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Frequency of violent behavior among youths similar in different countries

The JAMA Network Journals

CHICAGO - Adolescents from five different countries had similar frequencies of violence-related behaviors, including fighting and weapon carrying, according to an article in the June issue of The Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

According to information in the article, aggressive and violent behavior is a significant public health problem worldwide. The authors write: "In the United States, physical assault is the sixth leading cause of nonfatal injury in 15- to 19-year-olds and the seventh leading cause in 10- to 14-year-olds. Furthermore, homicide is the second leading cause of death in 15- to 19-year-olds and the fourth leading cause in 10- to 14-year-olds." Violence-related deaths among youths seem to be increasing, the article states.

Eleanor Smith-Khuri, M.D., of the National Institutes of Health, Bethesda, Md., and colleagues compared the frequency of violent behaviors among adolescents in five countries based on information from the World Health Organization's cross-national study of Health Behaviour in School-aged Children (HBSC), which surveyed health risk behaviors and lifestyles in young adolescents in developed countries. The HBSC survey data were obtained from adolescents aged 11.5, 13.5, and 15.5 years living in Ireland, Israel, Portugal, Sweden and the United States during the 1997-1998 academic year. The survey was administered to 10,610 boys and 11,530 girls.

The researchers found that though the majority of adolescents did not fight or carry weapons, the reported frequency of fighting (average, approximately 40 percent), weapon carrying (average, approximately 10 percent) and fighting injuries (average, approximately 15 percent) were similar among youths from all five countries. However, bullying frequency varied widely between countries, ranging from 14.8 percent in Sweden to 42.9 percent in Israel for adolescents who bullied once or more per school term.

The researchers write, "These violence-related behaviors often occurred together in adolescents cross-nationally. A large proportion of adolescents who fought also bullied and vice versa; the percentages of those both bullying and fighting were 29.5 percent in Israel, 22.1 percent in the United States, 17.8 percent in Portugal, and 15.9 percent in Ireland. This percentage dropped to 9.8 percent in Sweden, but this value was still relatively high considering that only 14.8 percent of Swedish youths engaged in any bullying at all."

The researchers conclude that "Engaging in at least an occasional fight was so frequent, particularly in boys but also in girls, and was so consistent across countries that it might not be considered abnormal or alarming. In contrast, frequent fighting and frequent bullying were relatively rare behaviors, as were fighting injuries or weapon carrying at any frequency. We found that adolescents who fight are more likely to be boys in a lower grade (6th grade vs. 10th) who currently smoke, have been drunk, and dislike school."

"We also observed that adolescents who engage in fighting are more likely to manifest the characteristics of frequently feeling irritable or bad tempered and having been bullied," the researchers write.

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(Arch Pediatr Adolesc Med. 2004;158:539-544. Available post-embargo at archpediatrics.com) Editor's Note: This study was supported by a contract from the National Institute of Child Health and Human Development, Bethesda, Md.; the World Health Organization Regional Office for Europe, Copenhagen, Denmark; and the respective participating countries.

Editorial: Adolescent Violence: Is it the same everywhere?

In an accompanying editorial, James A. Mercy, Ph.D., and Linda L. Dahlberg, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, write that if youth violence is the same everywhere in the world, "then perhaps standard approaches to prevention can be applied that address violence as a universal function of the developmental process. If not, then prevention programs may have to be tailored to the specific etiological and cultural context in which such violence occurs."

"Within a global context, however, these countries [the countries studied by Smith-Khuri et al] represent a limited range of economic, social, and cultural experience. A more definitive understanding of similarities and differences in the epidemiology of adolescent violence must be informed by both cross-sectional and longitudinal comparisons among countries with a broader range of economic, social, and cultural characteristics," the editorialists write.

They continue: "Our current understanding of violence among children and adolescents suggests that the source of cross-national differences in adolescent violence is likely to be found in the social and cultural context whereas similarities may possibly be attributable to the process of human development."

The editorialists write that parents are especially important in guiding the development of children and should be viewed as an important opportunity for prevention by health care professionals. They write, "family-based and parenting education programs are the most widely researched and most effective approaches to enhancing protective factors and reducing known risks for antisocial behavior in childhood and adolescence." (Arch Pediatr Adolesc Med. 2004;158:592-594. Available post-embargo at archpediatrics.com)

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations@jama-archives.org .

To contact corresponding author Peter C. Scheidt, M.D., M.P.H., call Bob Bock at 301-496-5133. To contact editorialist James A. Mercy, Ph.D., call Gail Hayes at 770-488-4902.

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