Fear of Violence, Family Support, and Well-Being among Urban Adolescents

Our study examines how the fear of violence and family support influence adolescent social, psychological, and physical well-being, after controlling for exposure to violence and a range of demographic factors. We conduct a secondary analysis of the Project on Human Development in Chicago Neighborhoods (PHDCN) data (N = 1337) using mixed-effect, multi-level regression models for the total sample and for males only and females only samples. We find that family support is the most robust, main effects predictor in all three models and across all outcomes. Our analyses show that the fear of violence is associated with increases in social problems (especially for boys) and with decreases in self-rated health. We discuss the results and implications in light of sociological theories on the health and well-being of adolescents.


Fear of Violence and Exposure to Violence
A fundamental shift occurred in how researchers perceive the social consequences of crime by not only considering the direct impact it has on victims, but also considering the indirect victimization, most notably, the fear of crime and victimization [11]. This change occurred as researchers acknowledged that the fear of crime in the United States is more prevalent than actual victimization [11]. In our study, we conceptualize the fear of violence as a legitimate, emotional reaction to the perception of impending victimization [11]. We recognize that the fear of violence is conceptually different from the perceived risk of victimization [10] and hypothesize that exposure to violence [12] is also conceptually distinct from fear of violence. We suggest that adolescents' general fear of violence (i.e. fear of being hurt by violence in the neighborhood, in front of their home, in their home, or at school or work), will be associated with deficits in well-being, even after controlling for exposure to violence.

Fear of Violence and Adolescent Outcomes
Many studies have documented what happens when youth are exposed to or victimized by violence; however, we know much less about how the general fear of violence impacts youth outcomes. Youth who have been victimized and/or exposed to violence may react by becoming very upset, experiencing intense fear, feelings of horror and helplessness [13], and have higher perceptions of danger [14]. We know that one of the most problematic aspects of exposure to violence and victimization is that multiple forms of violence co-occur and that, especially for children and adolescents, the impact is cumulative [15] [16]. For example, there are both short-and long-term negative outcomes, including problems with brain development, impulse control, empathy, anger management, problem-solving skills, alcohol abuse, depression, illicit drug use, intimate partner violence, suicide attempts, reduced life expectancy, homelessness, and future re-victimization [17] [18] [19] [20] [21].
Studies have also documented what predicts adolescent fear of violence: younger age, being female (except for school-related fears) [22], minority status, low income, low education, being a resident of an urban environment [3] [10], the experience of community incivility [23] [24] and, in some cases, having been  [26]. Of the few studies specifically addressing outcomes related to the fear of violence, it has been shown that youth who fear being victimized by crime may take defensive actions to feel protected [26] [27] [28] and can experience spatial and social isolation and marginalization [29].
Although there are few studies examining the outcomes of fear of violence among adolescents separately from exposure to violence, we drew from related studies in the adult population and those examining child/adolescent exposures to violence to hypothesize possible associated problems. Garofalo [28] suggests that fear of crime has broad social consequences, such as distrust and alienation from social life [30]. Fear of crime has been shown to be higher among adults who report fewer prosocial attitudes [31] and evidence suggests that exposure to violence decreases prosocial skills among children [21]. Youth who fear being hurt by violence may cope by avoiding the people or places (e.g. school) that scare them [30] [32] and may also be reluctant to report these problems [33].
Socially withdrawn children often feel and think poorly of themselves, possibly leading to peer rejection and victimization by peers [34]. Stafford, Chandola, and Marmot [35] have found that, among adults, the curtailment of social activities is one pathway linking fear of crime to mental and physical health. Among adults, neighborhood disadvantage, disorder, and fear of crime and violence have been found to decrease physical functioning, lower ratings of self-reported health, and increase the occurrence of chronic conditions [36]. Among children, perceptions of neighborhood safety have been linked to their levels of physical activity, and subsequently, their physical health [37]. Based on our review, we hypothesize that adolescent fear of violence will be associated with increases withdrawn symptoms and social problems and decreases in prosociality and self-rated health.

Family Support, Fear of Violence, and the Stress Process Model
Family support systems may be a critical resource for youth who fear violence because youth have underdeveloped cognitive and coping abilities at hand to successfully adapt to stressful events on their own [38] [39] [40] [41]. In a national study of Canadian youth, Sacco and Nakhaie [42] found that positive parenting and mother's support were important predictors for youth's perception of safety at school and going to and from school. Studies of youth resilience consistently show that children and adolescents who have positive family support are more likely to meet numerous developmental tasks including academic and social competence, and have better psychosocial functioning [43] [50], exposure to domestic violence [51], and exposure to community violence [52], we contend that positive family support may also moderate the relationship between fear of violence and adolescent outcomes.

Gender Differences in Adolescent Outcomes
Many stressful events do not occur precipitately, however, they can be traced back to social structures and an individuals' location within them (i.e. gender) [47]. As Aneshensel [53] and Horwitz [54] have suggested, we believe that gender is associated with a broad range of health and well-being outcomes and that males and females may respond to the same stressors in different ways. In general, research suggests that girls are more likely to respond to stressors with internalizing problems such as anxiety, depression, and social withdrawal and boys are more likely to respond to stressors with externalizing problems such as anger, behavioral problems, and aggression [55] [56]. For example, consistent with previous research [57], Keyes [58] examined emotional well-being, perceived positive feelings, and positive functioning in life. He reported that females tend to experience a higher rate of depression when compared to males, which may be an antecedent of social problems and withdrawal. Research exists that coping skills may be a learned behavior from others within an individuals' social sphere (i.e. family and friends) to cope with perceived stressful events (i.e. fear of violence, victimization) [47]. Nevertheless, it is unclear how perceived social and familial support vary by gender, such as whether females report more perceived support than males, or if no difference exists [49] [59] [60]. In addition, family support may be more a critical resource for girls than boys when dealing with stressors [49] [61] [62].

The Present Study and Research Questions
Scholars have recently emphasized a need in social science research to rely less on dichotomous diagnostic categorizations of individuals [53], to include multiple, continuous symptom scales in analyses [54], and to investigate social well-being alongside psychological and physical well-being [63]. Based on the above review, we hypothesize that, after controlling for several demographic factors and exposure to violence, both fear of violence and family support will be associated with adolescent levels of prosociality, social problems, withdrawn symptoms, and self-rated physical health (e.g. multiple, continuous symptoms scales) in main effects models. Our study assesses several dimensions of well-being, including social (i.e. prosociality), psychological (i.e. withdrawn symptoms), and physical (i.e. self-rated health). We also test whether family support moderates the effect of fear of violence on adolescent levels of prosociality, social problems, withdrawn symptoms, and self-rated physical health (i.e. a Stress Process model). Finally, we test models for males and females separately to identify gender-differentiated outcomes. Thus, we test the following research questions in our study: We use the first wave of data obtained in 1995 from cohorts 12 and 15 (N = 1517), because we are interested in the adolescent period and theory suggests that exposure to violence is particularly impactful on youth during these years.
In addition, it is currently unclear the extent to which the fear of violence is related to adolescent outcomes after controlling for exposure to violence and we do not test for change over time in this study. Therefore, we conduct an exploratory analysis of these relationships using only Wave 1 of the data. Race data showed the presence of several numerically small racial/ethnic categories (e.g., Asian American, Native American). We excluded these racial/ethnic groups so that our sample included only Latino, Black, and White respondents and, additionally, we selected cases with complete data on the variables used in our analyses for inclusion in the sample, resulting in an analytic sample of N = 1337.
The PHDCN is one of the largest longitudinal datasets and used in a vast amount of interdisciplinary studies that examine juvenile delinquency, substance properties of neighborhood conditions [64]. The design of the PHDCN, along with the low attrition rate, extensive racial/ethnic composition, and ecologically meaningful neighborhood clusters [64], lends itself to continued use today. Demographic characteristics of the sample are reported in Table 1.

Measures
Our dependent variables include prosociality, social problems, withdrawn symptoms, and physical health. Prosociality, operationalized as a willingness to help others, to be fair to others, and to be friendly to others, was derived from the Youth Self-Report (YSR) [66]. Youth rated themselves (0 = not true, 1 = somewhat or sometimes true, 2 = very or often true) on six items: "I am willing to help others if they need help," "I can be pretty friendly," "I enjoy being with other people," "I like to help others," "I try to be fair to others," "I try to help other people when I can." Previous factor analysis [67] shows that the items hang together on one factor and it is a valid measure. In our study, the scale was reliable (Cronbach's Alpha [CA] = 0.77) with scores ranging from 1 to 9. Higher scores indicate more prosociality.
Both the Social Problems and Withdrawn Symptoms scales come from the Child Behavior Checklist (CBCL) [68]. Youth are rated by their parents (0 = not true, 1 = somewhat or sometimes true, 2 = very or often true) on several items for each of nine primary subscales on the assessment. The CBCL is a standardized, reliable, valid, and widely used assessment in the social sciences [68]. The Social Problems scale includes 8 items: "Acts too young for age," "Clings to adults or too dependent," "Doesn't get along with other children," "Gets teased a lot," "Not liked by other kids," "Overweight," "Poorly coordinated or clumsy," "Prefers being with younger kids" (CA = 0.62). In our sample, the scale had scores ranging from 0 -10. Higher scores indicate more social problems. The Withdrawn Symptoms scale includes 9 items (CA = 0.74): "Would rather be alone than with others," "Refuses to talk," "Secretive, keeps things to self," "Shy or timid," "Stares blankly," "Sulks a lot," "Underactive, slow moving, or lacks energy," "Unhappy, sad, or depressed," "Withdrawn, doesn't get involved with others," with scores ranging from 0 to 10. Higher scores indicate more withdrawn symptoms.
Physical health was measured with a single, self-reported item. Respondents were asked, "Would you say that in general your health is excellent, very good, good, fair, or poor?" Responses ranged from 1 to 5. Responses were reverse-coded so that higher scores indicate better self-rated health. A number of studies used this single-item measure in past research and found it to have good validity and reliability [69]. from the Exposure to Violence assessment [71]. Youth responded yes (=1) or no (=0) to the following questions: "Are you afraid you might be hurt by violence in your neighborhood?," "Are you afraid you might be hurt in front of your apartment building or house?," "Are you afraid you might be hurt in your apartment building or house?," "Are you afraid you might be hurt by violence at school or work?" Responses to these items were summed, creating a count variable, and ranged from 0 to 4. Higher scores indicate a greater fear of violence. Researchers often use context-specific measures to create scales to capture an overall trait in an analysis [72]. In order to establish construct validity, the gold standard is to assess convergent validation [72]. Bartlett's test of sphericity was significant (χ 2 We included several control variables in our analysis: exposure to violence, gender, race, cohort, parent's education, neighborhood socioeconomic status (SES). Exposure to violence is a sum of three items from the Exposure to Violence assessment [71]. Youth responded yes (=1) or no (=0) to the following questions: "Have you ever seen someone shoved, kicked, or punched?", "Have you ever seen someone attacked with a knife?", "Have you ever seen someone shot?" Gender and cohort were dummy coded, with male and Cohort 12 as the reference group. Race was dummy coded into two variables (Black and Latino) with White as the reference group. Parent's education, neighborhood SES, and exposure to violence were all treated as interval level measures in the analyses.
Descriptive statistics and coding for all variables in our models are presented in Table 1.

Analytic Strategy
We first calculated descriptive statistics (Table 1) and then estimated several mixed-effect regressions for each of our dependent variables, using Maximum Likelihood estimation, and which takes into account nesting by neighborhood.
We assessed whether the relationship between fear of violence and each of the outcome variables was moderated by family support (Table 2). We also conducted mixed-effect, multi-level regressions for "males only" (Table 3) and for "females only" (Table 4) samples. We run separate analyses for boys and girls to assess whether relationships between our independent variables and dependents vary by gender. In addition, we conducted equality of regression coefficient tests to confirm gender differences [73]. Given that the participants are nested within neighborhoods, we use the xtmixed routine in STATA 13 [74]. We estimate mixed-effect, multi-level models because standard regression estimates individ-

Descriptive Findings
We report descriptive statistics for the sample in Table 1. Slightly more than half of the sample was female (51%), while 47% of the adolescents in the sample were Latino, 38% were Black, and 15% were White. In terms of educational attain-

Mixed-Effect, Multi-Level Regression Models
We report findings from the mixed-effect, multi-level regressions in three tables: the full model (Table 2), the males only model (Table 3), and the females only In the full model (Table 2)  In the males only model (Table 3)  In the females only model (Table 4)  After comparing models separately for males and females, we conducted tests for the equality of regression coefficients to confirm whether the gender differences were significant using the method outlined by Paternoster and colleagues [73] and testing significance at p < 0.05. We found that being Latino was more likely to decrease prosociality for boys and more likely to increase prosociality for girls (Equivalence test = −2.10). In addition, family support had a significantly more positive effect on prosociality for boys than girls. For self-rated health, the equivalence test (=2.00) confirmed that parent's education was positively associated for boys' health, but not girls' health. Using Paternoster's method, we were not able to confirm any significant gender differences on the effects of our variables on the outcome withdrawal symptoms. Finally, although the fear of violence was significantly related to an increase in social problems for both boys and girls, the effect was significantly stronger for boys (Equivalence test = 1.97).

Discussion and Implications
The purpose of this study was to investigate how fear of violence and family support affect adolescents' social, psychological, and physical well-being, after controlling for exposure to violence and a range of demographic factors. In our study, we found that fear of violence was associated with an increase in social problems (especially for boys) and a decrease in self-rated health (RQ 1). In addition, we found that family support was associated with increases in prosociality and self-rated health and decreases in withdrawn symptoms and social problems (RQ 2). Unexpectedly, we found no support for a Stress Process model (RQ 3). Finally, we did find evidence for multiple gender differences in the relationships between fear of violence and our outcome variables (RQ 4). Overall, we find that family support is the most robust predictor across all outcomes and in all three analyses (full, males only, females only). Family support is a compensatory factor because in main effects models, it is broadly beneficial to all youth, regardless of group membership [75]. For all adolescents in our sample, regardless of gender, race, SES, or exposure to or fear of violence, family support is key to increasing prosociality and self-rated health, and key to decreasing withdrawn symptoms and social problems. The implications of these findings propose that we must increase the accessibility of resources that promote supportive and healthy relationships within families. These types of family relationships increase the likelihood that young people will thrive and be successful in their transitions to adulthood [58] [76].
Fear of violence is a risk factor for adolescents in our sample because it is associated with decreases in self-rated health and increases in social problems (especially for boys). When comparing our models separately, we found that the fear of violence was associated with an increase in withdrawn symptoms for boys only, but our test of the equality of regression coefficients did not confirm this difference. Our measure of exposure to violence was not significant for any outcome in any model. This is contrary to what we expected, given past research finds strong support for the effects of exposure to violence on well-being. On the one hand, non-significance may be due to the measure's construction, since we used an additive measure of four binary fear of violence questions, although the measure did meet all criteria for convergent validity. However, the fact that exposure to violence was not significant in our models that included fear of violence lends support to the theory that the fear of violence is conceptually distinct from the exposure to violence. Although fear of violence and exposure to violence are significantly correlated, the small correlation coefficient (r = 0.10) supports the conclusion that they are related, but conceptually distinct.
Yearwood [77] suggests that professionals and parents in children's lives help them to manage their fears about actual or potential violence by allowing children to talk about what is going on, providing an outlet for their emotions, and to spend more time with children, providing reassurance that the feelings they are experiencing are normal. For example, in a qualitative study of twenty adolescents living in public-subsidized high rise building in Chicago, teens suggested that adults in their lives openly discuss life's dangers with them and ensure that they know that adults are available to protect them [78]. Promoting supportive relationships between parents and children may strengthen the family dynamic and allow youth to feel more comfortable discussing issues such as their fear of victimization and support their internal struggle to cope with that fear [79].
Our research confirms some of the findings from the few studies that specifically address adolescent outcomes associated with the fear of violence. Specifically, the fear of violence was associated with social problems for both boys and girls. Our study adds that, in our sample, the effect was stronger for boys' A. M. Drinkard et al.
social problems. We found it useful to examine gender-specific models for our outcomes, supporting Aneshensel's [53] and Horwitz's [54] observation that males and females respond to stressors in different ways. This relationship was evident in our adolescent sample. For example, parent's education was positively associated with boys' self-rated health, but not for girls. These gender-specific models also revealed patterns that differed by race. For example, being Latino was more likely to decrease prosociality for boys and more likely to increase prosociality for girls. Future studies should continue to explore how gender and race, and their intersections, lead to differential outcomes for adolescents.
Our study was enriched by the inclusion of multiple, continuous symptomatology scales, as suggested by Horwitz [54] and Keyes [63]. By examining physical health, psychological health, and social well-being outcomes on a continuum and as a group, we were able to describe in better detail the positive effects of family support and the negative effects of the fear of violence. Future studies should continue to assess adolescent well-being from a range of perspectives, taking a more holistic and systematic approach to understanding risks to their health.
Research following from the present study may have implications for the promotion of methods that may contribute in efforts to influence adolescent social, psychological, and physical well-being as a result of exposure to violence and associated trauma. This is important in today's climate where increasing incidents of neighborhood violence, bullying, mass shootings at schools, festivals, churches and mosques, shopping centers, and public venues take place. Understanding how resilience operates through coping strategies and support systems for adolescents that experience exposure to violence may decrease long-term negative effects. This may encourage increased social, psychological, and physical well-being trajectories.

Strengths and Limitations
Our study has several strengths, including one of the largest studies of U.S. children living in urban neighborhoods, reliable and valid scales measuring key variables, and a large percentage of African American and Latino children in our sample. Nevertheless, all of our findings need to be considered within the context of the study's limitations. First, our data were collected in Chicago, which limits the generalizability of our findings to other urban areas, as well as, to suburban and rural youth. However, the original investigators selected Chicago because it has been extensively studied and did reflect many of the urban issues important to sociological theories of crime and delinquency [64]. Second, the data used in our study were collected in the mid-90's which may limit the generalizability of our findings about youth twenty years later. Finally, as with all cross-sectional studies, we cannot make causal attributions to the relationships between our independent and dependent variables.