Conduct Problems As a Pathway From Childhood Adversity to Community Violence Exposure: The Protective Roles of Caregiver Knowledge and Involvement

Abstract

Exposure to community violence (ECV) poses a prevalent threat to the health and development of adolescents. Research indicates those who have more Adverse Childhood Experiences (ACEs) are at higher risk for ECV, which further exacerbates risk of negative mental and physical health impacts. Additionally, those with more ACEs are more likely to exhibit conduct problems, which has also been linked to risk for ECV. Despite the prevalence and impact of ECV, there is limited longitudinal research on the risk factors that precede this exposure as well as family-level factors that may prevent it. The current study examined conduct problems as a potential mediator between ACEs and future indirect (i.e. witnessing) ECV in adolescents. Additionally, this study included caregiver factors, such as caregiver knowledge about their adolescent, caregiver involvement, and caregiver-adolescent relationship quality as potential protective moderators. Participants included (N = 1137) caregiver-adolescent dyads identified as at-risk for child maltreatment prior to child’s age four for inclusion in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Conduct problems at age 14 mediated the relationship between ACEs from ages 0-12 and indirect ECV at age 16 (standardized indirect effect = .03, p = .005). Caregiver knowledge moderated the indirect relationship (b = −.40, p = .030), and caregiver involvement moderated the direct relationship between ACEs and indirect ECV (b = −.03, p = .033). Findings expand our knowledge about the longitudinal pathways that increase risk of violence exposure over the course of adolescent development, as well as the protective benefits caregivers can offer to disrupt these pathways and reduce risk of future traumatization. Implications are discussed for interventions that aim to address and prevent trauma and adverse outcomes among youth exposed to child maltreatment, household dysfunction, and community violence.

Keywords

community violence violence exposure youth violence treatment/intervention child abuse Family issues and mediators conduct problems

Exposure to community violence (ECV) poses a prevalent threat to the health and development of adolescents in the United States (i.e., bullying, fighting, rule-breaking, theft; Dahlberg & Mercy, 2009). More than two-thirds of youth under age 18 in the U.S. (67.5%) report direct or indirect (i.e., witnessing) exposure to at least one form of violence, with risk for subsequent exposure increasing thereafter (Finkelhor, Turner et al., 2015b). Importantly, research indicates that indirect exposure to violence is associated with similar adverse outcomes for adolescents as those who are directly victimized (Zimmerman & Posick, 2016). The widespread mental health consequences of ECV include increased risk for both internalizing and externalizing symptomatology (Fowler et al., 2009). However, there is limited research on the risk factors that precede indirect ECV and the family-level factors that may prevent it. Children and adolescents who experience more Adverse Childhood Experiences (ACEs) are at increased risk of ECV (Lee et al., 2017; Walling et al., 2011). They are also more likely to engage in antisocial behavior and exhibit conduct problems (Bernhard et al., 2018). Engaging in these behaviors increases risk for direct and indirect ECV, as it exposes adolescents to risky and dangerous situations (Burnside & Gaylord-Harden, 2019; Lauritsen et al., 1992). Yet, the longitudinal pathway from ACEs to indirect ECV through conduct problems has not been previously tested. The present study used data from a sample of adolescents identified as at-risk for family violence and maltreatment to prospectively examine: (1) the role of conduct problems as a mediator in the association between ACEs and future indirect ECV, and (2) key caregiving factors (i.e., knowledge, involvement, relationship quality) as moderators of this association, potentially protecting adolescents with ACEs from future conduct problems and indirect ECV.

Adverse Childhood Experiences Increase Risk for Exposure to Community Violence

ACEs include several types of child maltreatment (i.e., physical abuse, sexual abuse, psychological abuse, emotional neglect, physical neglect) and household/family dysfunction (i.e., parental divorce or separation, violence towards mother, substance use in the household, living with mentally ill or suicidal individuals, living in a household with criminal activity; Felitti et al., 1998). A large body of evidence has suggested an association between ACEs and a wide variety of behavioral and social risks, as well as mental and physical health risks (Hughes et al., 2017; van der Feltz-Cornelis et al., 2019). The ACEs framework, however, has been criticized for its narrow focus on household/family adversities and exclusion of adversities that occur in other ecological contexts, especially ECV (Finkelhor et al., 2015a; Lee et al., 2017). Despite its predictive value for negative mental and physical health outcomes (Fowler et al., 2009; Wright et al., 2017), ECV (both direct and indirect) has typically been measured separately from other forms of ACEs, which may lead to an underestimation of the full burden of the adversities children and adolescents experience (Finkelhor et al., 2015a).

Bronfenbrenner’s (1979) Ecological Systems Theory of Development emphasizes the interactive nature of the various environmental systems that surround youth and influence their development, including individual (e.g., sex, race), family (e.g., conflict, monitoring), and school/community factors (e.g., school/community violence; Bronfenbrenner, 1979). Consistent with this theory, individuals who experience ACEs may be more likely to live in neighborhoods with high rates of poverty, violence, and crime, increasing their risk for violence exposure in their communities (Finkelhor et al., 2007; van der Feltz-Cornelis et al., 2019). Previous research, including a recent study conducted with the same dataset used in the current study, confirms that ACEs are associated with an increased risk for physical victimization in their community (Fagan, 2020). Still, little is known about the pathways connecting family-level adversities, such as ACEs, with increased risk for community-level adversities like witnessing violence.

Pathways Through Conduct Problems

One potential pathway that could account for the association between ACEs and indirect ECV is adolescent conduct problems, operationally defined in the current study as symptoms of conduct disorder (i.e., aggression toward people and animals, destruction of property, truancy; American Psychiatric Association, 2000). General strain theory, which builds on the foundation of Bronfenbrenner’s (1979) Ecological Systems Theory, would suggest that ACEs acts as a strain on children and adolescents, increasing negative emotionality, and leading to aggression and/or delinquent behaviors (Agnew, 1992). Indeed, numerous studies have confirmed that ACEs increase risk of developing conduct disorder symptoms, including engagement in antisocial, violent, and delinquent behaviors (i.e., bullying, fighting, theft, rule-breaking; Bernhard et al., 2018). These conduct problems in turn heighten risk for ECV, a pathway that was first proposed by the lifestyle routine and activities theory (Gover, 2004) and has since been supported by numerous empirical studies (Burnside & Gaylord-Harden, 2019; Lauritsen et al., 1992). Overall, research indicates that both conduct problems and ACEs function as individual- and family-level risk factors, respectively, that increase adolescents’ risk of direct and indirect ECV.

The Protective Role of Caregiving

It is also important to consider the role that caregivers may play in protecting against risk for future indirect ECV by reducing the risk of conduct problems. Research has established caregiver support as a crucial protective factor for fostering resilience among those who have experienced ACEs (Grych et al., 2015; Houston & Grych, 2015). Caregiver support can be represented by behavioral constructs such as caregiver knowledge of adolescents, caregiver involvement with adolescents, and caregiver-adolescent relationship quality. Caregiver knowledge reflects caregiver’s awareness of adolescents’ daily activities, whereabouts, and peer-relationships, which can serve as a proxy for concern about adolescents’ well-being (Cohen & Rice, 1995). Studies have shown that caregiver’s knowledge of adolescent’s behavior may act as a protective buffer against development of adolescent maladjustment behaviors, such as delinquency and antisocial problems, depressed mood, and self-esteem (Kerr & Stattin, 2000; Racz & McMahon, 2011; Sullivan et al., 2004). Interestingly, how parents acquire knowledge of adolescents’ behaviors is central to the protective influence of caregiver’s knowledge; with adolescent’s self-disclosure appearing to be a more prominent influence than parents’ own monitoring and soliciting behaviors (Kerr & Stattin, 2000; Lamari-Fisher & Bond, 2021; Racz & McMahon, 2011; Stattin & Kerr, 2000).

Moreover, caregiver-adolescent relationship characteristics, including caregiver involvement and relationship quality, have demonstrated value for adolescent well-being (Rayburn et al., 2018; Wenk et al., 1994). Caregiver-adolescent involvement, typically conceptualized behaviorally (Wenk et al., 1994), can range from shared activities to shared communication to involvement in schoolwork (Hill, 2015). Caregiver–adolescent relationship quality is an indicator of how emotionally involved caregivers are in their adolescent’s life (Wenk et al., 1994). Similar to caregiver knowledge, caregiver involvement and relationship quality have demonstrated utility in reducing problematic adolescent behaviors, such as aggression, delinquency, and conduct problems (Fagan, 2020; Loeber & Stouthamer-Loeber, 1986; Pearce et al., 2003). It is likely that increased involvement and relationship quality strengthens adolescent–parent attachment, which in accordance with social bond theory (Hirschi, 1969) and demonstrated empirically (e.g., Han et al., 2016; Hoeve et al., 2012), protects adolescents from involvement in delinquent behaviors. Consistent with Ecological Systems Theory of Development (Bronfenbrenner, 1979), caregiver knowledge, involvement, and relationship quality are collectively putative proximal factors protective against the consequences of ACEs (Yule et al., 2019). Given their ability to buffer against adolescents' problematic behaviors, they may disrupt pathways from ACEs to conduct problems to indirect ECV.

Current Study

The present study sought to address gaps in the extant literature regarding the association between ACEs and indirect ECV (Burke et al., 2011). Utilizing data from adolescents at risk for maltreatment, we aimed to prospectively test the mediating role of conduct problems in the association between ACEs and indirect ECV, as well as the moderating roles of caregiver knowledge, involvement, and relationship quality. We hypothesized that: 1) ACEs prior to age 12 would be significantly associated with indirect ECV at age 16; 2) adolescent conduct problems at age 14 would mediate the relationship between ACEs prior to age 12 and indirect ECV at age 16; and 3) caregiver knowledge, involvement, and relationship quality at adolescent age 12 would moderate this process, with higher levels of the caregiving dimensions attenuating the association between ACEs, subsequent conduct problems, and indirect ECV.

Methods

Sample and Procedures

The present study utilized data from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), a multi-site consortium of ongoing prospective studies investigating the causes and consequences of child abuse and neglect (see Runyan et al., 1998 for a more detailed description). The initial sample included 1354 caregiver–child dyads who were selected prior to age four based on prior Child Protective Services (CPS) involvement (Northwest, Midwest, and Southwest sites), identification as high risk for child maltreatment at birth based on a state public health tracking system (South site), and involvement with a pediatric clinic serving low-income children (East site). Sociodemographic characteristics of the sample are listed in Table 1. Approximately half of the participants were female (51.7%) and the sample was racially/ethnically diverse (55.2% Black, 25% White, 7.2% Latinx, 12.6% Mixed/Other).

Table 1.

Sociodemographic Information and Descriptive Statistics.

	(N = 1137)	Min	Max
Youth sex; N (% female)	588 (51.7%)	—	—
Child Race/Ethnicity; N (%)	—	—	—
Black	628 (55.2%)	—	—
White	284 (25%)	—	—
Latinx	82 (7.2%)	—	—
Mixed/Other	143 (12.6%)	—	—
Family structure at age 12; N (%)	—	—	—
Single biological parent	492 (57.1%)	—	—
Step or cohabitating caregiver	131 (15.2%)	—	—
Two biological parents	128 (14.8%)	—	—
Other kin or non-kin caregiver	111 (12.9%)	—	—
Met criteria for conduct disorder	60 (5.3%)	—	—
Family income below federal poverty limit (birth through age 12); N (%)	908 (79.9%)	—	—
Adverse childhood experiences (birth through age 12, M (SD)	3.06 (2.11)	0	8
Caregiver–youth relationship quality (age 12), M (SD)	4.40 (0.63)	1	5
Caregiver involvement (age 12), M (SD)	5.08 (2.17)	0	9
Caregiver knowledge (age 12), M (SD)	1.61 (0.40)	0	2
Conduct disorder symptoms (age 14), M (SD)	3.62 (3.81)	0	21
Exposure to community violence (age 16), M (SD)	1.25 (1.31)	0	6

Note. M = mean; SD = Standard Deviation. Age 12 N = 862.

The present study reported on data from 1137 caregiver–adolescent dyads present for at least one of the three biannual interviews between ages 12 and 16. All sites utilized uniform assessment measures, data collection, data entry, and data cleaning protocols. Participants completed assessments on laptop computers with Audio Computer-Assisted Self Interviews for sensitive information. Additionally, each of the LONGSCAN sites systematically reviewed and coded CPS records of maltreatment using a modification of the Maltreatment Classification System (MMCS; Barnett et al., 1993; English, 1997). Coders at each site were trained to use the MMCS by experienced coders until they reached 90% agreement with the gold standard. To further ensure reliable coding, coders at all five sites coded a subsample (n = 109) of the CPS narratives that represented cases from each site. Kappas for MMCS codes by LONGSCAN coders were high (ranging from .73 for emotional maltreatment to .87 for physical abuse; English and the LONGSCAN Investigators, 1997). Consistent with previous studies, the present study used indicators of whether or not there were allegations of neglect, physical, sexual, or emotional abuse based on previous findings that children and adolescents with alleged and substantiated maltreatment reports are at a similarly increased risk for maltreatment recidivism and mental health consequences (Kohl et al., 2009).

Measures

Family Demographics

Caregivers reported child sex and race/ethnicity at the age 4 interview. They reported household income and number of dependents at each interview between age 4 and age 12. An indicator of whether families’ annual income fell below the federal poverty limit at any interview between ages 4 and 12 was determined by comparing annual income to the federal poverty guidelines during the years the data were collected. Caregivers at the age 12 interview also reported their relationship to the adolescent as well as their family structure.

Adverse Childhood Experiences

A continuous sum score of the number of ACEs adolescents experienced between birth and the age 12 interview was created based on eight indicators (caregiver mental health problem, family member substance use or incarceration, witnessed family violence, child neglect, and physical, sexual, and emotional abuse), consistent with the ACEs survey developed by the Centers for Disease Control and Prevention (CDC; Bynum et al., 2010). Considering a high proportion of families in the present study had unique family structures (e.g., adoptive, relative, or non-relative foster families), we excluded single-caregiver family structure/caregiver divorce or separation as an ACE. Furthermore, we included a single measure of neglect, rather than individual indicators of physical and emotional neglect, consistent with the CDC survey (Bynum et al., 2010). The composite score ranging from zero to eight was constructed from dichotomous indicators of whether adolescents ever experienced each adversity based on all available data. Details about the methods and measures involved in creating the eight indicators can be found in the Supplemental Materials, as well as in previous studies (Morrow & Villodas, 2018).

Conduct Problems

The NIMH Computerized Diagnostic Interview Schedule for Children IV (DISC-IV) was administered to adolescents at the age 14 interview to assess more than 30 psychiatric diagnoses as well as symptoms for each disorder that have occurred in the adolescents over the preceding year using both adolescent and caregiver reports based on the DSM-IV-TR (Shaffer et al., 2004). These symptoms are later derived into symptom counts for each disorder as well as diagnoses when all relevant criteria are met (e.g., Shaffer et al., 2004). The present study utilized the conduct disorder symptom count, which includes a range of behaviors (i.e., aggression toward people or animals, destruction of property, and deceitfulness or theft) that mirror the DSM-IV-TR criteria for Conduct Disorder (American Psychiatric Association, 2000).

Exposure to Community Violence

The History of Witnessed Violence measure (Knight et al., 2008) was administered at the age 16 interviews to assess whether adolescents witnessed any of six items that increase in severity ranging from witnessing someone outside of their family get slapped, kicked, hit with something, or beaten up to witnessing someone outside of their family being killed, raped, or sexually assaulted. The present study utilized a sum of the number of items that adolescents endorsed witnessing at least once to a non-family member.

Caregiver–Adolescent Relationship Quality and Caregiver Involvement

The Quality of Parent–Child Relationship includes 15 items that were adapted from the Add Health Study (Resnick et al., 1997) to measure adolescents’ perception of the quality of their relationship with their caregiver and the level of their recent involvement. It was administered to adolescents at the age 12 interview. Six items assessed various dimensions of relationship quality, including the level of closeness, understanding, trust, shared decision making, caring, and getting along. Items were measured using a 5-point Likert scale ranging from 1 (never/not at all) to 5 (always/very much). Caregiver’s level of recent involvement was assessed with nine items that examined the nature and extent of shared activities in the last month. Involvement items such as “Have you played a sport with (caregiver)?” were rated dichotomously (i.e., 0 = no and 1 = yes). A mean composite score was calculated for relationship quality, and a total composite score was calculated for the overall level of recent involvement. Internal consistency for the relationship quality scale in the current sample at age 12 was good (α = .81), whereas the internal consistency for the caregiver involvement scale in the current sample at age 12 was slightly below the typical threshold considered adequate (α = .68), which is common among formative scales (Polit & Yang, 2016).

Caregiver Knowledge

Adolescents’ perceptions of their caregivers’ knowledge of their daily whereabouts, including who their friends are, what they do during their free time, where they hang out in the afternoons after school and at night, and how they spend their money, was assessed using five items that have been used in previous studies (Laird, et al., 2003). This scale was administered to adolescents at the age 12 interview. Each item was measured using a 3-point scale ranging from 0 (don’t know), 1 (know a little), and 2 (know a lot). A mean score of the five items was calculated, with higher scores indicating higher levels of caregiver knowledge. Internal consistency for the caregiver knowledge scale at the age 12 interview in the current sample was just below the typical threshold considered adequate (α = .69), which is common among scales with very few items (Polit & Yang, 2016).

Data Analysis

Missing data analyses and bivariate correlations were computed in SPSS version 25 (IBM Corp, 2017). All other analyses were performed using Mplus version 8.1.5 (Muthén & Muthén, 2017). Mplus uses Full Information Maximum Likelihood estimation to produce unbiased standard error estimates when data are MCAR by using all available data for each individual. Bivariate correlations among all variables were computed to identify covariates and to confirm hypothesized relationships to be specified in the path models (see Table 2).

Table 2.

Bivariate Correlation for Study Variables of Interest.

Variables	1	2	3	4	5	6	7
1. ACEs (ages 0–12)	—
2. CD symptoms (age 14)	0.13**	—
3. ECV (age 16)	−0.03	0.23**	—
4. C-Y RQ	−0.10**	−0.13**	−0.03	—
5. Caregiver involvement	−0.12**	−0.03	0.09	0.42**	—
6. Caregiver knowledge	−0.08*	−0.13**	−0.11*	0.40**	0.31**	—
7. Youth sex	−0.03	−0.09**	−0.10**	−0.04	0.08*	0.06	—
8. Poverty	0.07**	0.08**	0.11*	0.08	0.05	−0.08*	−0.02

Note. ACEs = Adverse Childhood Experiences; CD = Conduct Disorder; ECV = Exposure to community violence; C-Y RQ = Caregiver–youth relationship quality.

*p < .05; ** p < .01.

Path Analyses

Path models examining the mediation and moderated mediation of the study variables were then tested using a structural equation modeling framework. In addition to the $χ^{2}$ statistic, Mplus provides several alternate indicators of overall model fit, including (a) the Comparative Fit Index (CFI; Bentler, 1990), (b) the Tucker–Lewis Index (TLI; Tucker & Lewis, 1973), (c) the Root Mean Square Error of Approximation (RMSEA; Steiger, 1990), and (d) Standardized Root Mean Residuals (SRMR; Bentler, 1995). Based on recommendations from Hu and Bentler (1999), values greater than .95 indicated acceptable model fit for both the CFI and TLI, and values less than .05 indicated acceptable model fit for the RMSEA and SRMR. The fit of individual paths was determined based on their statistical significance. Standardized path coefficients are presented for each path and can be interpreted using Cohen (1988) recommendations for small (.10), medium (.30), and large (.50) effects. Mediation paths were identified by calculating indirect effects based on the product of the unstandardized path coefficients between the predictor and mediator variables (path a) and the mediator and outcome variables (path b). The significance of indirect effects was determined using bias-corrected bootstrapped confidence intervals (CIs) based on 1000 bootstrapped samples, as recommended by Preacher and Hayes (2008). Participants’ race/ethnicity, sex, and whether households fell below the federal poverty limit were included as covariates. To determine whether the proposed mediation model was moderated by caregiver–adolescent relationship quality, caregiver involvement, or caregiver knowledge, we tested whether the paths between ACEs and conduct problems and ACEs and indirect ECV were moderated by each of these variables (See Figure 1 for Conceptual Model). To do this, we constructed three interaction terms between ACEs and each caregiving variable and tested them simultaneously in a moderated mediation model. Follow-up tests were conducted to probe statistically significant interactions using the Model Constraint command in Mplus to test the significance of the indirect effects at low (minimum value), medium (mean value), and high (maximum value) levels of the significant moderator(s). These values were chosen given the relatively limited range of the moderator value and ensured that the chosen values were real, observed values within our sample (Hayes, 2018).

Figure 1. Conceptual model.

Hypothesed structural path model depicting pathways from ACES to ECV via conduct problems, with proposed moderators caregiver–youth relationship quality, caregiver involvement and caregiver knowledge. RQ = Relationship Quality.

Results

Missing Data

Missing data ranged from 0 to 39% on the measures across the three interviews.

Of the 1137 adolescents included in the present study, 932 (82%) had complete data for at least two of the three interviews. Participants with missing data for at least one wave of data collection did not significantly differ from those with complete data on sex, χ² (1) = 2.17, p = .141, race/ethnicity, χ² (6) = 5.937, p = .430, whether they ever experienced poverty prior to age 12, χ² (1) = .25, p = .615, or ACEs prior to age 12, t (1135) = .08, p = .934. There was no evidence that missingness was associated with any of the study variables, so the data were treated as though they were Missing at Random and Full Information Maximum Likelihood estimation was used, which provides unbiased estimates under this missing data assumption (Enders, 2010)

Bivariate Associations and Descriptive Statistics

Descriptive statistics are presented in Table 1. Bivariate correlations between all study variables are presented in Table 2. At age 14, 60 youth in the sample (5.3%) met clinical criteria for conduct disorder. Females had significantly fewer conduct disorder symptoms, b = −.09, p < .01, whereas adolescents who had ever lived in poverty had significantly more, b = .08, p < .05. Black adolescents were at significantly higher risk of indirect ECV, b = .20, p < .001, and females were at significantly lower risk of indirect ECV, b = −.09, p < .01. While ACEs were not significantly directly correlated with ECV, bivariate correlations confirmed hypothesized relationships in our path model such that ACEs were significantly associated with conduct disorder symptoms (r = .13, p < .01) and conduct disorder symptoms were significantly associated with indirect ECV (r = .23, p < .01). Caregiving variables (i.e., relationship quality, involvement, knowledge) were all significantly associated with one another.

Caregivers and Family Structures

Caregiver reporters were predominantly biological mothers living in a wide range of non-traditional family structures at the age 12 interview. Family structures were classified as single biological parent (57.1%), step/cohabitating caregiver (15.2%), two biological parents (14.8%), or other kin or non-kin caregivers (12.9%) (See Table 1). Family structure was not related to any outcomes and was not a significant covariate so it was not included in our final model.

Mediation Model

The overall model fit the data well, χ² (3) = .23, p = .973, CFI = 1.000, TLI =1.139, RMSEA = 0.000, 90% CI [.000, .000], SRMR = .002. More ACEs at age 12 was not significantly associated with more indirect ECV at age 16, β = −.02, p = .610, 95% CI [−.089, .052]. More ACEs at age 12 was significantly associated with having more conduct disorder symptoms at age 14, β = .12, p < .001, 95% CI [.050, .185]. Having more conduct disorder symptoms at age 14 was significantly associated with more indirect ECV at age 16, β = .22, p < .001, 95% CI [.121, .316]. Although the direct effect of ACEs to witnessing violence (i.e., indirect ECV) was not significant, the indirect effect (i.e., mediation) of ACEs to witnessing violence (i.e., indirect ECV) via conduct disorder symptoms was significant, standardized indirect effect = .03, p = .005, 95% CI [.011, .047]. More ACEs were associated with more conduct disorder symptoms, which were in turn were associated with more witnessing violence. It should be noted an alternative model was considered such that indirect ECV (age 14) may mediate the relationship between ACEs (age 12) and delinquency (age 16), but no key pathways or proposed interactions were significant (see Supplemental Materials).

Moderated Mediation Model

Following the mediation model, the roles of caregiver–adolescent relationship quality, caregiver involvement, and caregiver knowledge were tested as potential moderators. The moderated mediation model also fit the data well (see Figure 2), χ² (3) = 0.23, p = .973, CFI = 1.000, TLI = 1.176, RMSEA = 0.000, 90% CI [.000, .000], SRMR = .001. The path from ACEs to conduct disorder symptoms was significantly moderated by caregiver knowledge, b = −.40, p = .030, 95% CI [−.781, −.041], but not by caregiver–adolescent relationship quality or caregiver involvement. Additionally, the path between ACEs and indirect ECV was significantly moderated by caregiver involvement, b = −.03, p = .033, 95% CI [−.053, −.004], but not by caregiver knowledge or caregiver–adolescent relationship quality. When caregiver knowledge was low, b = .07, p = .012, or moderate, b = .02, p = .001, there was a positive indirect effect from ACEs to witnessing violence (i.e., indirect ECV) via conduct disorder symptoms. In contrast, when caregiver knowledge was high, the indirect effect from ACEs to witnessing violence (i.e., indirect ECV) via conduct disorder symptoms was non-significant, b = .01, p = .263. These findings indicate that for adolescents who reported low and moderate levels of caregiver knowledge, more ACEs at age 12 was related to conduct disorder symptoms at age 14, which was in turn related to more indirect ECV at age 16, but this pathway was not present for adolescents who reported high levels of caregiver knowledge. Further, the direct effect of ACEs on witnessing violence was non-significant when caregiver involvement was low, b = .13, p = .056, or moderate, b = −.03, p = .161. However, when caregiver involvement was high, the direct path between ACEs and witnessing violence (i.e., indirect ECV) was significant and negative, b = −.15, p = .003, indicating that a history of more ACEs at age 12 was related to less indirect ECV at age 16 for adolescents who reported high levels of caregiver involvement.

Figure 2. Moderated mediation model results.

Results of moderated mediation model. Solid black arrows represent significant paths. Dotted gray arrows represent non-significant paths. Caregiver–youth relationship quality was not included in this model for simplicity as it did not significantly moderate any of the paths. β = standardized path coefficient; b = unstandardized path coefficient. *p < .05 **p < .01 *** p < .001.

Discussion

The present study expands on previous literature by prospectively examining the association between ACEs and indirect ECV, as well as crucial individual- and family-level factors that moderate and mediate this relationship in a sample of adolescents identified as being at risk for household dysfunction and maltreatment. Using an Ecological Systems Theory of Development framework (Bronfenbrenner, 1979), we found that adolescents conduct problems mediated the association between ACEs and the increased risk for indirect ECV. However, this pathway was only significant for adolescents who reported low or moderate levels of caregiver knowledge. At high levels of caregiver knowledge, the mediation effect became non-significant. Additionally, although there was generally no significant independent effect of ACEs on indirect ECV, for youth with high caregiver involvement, those with more ACEs had less subsequent indirect ECV. These findings shed light on at-risk adolescents’ path towards indirect ECV and the importance of caregiver protective factors in preventing future violence exposure.

Pathway from Adverse Childhood Experiences to Exposure to Community Violence

Although previous studies have reported that ACEs increase the risk for subsequent ECV (Finkelhor et al., 2007; Lee et al., 2017; van der Feltz-Cornelis et al., 2019; Walling et al., 2011), we did not find evidence of a direct association. The lack of direct association between ACEs and ECV may be partially explained by the focus of the current study on witnessing or indirect ECV. Fagan (2020) found that adolescents experiencing more ACEs had significantly greater likelihood of physical victimization but not witnessing violence. It may be that the trajectory from ACEs to direct ECV versus indirect ECV may differ such that indirect ECV is mediated by conduct problems, as demonstrated in the current study. Additionally, given the age gap between when ACEs (age 12) and indirect ECV (age 16) were measured, the direct relationship may have been weakened by a variety of other factors not tested in the current study (i.e., school climate, neighborhood safety) that have demonstrated benefits for adolescent well-being following ACEs (Moore & Ramirez, 2016).

Despite the lack of a direct relationship, the current study did demonstrate a significant indirect relationship between ACEs and witnessing violence through conduct problems, with modest effect sizes. Although effect sizes were modest, this is likely attributable to the complexity of the model, number of variables involved, and the relatively large time span examined. These findings add substantially to our understanding of the behavioral mechanisms that may explain the documented association between ACEs and indirect ECV. Understanding that conduct problems may act as an intermediary step from ACEs to indirect ECV aligns with much of past theoretical and empirical work (Bernhard et al., 2018), such as general strain theory (Agnew, 1992) and the lifestyle routine and activities theory (Gover, 2004; Lauritsen et al., 1992). Based on these theories and our mediation findings, it appears adolescents who are exposed to family-level adversities (i.e., ACEs) may be driven to engage in more conduct problems. Even at non-clinical levels (i.e., only 5.3% of the sample met clinical cutoff for conduct disorder), these conduct problems likely expose them to risky and dangerous situations in which they may witness or be victimized by community violence. Bronfenbrenner’s (1979) Ecological Systems Theory of Development emphasizes the importance of understanding interactions (directly or indirectly) among individual- (i.e., conduct problems), family- (i.e., ACEs), and community-level factors (i.e., ECV). This study is the first to our knowledge to test the longitudinal relationship between ACEs, conduct problems, and indirect ECV, adding to our understanding of the trajectory of violence exposure for at-risk adolescents.

Protective caregiving factors

Caregiver knowledge and involvement emerged as important factors in the association between ACEs and indirect ECV. Caregivers’ knowledge about their adolescent’s whereabouts, social relationships, and daily activities disrupted the indirect pathway from ACEs to witnessing violence through conduct problems, indicating that when caregiver knowledge was high, there was no association between ACEs and conduct problems, and, thus, no indirect effect of ACEs on witnessing violence. This finding is consistent with well-established literature indicating that caregiver knowledge is associated with lower antisocial behavior (Racz & McMahon, 2011). Our finding expands upon the protective benefits of this relationship as no previous studies have examined the implications of this association for indirect ECV risk. However, the mechanism through which caregiver knowledge mitigates the pathway from ACEs to conduct problems is less apparent. Research suggests it is how parents acquire knowledge about their adolescents that is more influential for the protective value of parenting knowledge than the knowledge itself; indicating child self-disclosure may be more impactful than parental monitoring and solicitation (Kerr & Stattin, 2000; Stattin & Kerr, 2000). Additionally, adolescent self-disclosure increases as a result of positive parent–adolescent dynamics, such as high levels of adolescents’ trust and parenting acceptance (Smetana et al., 2006). Considering parental knowledge in this study was measured through adolescent report, it could be that the protective effect of parent’s knowledge in the relationship between ACEs and conduct problems was the byproduct of increased adolescent self-disclosure, which reflects positive parent–adolescent relationship characteristics, but further research is needed to support this.

Although we expected that higher levels of caregiver involvement would attenuate the association between ACEs and indirect ECV, we instead found that among adolescents with caregivers who were highly involved in their lives, there was a significant negative relationship between ACEs and indirect ECV, such that more ACEs were associated with less indirect ECV. Also, unexpectedly, for adolescents with low or medium levels of caregiver involvement, there was no direct relationship between ACEs and indirect ECV. It is possible that caregivers who are more engaged in their adolescent’s activities take extra precautions to protect them from future risk (e.g., ECV), especially when their adolescents have already experienced a higher level of ACEs. This finding is complementary to a past study that highlighted the role of family functioning, including high caregiver involvement, in preventing ethnic minority adolescents from subsequent direct and indirect ECV (Gorman-Smith et al., 2004). It was more surprising, however, that ACEs were not directly associated with ECV among adolescents who reported lower levels of caregiver involvement, as this association has been previously demonstrated (Loeber & Stouthamer-Loeber, 1986). It is possible that this association is primarily indirect and better accounted for by mediating processes (e.g., development of conduct problems).

It should be noted that the association between ACEs and adolescents’ subsequent conduct disorder symptoms was not moderated by caregiver involvement. This is contrary to past findings on the protective effect of caregiver involvement on adolescent conduct problems (Loeber & Stouthamer-Loeber, 1986). However, considering our ultimate aim was to understand protective factors that could reduce the risk of additional trauma/adversity through indirect ECV for adolescents with ACEs, caregiver involvement showed a significant role in decreasing the risk for indirect ECV, especially for adolescents with more ACEs who are at greater risk of violence exposure and other negative outcomes (Finkelhor et al., 2007; Hughes et al., 2017; van der Feltz-Cornelis et al., 2019). The association between ACEs and adolescents’ subsequent conduct disorder symptoms was also not moderated by caregiver–adolescent relationship quality. This was surprising given that caregiver–adolescent relationship quality has been used as an additional indicator of emotional involvement (Wenk et al., 1994), and research has indicated lower levels of relationship quality can strongly exacerbate risk of conduct problems (Keijsers et al., 2011). It is possible that our measurements of caregiver involvement and knowledge adequately captured active aspects of overall caregiver–adolescent relationship quality, and that the remaining variance in relationship quality did not overlap strongly enough to independently moderate the association. Future research should continue to examine aspects of caregiving factors, such as the impact of sources of caregiver knowledge, as well as distinguishing between the protective benefit of emotional versus activity involvement.

Taken together, having a caregiver who was more knowledgeable about their adolescent and actively involved in their adolescent’s activities was protective against indirect ECV among adolescents with ACEs. While there is some evidence from low-risk samples that caregiver over-involvement can have negative effects on adolescent mental health (Stattin & Kerr, 2000; Willoughby & Hamza, 2011), our findings suggest that among high-risk families, caregivers’ active efforts in communicating and engaging with adolescents can be imperative to reduce risk of future adversity and trauma exposure.

Limitations

These findings should be viewed within the context of certain limitations. Although the longitudinal design adds strengths, given this study did not use an experimental design, causal claims cannot be made. This sample is a particularly high-risk group and results may not generalize to families in the broader U.S. population. While research does not indicate the measures used in the current study are inappropriate for diverse samples, they may lack cultural relevance or fail to capture specific aspects of parenting in families of color. Racial socialization, for instance, is the process by which parents teach children about one’s race within a society (Coard & Sellers, 2005) and is a salient aspect of parenting, particularly among Black families (Tang et al., 2016). Therefore, future studies should utilize measures that include and prioritize culturally relevant aspects of parenting, which could shed more light on protective factors utilized by parents of color. Additionally, adolescents’ self-report of conduct problems may have been underreported for social desirability. Although our measurement of caregiver involvement is considered valid, it fails to capture certain other types of caregiver involvement, such as time spent doing activities together within the home or talking about non–school-related topics. Additionally, the current study examined witnessing (i.e., indirect victimization) community violence but not direct victimization by community violence. Although research indicates indirect ECV has similar detrimental effects on adolescents as direct ECV (Zimmerman & Posick, 2016), future studies seeking to further understand the association between ACEs and community violence overall may include measures of direct victimization.

Importantly, though the present study focused on understanding the relationship between a family-level risk (e.g., ACEs) and protective factors (i.e., caregiver knowledge and involvement) on indirect ECV, it is crucial to highlight that other community and societal factors (e.g., systemic racism, police brutality, poverty, access to social services) are especially relevant for understanding risk for indirect ECV. Furthermore, the protective caregiving factors in this study cannot be promoted without simultaneously addressing inequitable access to resources that affect marginalized families’ well-being (Shonkoff et al., 2021). Adolescents of color are at increased risk of exposure to ACEs, delinquency, and witnessing violence—undoubtedly a reflection of the socioeconomic, political, and environmental barriers that face marginalized adolescents (Shonkoff et al., 2021). That being said, non-White adolescents are not a monolith, and unique cultural contexts specific to Black, Latinx, and/or White youth could impact the associations identified here. For example, research on a parent-centered intervention for reducing adolescent behavior problems suggests that certain aspects of the parent–adolescent relationship (i.e., communication, monitoring) may be particularly important among Latinx families, whose cultural values prioritize familismo (Pantin et al., 2009). It is vital that future research explore these and other moderating factors.

The high rate of poverty in the current sample is also crucial for contextualizing our findings and is intertwined with the racial and ethnic disparities mentioned above (Shonkoff et al., 2021). For example, caregivers of adolescents in poverty are more likely to have irregular work schedules contributing to reduced parental monitoring (Hsueh & Yoshikawa, 2007). Poverty also exacerbates risk through parental stress which may influence negative parent–child interactions, experiences that are highly predictive of children’s conduct problems (Morelli et al., 2020). Poverty represents a perilous context that increases risk for the adverse outcomes explored in this study, both directly and indirectly. Consistent with Ecological Systems Theory of Development (Bronfenbrenner, 1979), future studies should be conducted to examine interactions between social determinants of health at the systemic, community, and family level in order to shape interventions and policies that address families’ needs, utilizing cultural humility and working toward justice and equity.

Implications

Despite these limitations, our findings provide promising implications for efforts to reduce risk of violence exposure for adolescents who are already at heightened risk due to past adverse experiences. First, this study provides evidence for a pathway from ACEs to indirect ECV through adolescent conduct problems. Given this pathway, prevention programs focused on behavior among adolescents exposed to ACEs could be useful for mitigating risk for indirect ECV. Our findings also suggest that bolstering family-level factors, specifically caregiver knowledge, could mitigate risk for conduct problems, in turn attenuating risk for indirect ECV. Many established caregiver-focused interventions for adolescent conduct problems, such as different iterations of parent management training (Kazdin, 2010), emphasize the importance of caregivers’ efforts to monitor and supervise their adolescents, as well as the strategies that build open and effective communication channels between caregivers and their adolescents. These strategies have also been integrated in prevention frameworks. For example, the Adolescent Transitions Program was designed as a school-based intervention program for at-risk youth, providing intervention at universal (i.e., family resource center), selected (i.e., FCU), and indicated (e.g., family-focused interventions, PMT) levels (Dishion & Kavanagh, 2003) This model successfully reduced adolescent substance use risk and the interaction effects were notably mediated by caregiver knowledge of their adolescents’ whereabouts, peers, and activities. Also of note, these caregiver-focused intervention strategies often emphasize the importance of caregiver involvement in adolescents’ lives, which the present study also found to be protective against indirect ECV risk. A focus on these protective caregiving factors (i.e., caregiver knowledge and involvement) for adolescents with ACEs could reduce further traumatization. Furthermore, our findings support the necessity of effective prevention and early intervention to help mitigate the effects of ACEs on adolescents. Finally, this study supports the necessity for community programs and policies that address multiple levels of socio-ecological stressors facing families and affecting youth development, as well as access to effective context-relevant interventions to support caregivers.

Conclusion

Indirect ECV threatens the healthy development of adolescents. For those with ACEs, this exposure can add to traumatization and exacerbate maladaptive outcomes (Dahlberg & Mercy, 2009; Fowler et al., 2009; Turner et al., 2010). This study contributes to the literature on indirect ECV in adolescents by identifying an underlying mechanism of conduct problems, which helps explain the longitudinal trajectory from ACEs to future indirect ECV. Using an Ecological Systems Theory of Development framework (Bronfenbrenner, 1979), our findings revealed a pathway from ACEs to indirect ECV that was mediated by adolescent conduct problems. Findings also demonstrate the protective benefit of caregiver knowledge in disrupting this pathway for adolescents with ACEs, reducing risk of future conduct problems, and in turn ECV risk. Additionally, when adolescents reported high caregiver involvement, more ACEs were linked to less indirect ECV, indicating that caregiver involvement is another important protective factor for adolescents with high levels of ACEs. Overall, this study is the first to our knowledge to longitudinally test the link between ACEs and indirect ECV via conduct problems and provides evidence of the importance of caregiving factors in protecting at-risk adolescents from future traumatization through witnessing violence. Programs that aim to reduce the risk for indirect ECV among adolescents at-risk for adversity should include supportive caregiver intervention strategies that assist caregiver involvement and knowledge about their adolescent to foster healthy behavioral development, particularly following exposure to ACEs.

Supplemental Material

sj-pdf-1-jiv-10.1177_08862605221081932 – Supplemental Material for Conduct Problems As a Pathway From Childhood Adversity to Community Violence Exposure: The Protective Roles of Caregiver Knowledge and Involvement

Supplemental Material, sj-pdf-1-jiv-10.1177_08862605221081932 for Conduct Problems As a Pathway From Childhood Adversity to Community Violence Exposure: The Protective Roles of Caregiver Knowledge and Involvement by Meghan C. Evans, Jacqueline B. Duong, Nicholas M. Morelli and Kajung Hong, Claire Voss, Lucybel Mendez, Jackelyne Garcia, Xavier Elzie and Miguel T. Villodas in Journal of Interpersonal Violence

Footnotes

Author’s Note

The Consortium for Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) was supported by grants from the Children’s Bureau, Office on Child Abuse and Neglect, and Administration for Children, Youth, and Families. The authors would like to acknowledge all of the LONGSCAN principal investigators, coordinating center, and study staff. We would also like to thank the youth and families of the LONGSCAN study for providing their time and valuable information. The authors declare that they have no conflicts of interest.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Meghan C. Evans

Jacqueline B. Duong

Supplemental material

Supplemental material for this article is available online.

Author Biographies

Meghan C. Evans is a clinical psychology doctoral student in the Counseling, Clinical, and School Psychology Doctoral Program at University of California, Santa Barbara. Her current research interests include utilizing community-based participatory methods to partner with marginalized communities and increase access to and quality of strength-based interventions for youth and families exposed to trauma, violence, and ACEs.

Jacqueline B. Duong is a doctoral student in the Clinical Science in Child and Adolescent Psychology Doctoral Program at Florida International University. Her research interests include examining the mechanisms underlying intergenerational transmission of trauma and resilience as well as how risk and resilience factors vary cross-culturally.

Nicholas M. Morelli is a doctoral student in the Clinical Psychology Joint Doctoral Program at San Diego State University/University of California, San Diego. He is interested in how exposure to trauma affects child development, as well as the development and implementation of psychosocial interventions that aim to reduce trauma-specific symptomatology and promote well-being among families.

Kajung Hong is a doctoral student in the Clinical Psychology Joint Doctoral Program at San Diego State University/University of California, San Diego. She is interested in understanding how maltreatment history affects one’s psychological functioning and parenting behaviors. She is also interested in developing parenting interventions to foster sensitive caregiving by understanding protective and risk factors for coping with maltreatment experiences.

Claire Voss is a post-baccalaureate research assistant in the Department of Psychology at San Diego State University. Her research interests include the interplay between childhood trauma, technology, and mental health. She is interested in examining the use of technological interventions to promote well-being.

Lucybel Mendez is a doctoral student in the Clinical Psychology doctoral program at University of Utah. Her research focuses on understanding the relationship between child maltreatment and subsequent maladaptation, such as juvenile delinquency. She is interested in the risk and protective mechanisms related to this developmental pathway and how culture contributes to the development or absence of psychopathology.

Jackelyne Garcia is a Masters student in the Department of Psychology at San Diego State University. She is broadly interested in understanding and minimizing racial/ethnic disparities in access to mental health through culturally sensitive empirical research on underrepresented populations. She is also interested in further examining risk and protective factors through an ecological perspective.

Xavier Elzie is a Masters student in the Department of Psychology at San Diego State University. He is interested in examining parental factors, specifically aspects of fathering, that influence developmental outcomes for children who have experienced or at heightened risk for trauma exposure. He is also interested in the development and implementation of interventions that address childhood trauma and adversity.

Miguel T. Villodas, PhD, is an Assistant Professor in the Department of Psychology at San Diego State University and an affiliated investigator with the Child and Adolescent Services Research Center. He conducts research on the promotion of mental health and well-being among Black and Latinx communities by using quantitative methods to characterize how adversity affects development and adapting/enhancing psychosocial interventions.

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