key: cord-0004366-te74xvnd authors: Kulig, Judith C.; Nahachewsky, Deana; Hall, Barry L.; Kalischuk, Ruth Grant title: Rural Youth Violence: It Is a Public Health Concern! date: 2005-09-01 journal: Can J Public Health DOI: 10.1007/bf03404032 sha: d340cded5b649a5a30eb0df3cc8396b938867ca9 doc_id: 4366 cord_uid: te74xvnd Youth violence is a significant issue for public health because of the potential for longterm impacts on individuals, families and communities. Limited exposure to violence is seen as a component of healthy living. However, there is limited understanding of violence from a public health perspective within rural communities. Rural refers to those communities with a population less than 10,000 outside the main commuting zone of a large urban area. Population health approaches, including the social determinants of health, are well supported by public health officials. Generating information about rural youth violence from a Canadian perspective would add to our understanding of these social determinants while providing guidance for policy and program development. Current understandings of youth violence are limited to an urban, and oftentimes, American perspective. An ongoing two-phase Canadian study on rural youth violence included qualitative interviews with 52 youth and the completion of a questionnaire that had been developed from the qualitative responses. The questionnaire has been completed by a larger sample of rural youth. The findings generated from this ongoing study will be useful in linking violence with social factors that impact health and thereby guide population health programs and policies. In this way, the role of public health to develop policies and implement programs will be directly influenced by evidence while addressing an ongoing public health concern. V iolence among youth is a significant issue for public health because of the potential for long-term impacts on individuals, as victims and perpetrators, their families and communities. The fear of violent acts is of itself a major cause of anxiety, 1 requiring intervention by community mental health professionals. In addition, the injuries sustained from violent encounters have costly public health treatment consequences. 2 Of importance, within the determinants of health framework, limited exposure to violence is an essential component of healthy living. 3 However, there continues to be little understanding of the effects of youth violence from a public health perspective, particularly within rural communities. In this instance, rural refers to those communities with a population under 10,000 outside the main commuting zone of a larger urban area. 4 This definition includes communities that are rural, remote and/or northern. The authors of this paper note the deficit of information about youth violence within rural settings in a Canadian context, including no available statistics on violence that differentiate youth by geographic location, 5 and refer readers to their ongoing Canadian study on this topic. 6 The key message is that rural youth violence is a public health issue that needs to be addressed through population health approaches. Population health approaches focus on the full range of factors that determine health and address the entire population within society. 7 The Toronto Charter for a Healthy Canada 8 has been presented as further evidence of the importance of social factors, such as early life and education in the creation of healthy individuals and families. The strength of a social factors approach is that health is recognized as linked to a number of inter-related variables. 7 Definitions of violence include physical forms (i.e., sexual violence, involvement of weapons including body parts and knives 9 ) or non-physical forms (i.e., bullying 9 ). Some authors view violence as a violation of basic human rights in settings such as homes and schools. 10 Youth violence is now being increasingly viewed as a major health problem that impacts many levels of local communities from policing to health care. 11, 12 Furthermore, if violence is acknowledged through a population health approach, then resources such as multidisciplinary implemented teen centres would be readily available to prevent and deal with this issue. For instance, the more successful programs include multiple agencies who are involved with youth. 13 Violence is a concept that fits within the social factors framework and increasingly is discussed in government documents 3 as a public health concern. The necessity of addressing crises in public health, including diseases such as SARS and West Nile Virus, reduces available opportunities and resources to deal with ongoing issues such as violence. However, there has been a documented need to review and strengthen the Canadian public health system, 14, 15 increasing the potential to systematically and appropriately address ongoing issues such as violence. The social factors noted above are considered within society as a backdrop but with little consideration for the differences between groups within society. Thus, urban-based policies and programs are often imposed upon rural communities. Examples of the uniqueness of rural communities include tangible aspects such as decreased access to services, as well as esoteric differences such as the nature of internal relationships between residents. Such subtleties have been generally not always well understood, acknowledged or addressed by health policies or the formal health care delivery system. Several authors have noted differences in health status among rural individuals based upon their geographic location, 16, 17 but overall, there is limited information that documents the impact of rurality on health status or issues such as violence among youth. Research on determining the characteristics and attributes of youth who are violent or who are involved in acts of violence is most often urban-based and does not explicitly address the inter-relationships with social factors. 18 Behaviours exhibited at certain ages have been found to be a predictor of violence later in life. Once again, the findings have not been confirmed within rural populations. One study 19 found that cer-tain characteristics and behaviours associated with aggression, hostility and the like, that adolescents exhibited as early as age 10, were predictors of being subsequently involved with violence and violent acts. Another study showed that 4-7 year old children witnessing violence have a greater chance of displaying aggression. 20 Youths who engage in violence come from a variety of backgrounds. 21 Family characteristics such as acceptance and engagement in violence 22 and higher mobility rates 23 are both linked with children's involvement in violence in urban contexts, but are unknown in rural ones. Bullying is considered a form of violence that, although not new, appears to be increasing in incidence, prevalence and brutality. Youth who bully others have also usually engaged in other types of negative and often illegal-type behaviours such as stealing and using alcohol and drugs. While bullying inclinations peak sometime during grades six and eight, an American study has shown that such tendencies and characteristics actually begin sometime in elementary school and continue to persist throughout one's high school years. 24 Other studies have documented that bullying is not an infrequent occurrence within rural communities. 25, 26 There are gender differences when it comes to youth involvement in violence that also need to be examined through a rural lens. We need to determine if the current findings based in urban contextsincluding that males are two to five times more likely than females to be involved in nearly all acts of violence 27 and that males and females are involved in different types of violence (i.e., physical versus verbal, respectively) 24 -are true for rural youth. Gun carrying and its association with youth violence has been examined in rural Texas. Findings revealed that the prevalence of carrying a handgun by youth had increased by 138% in a seven-year time frame. For 53% of the participants, youth stated they carried guns to school because they were angry with someone and had thoughts about shooting that person, whereas 48% of the participants carried a gun to "feel safer". 28 Differences in the risk-taking behaviours of rural, suburban or urban youth have revealed that the three health risk behaviours were use of substances (e.g., tobacco, alcohol and illegal drugs), participation in sexual activity, and weapon carrying both in the school and in the community. 29 The only published Canadian study on rural youth violence was a self-administered questionnaire with 347 youth. 30 Youth exposed to violence as victims or perpetrators reported higher levels of depression and psychiatric problems such as poor selfesteem. The only other relevant Canadian study focussed on stress, coping and behavioural problems among urban and rural youth and found no significant differences between the two groups. 31 The authors are currently conducting a two-phase study within rural Alberta communities to address the lack of information regarding rural youth violence and to suggest policy implications for the public health system. Ethical clearance was provided by the third author's institution. Phase one included interviews with 52 youth in two resource-reliant rural communities. 6 Phase two of the study involved the use of a questionnaire. Policy forums that allow discussion about the findings within the specific rural communities will be conducted in each of the four participating communities. Such forums are an essential component of addressing rural youth violence and determining appropriate population health strategies that will address the social factors related to violence. In summary, rural youth violence is an issue that has not been adequately examined or understood from a population health approach. It is imperative that studies be undertaken in rural communities across the country. The generation of such information and the widespread dissemination of the findings will be useful for public health managers in order to develop policies and implement programs that help create a healthy society for individuals, families and communities. Crime is a public health problem New directions in violence prediction: The public health arena Federal/Provincial/Territorial Advisory Committee on Population Health. The Opportunity of Adolescence: The Health Sector Contribution A Graphical Overview of Crime and Administration of Justice in Canada Youth Violent Crime Grant Kalischuk R. Violence among rural youth: A focus on health Strategies for Population Health: Investing in the Health of Canadians. 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Supplement to School-related violence among high school students in the United States, 1993-1995 Developmental risk factors for youth violence Early predictors of adolescent violence Addressing the problem of juvenile bullying What do kids say about bullying? The perceived roles of bullying in small-town Midwestern schools Profiles of violent youth: Substance use and other concurrent problems A profile of rural Texas adolescents who carry handguns to school Health risk behaviors among adolescents attending rural, sub-urban, and urban schools: A comparative study Violence exposure and mental health of adolescents in small towns: An exploratory study Stress, coping, and behavioral problems among rural and urban adolescents Acknowledgements: The authors acknowledge funding provided by the Alberta Heritage Foundation for Medical Research. Deana Nahachewsky received a CIHR Health Professional Student Research Award which supported her work on this project. The authors thank research assistants Tanya Hossli, Lindsay Hampton and Paul Armstrong for conducting the interviews; Tina MacQuarrie for preparing the transcripts; and graduate research assistant Lesley Masuk for assisting with data analysis. Our thanks are also extended to the students who participated in the interviews and surveys and the communities and school staff for their cooperation.