Cumulative Exposure to Violence in Adolescence Predicts Substance Use, Psychological Distress and High-Risk Weapon Carriage in Emerging Adulthood

Introduction: Weapon-related violence is a major U.S. public health problem. Of the 4,797 homicides occurring among youth (ages 14-24) in 2015, 87% resulted from firearms and 7% resulted from penetrating knife injuries. Early exposure to violence (ETV) is associated with a variety of negative sequelae later in life, but is a less-documented corollary of weapon carriage. Theories of weapon carriage posit that previously victimized youth may be more inclined to carry weapons following their violence exposure due to their increased risk for other consequences of violence exposure, such as depression and, particularly, substance use. We examined associations between adolescent ETV and the likelihood of weapon carriage during emerging adulthood, while considering mediating pathways and modifiers.

Methods: Five hundred sixty-six participants (83.9% African American; 54.9% female) completed annual surveys over eight waves (M_ages 14.8-17.9 and 20.1-23.1). We first examine direct effects of adolescent ETV, baseline controls and demographic covariates on the probability of engaging in weapon carriage (gun/knife/other weapon) at M_age 23.1. Next, we examine the indirect effect of ETV on weapon carriage through psychological distress and alcohol/marijuana use (AOD) during emerging adulthood. Finally, we introduced sex as a moderator of the indirect effects for psychological distress and AOD use.

Results: In a main effects model (i.e., excluding mediators), adolescent ETV was associated with higher odds of weapons carriage in emerging adulthood (O.R.=1.80, C.I.[1.19, 2.74]). Males reported more carriage (O.R.=2.94, C.I.[1.91, 4.54]), but carriage was not associated with race, age or baseline AOD, psychological distress, or adolescent carriage. A parallel mediation model revealed that emerging adult psychological distress (b_PD=0.57, CI [0.13, 1.01]) and AOD (b_AOD=0.19, CI [0.12, 0.27]) were each positively associated with weapons carriage and fully mediated the effect of adolescent ETV (Ind_{ETV->PD->Carriage}=0.15, C.I.[0.04, 0.31] and Ind_{ETV->AOD->Carriage}=0.16, C.I.[0.06, 0.31], respectively) such that ETV increased levels of psychological distress and AOD, which in turn predicted greater odds of weapons carriage. Tests of moderated mediation revealed that sex moderated the indirect effect of substance use (b=-0.18, C.I.[-0.40, -0.03]) in that females approached the carriage rates of males only when reporting the highest rates of substance use.

Conclusions: Researchers report a variety of correlates with weapons carriage behavior later in life (e.g., exposure to violence/weapons; sex; substance use; mental health; access to weapons), yet specific pathways to weapons carriage are difficult to examine. In addition to interventions designed to reduce early exposure, the results support AOD and mental health-focused interventions for exposed youth. In particular, young women with a history of exposure may be at greatest risk for later weapons carriage when their substance use is high. Example weapons carriage intervention strategies are discussed.