enter lower socioeconomic communities, and that the college students in Jamaica are more likely to be from upper socioeconomic level families. Therefore, Jamaican college students may indeed have less exposure to community violence than college students in New York City even though there is a higher level of violence in Jamaica. Exposure of individuals to community violence is a complex psychosocial phenomenon and is not a simple reflection of the amount of violence in the community.
The finding that immigrants have higher levels of psychological distress than do either other individuals in their new nation of residence or individuals living in their former nation provides support for the concept of acculturative stress even though the finding also suggests that the effect size of acculturative stress may be rather small. The finding of an effect of acculturative stress also reminds us that exposure to community violence is not the only source of psychological distress among adolescents.
The principal focus of the present study was on culture as a moderator of the relationship between exposure to community violence and psychological distress. The finding of no statistically significant differences in the size of the relationship between exposure to community violence and psychological distress among the three groups differing in culture and in nation of residence raises questions about the assumption that culture may be a protective (or vulnerability) factor with regard to exposure to community violence. We should, however, consider the possibility that this finding is an artifact of method before developing a conceptual interpretation.
First, the size of a correlation coefficient is limited by the reliability of the measures of the two variables correlated and by the degree of truncation of the distributions of the two variables (McNemar, 1969). In the sample used in the present study, the reliabilities were quite high (.88 for exposure to community violence and .93 for psychological distress); and the distributions for the measures for the two variables was quite wide and not truncated. Thus, the correlations obtained in the present samples closely represent the correlations in the respective populations. Second, the findings may be a Type II statistical error (that is, failing to reject the null hypothesis when the null hypothesis is in fact false). Power analysis (Cohen, 1988), however, indicates that samples of the size used in the present study would detect small to medium differences in correlation 79% of the time using the .05 criterion. If differences in size of the relationship between exposure and distress do exist between these populations, the differences must be rather small. Thus, we may conclude that the failure to find a difference between the cultural and national groups in the relationship between exposure and distress is not likely to be an artifact of method.
The size of the relationship between exposure and distress does not appear to be highly sensitive to the variations in culture and nation of residence represented by the groups in this study, even though the cross-national differences in level of violence and the cross-cultural differences in attitudes toward use of violence in interpersonal relations appear to be substantial.
The relationship between exposure to community violence and psychological distress among individuals also appears to be not very sensitive to differences among samples in either level of exposure or level of distress. The relationship between exposure and distress was essentially the same for the three groups even though Jamaican Americans differed from the other groups in level of psychological distress, and Jamaicans living in Jamaica differed from the other groups in level of exposure to community violence. One should note, however, that the levels of both exposure to community violence and psychological distress in the groups in this study are really quite moderate, and the findings may be limited to situations in which levels of exposure and levels of distress are not high. Our tentative conclusion, then, should be amended to say that the relationship between exposure to community interpersonal violence and psychological distress among individuals is relatively insensitive to small differences in sample levels of either exposure or distress.
One may tentatively conclude that the effect size of the relationship between exposure to community interpersonal violence and psychological distress is quite robust across national differences in level of violence, cultural differences in attitudes and behavior related to interpersonal violence, differences among samples in levels of exposure and differences among samples in level of distress, when the overall levels of exposure and distress within the groups are moderate. In these circumstances variation in exposure to community violence accounts for slightly less than 10% of the variance in psychological distress among the individuals comprising the samples. There is not a one-to-one correspondence between amount of exposure and amount of distress; obviously other variables also affect the level of psychological distress. Nevertheless, in a broader context, the impact of exposure to community violence on psychological distress is substantial. The effect size for the relationship between exposure to community violence and psychological distress is equal to or larger than the effect sizes estimated by meta analyses for other psychosocial stressors such as the experience of child sexual abuse (Paolucci, Genuis, & Violato, 2001; Rind, Tromovitch & Bauserman, 1998), natural disasters (Rubonis & Bickman, 1991), and negative life events (Lazarus, 1990). Further, using the binomial effect size display (Rosenthal & Ruben, 1982) indicates that the effect size for the relationship between exposure to community violence and psychological distress represents the ability to increase the success rate of predicting the level of distress from knowledge of exposure from 35% to 65%--that is, large enough to be of both theoretical and practical importance.
This study has provided some initial empirical observations about cross-cultural and cross-national differences in exposure to community violence, psychological distress, and the relationship between the two among adolescents. The principal finding is that the size of the relationship between exposure and distress among adolescents is robust in the face of national differences in rates of interpersonal violence, cultural differences in attitudes and behaviors regarding interpersonal violence, and population differences in level of exposure and level of distress. The study has also demonstrated the complexity of the phenomenon of impact of community violence and raised some interesting conceptual issues. We echo the World Health Organization's recommendation that research on the effects of community violence become a priority for international public health research (Krug et al., 2002).
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This research was supported, in part, by grant GM08153 from the National Institute of General Medical Sciences (Dr. Rosenthal); data collection in Jamaica was supported by other, private sources.
The authors wish to thank John Maxwell and Natalie Gentles for their facilitation of data collection in Jamaica.
W. Cody Wilson, Research Foundation of The City University of New York.
Reprint requests should be sent to Beth Spenciner Rosenthal, Social Sciences Department, York College of The City University of New York, 94-20 Guy R. Brewer Blvd., Jamaica, NY 11451. E-mail: firstname.lastname@example.org
Table 1 Cross-Group Comparisons of Exposure, Distress, and Relationship Between Exposure and Distress (N = 617) Variable Exposure (a) Distress (b) Group n M SD M SD African American 179 28.9 7.1 50.5 13.7 Jamaican American 137 28.9 7.1 54.2 15.5 Jamaican West Indian 301 25.7 5.8 50.0 13.4 Total 617 27.4 6.7 51.1 14.0 Variable Relationship (c) Group r African American .37 Jamaican American .30 Jamaican West Indian .30 Total .33 (a) ANOVA: F(2, 614) = 18.4, p <.0001, eta =.24. (b) ANOVA: F(2, 614) = 4.5, p =.01, eta =.1 2. (c) Chi square = [SIGMA] (N-3) [([[bar.Z].sub.r] - [Z.sub.r]).sup.2]; [chi square] (2) = 0.83, p = .66.…