Community and society factors .1 Social inequality and deprivation

There are strong relationships between violence and social inequality and deprivation. The rates of emergency hospital admissions for assault are around four times higher among people 10–29 years old in England who live in the most deprived areas than among those who live in the least deprived areas (unpublished Hospital Episode Statistics, routine analysis from the Centre for Public Health, Liverpool John Moores University, 2010) (Fig. 3.2).

Similar trends are seen among children 0–14 years old, showing that relationships between social deprivation and violence can be established very early in life (117).

In Scotland, death rates for assaults involving sharp weapons are significantly elevated among individuals from the most deprived areas compared with those from the least deprived areas (118). In Israel, students in schools with a high proportion of students from socioeconomically deprived families have been found to be more likely to carry knives (6). However, a study in Sweden found that area-level measures of socioeconomic deprivation

were not independently associated with violent injury in children and adolescents but that high concentrations of social benefit recipients were (119). Here, receiving social benefits was explained as being likely to reflect a clustering of health and psychosocial problems.

Several studies have found income inequality to be more important in predicting violence than overall poverty levels, with studies finding homicide rates increasing along with the magnitude of income differences between those with high income and those with low income (120–122). Such relationships are thought to be linked to factors such as poor social trust and relationships in unequal societies (see section 3.4.4). A study across 33 countries, including many in the European Region, found correlations between income inequality and both homicide and social capital (interpersonal trust) and suggested that societies with substantial income inequality and low societal trust may lack the social capacity needed to develop safe communities (123). Analysis of the Health Behaviour in School-aged Children survey covering 37 (mostly European Region) countries has also shown associations between country-level income inequality and school bullying (124).

38 3. Risk factors for violence among young people and violence using knives

3.4.2 Alcohol availability

Easy access to alcohol can contribute to violence among young people. For example, high densities of alcohol outlets have been associated with increased violence in several countries (125).

In Norway, the increasing density of alcohol outlets (number of public drinking premises per 10 000 inhabitants) between 1960 and 1995 was associated with growing numbers of violent crimes investigated by the police. An increase of one alcohol outlet corresponded to an increase of 0.9 assaults investigated each year (126).

Few studies have explored the influence of the actual volume of alcohol sold in communities on violence or the role of alcohol availability on knife-related violence. However, in Canada, the risk of hospitalization due to an assault involving a sharp or blunt weapon increased with the volume of alcohol sold in local stores (127).

Certain environmental factors in drinking environments can also contribute to increased aggression and violence. Studies have associated factors such as crowding, promotion of inexpensive drinks, tolerance of antisocial behaviour, poor cleanliness, loud music and poor staff practices with violence and other alcohol-related problems in drinking premises (128).

Fig. 3.2. Emergency hospital admissions for assault in England, 2004/2005 to 2008/2009: crude rate per 100 000 residents aged 10–29 years by deprivation quintile

Source: unpublished Hospital Episode Statistics, routine analysis from the Centre for Public Health, Liverpool John Moores University, 2010.

Armenia

2004/2005 2005/2006 2006/2007 2007/2008 2008/2009 Emergency hospital admissions for assault per 100 000 residents aged 10–29 years

Year

2001/2002 2002/2003 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 2008/2009

Homicides per million population

Year

Sharp-weapon homicides, victims ≤19 years Sharp-weapon homicides, victims ≥20 years Firearm homicides, victims ≤19 years Firearm homicides, victims≥20 years 0

1995 1997 1999 2001 2003 2005 2008

Prevalence (%)

Year

Perpretrator Carrying a knife Used weapon in assault Being a victim of assault

2.8

1998 2005 1998 2005 1998 2005 1998 2006 1998 2008 1998 2008 1999 2007 1998 2008 1998 2005 1998 2005 1998 2005 1998 2006 1998 2008 1998 2008 1999 2007 1998 2008

Percentage Committed at least

one assault in the last 12 months norms of masculinity

Sex:

Stuttgart Hannover Kiel Hamburg Rostock Leipzig Stuttgart Hannover Kiel Hamburg Rostock Leipzig

Perpetrators Victims

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Less severe assaults per 100 000 of age group

1200.0

0–13 14–17 18–20 21–24 25–29 30+

More severe assaults per 100 000 of age group

Deprivation quintile:

3. Risk factors for violence among young people and violence using knives 39

3.4.3 Illicit drug trade

Violence can be a systemic part of the illicit drug trade, used for purposes such as solving disputes, sanctioning informers, eliminating rivals and punishing debtors (129,130). Thus, the presence of illicit drug trade, and particularly involvement in drug markets, is associated with both violence and weapon-carrying (130–137).

In the United States of America, the introduction of crack cocaine into metropolitan areas was found to have contributed to increased assault and homicide, which later declined as drug market activity declined (131,138–140). A study of drug markets in London found that violence was commonly used to enforce drug debt payments, with the highest levels of violence occurring in large inner-city drug markets that featured transient populations, unstable buyer–seller relationships and high competition (130).

A study of 14- to 17-year-old detainees in Canada, the Netherlands and the United States of America found that those involved in selling drugs reported greater involvement in violence as a perpetrator than as a victim while selling drugs. One quarter had been injured or assaulted and robbed by someone while selling drugs in the previous year, and almost half had inflicted injury or assault and robbery on someone else. Two thirds reported having carried or used a weapon while selling drugs (140).

3.4.4 Urban and community environments

Young people living in urban areas tend to be at increased risk of violence and knife-related violence (23,141–143). In Sweden, for example, the incidence of stab wounds has been associated with densely populated counties (144), while in England, increases in hospital-treated knife assaults between 1994 and 2008 disproportionately affected urban residents (22). However, some studies in the United States of America have found that young people in rural areas have an equal or even increased risk of carrying weapons (25,145).

The reasons for weapon-carrying are likely to differ between rural and urban areas.

Community disorganization, low levels of neighbourhood resources and low social capital (such as poor social cohesion and a lack of trust among community members) can be important contributors to violence among young people (107,146,147). Country-level data from the International Self-report Delinquency Study found that neighbourhood problems (such as delinquency, drug dealing and graffiti) were strongly associated with violence among young people (32). In the United States of America, low social support, including from teachers, classmates, friends and parents, has been associated with an increased risk of weapon-carrying (147). Also in the United States of America, the risk of being involved in violence at age 18 years increased when young people were exposed to community risk factors in adolescence, including community disorganization, the availability of drugs and the presence of crime-involved adults in the community (148). Exposure to and fear of violence in the community has been found to increase the risk of weapon-carrying, with one study in the United States of America finding that, the more fearful students were of other people living in their neighbourhood, the more likely they were to carry a weapon (149). A different study in the United States of America found significant relationships between exposure to community violence and weapon ownership among at-risk young people. Here, each increase on a scale measuring participants’ frequency of exposure to community violence (such as hearing gunshots, seeing drug deals and seeing someone beaten up, shot or stabbed) increased participants’

likelihood of owning a weapon (97). In this study, neighbourhood disadvantage was not significantly associated with weapon ownership.

40 3. Risk factors for violence among young people and violence using knives

3.4.5 School environment

The environment of schools that children attend can influence their behaviour and risk of involvement in violence among young people.

Children with negative perceptions of the school climate (such as student behaviour and teacher control) and less attachment to school can be at greater risk of exposure to violence and weapon-carrying (15,67,150). In Israel, having a negative perception of school policy has been associated with carrying a knife to school (6), while young men carrying a weapon in Switzerland who had used their weapon in a fight were more likely to report poor attachment to school (9).

In the United States of America, social disorganization at the school level, including high student–teacher ratios and suspension rates, has been associated with bullying (151). Students in Switzerland aged 16–20 years in vocational schools (versus other schools) and in classrooms with higher levels of violence and antisocial behaviour among fellow students (versus lower levels) were more likely to have been involved in violence themselves in the previous 12 months (152). One study in the United States of America found that students who had seen other students carrying knives at school were more fearful of being stabbed at school (153). However, those who thought it was easy to carry a knife to school were no more likely to be fearful about being stabbed at school.

The authors suggested that students’ knowledge of weapon-carrying in school could therefore be more important in influencing their fear of violence than their perceptions of school security measures.

3.4.6 Institutional environments

Children and young people living in institutional settings may be particularly vulnerable to violence among young people. A study of children living in residential care homes in the United Kingdom found that most of those surveyed had suffered verbal attacks by peers, and almost half had been victims of physical attacks or attacks on their property (154). Children who are referred to

residential care homes have often suffered adverse childhood experiences, making them vulnerable to involvement in violence among young people as both victims and perpetrators (see Box 3.3).

Factors that have been identified as contributing to peer violence in residential care home settings include a lack of clear aims and objectives, an inability to meet the needs of young residents, a lack of control over referrals and inadequate admission processes and an acceptance of macho and hierarchical cultures (154). Such cultures can also affect other institutional settings, such as boarding schools and military academies.

3.4.7 Availability of weapons

The availability of weapons in households or communities can make them easily accessible to young people. Studies of availability of firearms have shown that countries or states with less restrictive policies on firearms and higher ownership of firearms tend to experience higher levels of firearm-related violence (155–157).

Having easy access to a gun has been associated with weapon-carrying among young males in the United States of America (158). Although few studies have explored the effects of knife availability, a large, national study of male army recruits in Switzerland (aged 20 years) found that the prevalence of self-reported injury-causing violence in the past 12 months increased from 1.5% among those who owned no knives to 4.6%

among those who owned one or two knives and 8.9% among those who owned three or more knives. Similar increases were seen according to ownership of other weapon types (8). Perceptions of widespread knife availability and carrying in the community can also contribute to weapon-carrying by encouraging young people to carry knives as a form of protection (159).

3.4.8 Women and gender inequality

Although women are less likely to be involved in violence among young people per se, they can be at increased risk of being victims of certain types of violence, particularly intimate partner violence and

3. Risk factors for violence among young people and violence using knives 41 sexual violence. International studies have found

that violence against women can be increased in societies in which women have less economic and social power or in which male superiority is accepted and violence tolerated (1). Studies in the United States of America have shown that female adolescents and young adults who report less power within intimate relationships experience higher levels of dating violence (160,161). Few studies have explored the role of gender in knife-related violence. However, qualitative research within the United Kingdom has suggested that young “girlfriends” and other female associates (such as sisters) of violent gang members can often be exploited, including being subjected to physical and sexual abuse by partners and other gang members (162,163).

3.4.9 Social and cultural norms supportive of violence

Social and cultural norms that are tolerant of violence, for example by endorsing violence as a normal method of resolving conflict or punishing a child, can support and reinforce violence in society (1). Young people can learn social tolerance towards violent behaviour in childhood, for example through the use of corporal punishment (164) or witnessing family and other forms of violence (see section 3.2.6) (165,166). In the United States of America, adolescents who perceive their parents as having attitudes supportive of violence (68) have shown higher levels of aggression and weapon-carrying (72,102). Children who live in communities with high levels of crime, gang involvement and drug-dealing can also be sensitized to these problems and the violence associated with them (see section 3.4.4) (107).

For many years there has been a scientific and public debate about whether consuming mass-media products portraying violence influences actual violence. Although evidence for such an effect from violent movies is ambiguous, for violent video games a meta-analysis of more than 130 studies strongly suggested that exposure to such games is a causal risk factor for increased aggressive behaviour, aggressive cognition and

aggressive affect and for decreased empathy and prosocial behaviour (167). In a study in Germany, exposure to violent video games at around age 13 years predicted involvement in physical violence 30 months later (168). One possible explanation for this effect is that playing violent video games is more interactive than watching films.

3.5 Factors protecting against violence among