Witnessing Community Violence, Gun Carrying, and Associations with Substance Use and Suicide Risk Among High School Students — Youth Risk Behavior Survey, United States, 2021

Discussion

Approximately one in five high school students ever witnessed community violence, and 3.5% of high school students carried a gun during the previous 12 months. Witnessing community violence and gun carrying were associated with student substance use and suicide risk. These findings were consistent with other studies indicating associations between witnessing community violence and gun carrying and increased risk for suicide, substance use, and other adverse health outcomes (3,4).

Community violence has been described as an adverse childhood experience (ACE), and both ACE exposure and witnessing community violence have been associated with weapon carrying (5). Previous research has demonstrated that young persons might carry weapons for self-defense to protect against future violence, particularly when they have been directly victimized or perceive high levels of community violence (5). The overall prevalence of witnessing community violence and gun carrying, as well as the statistically significant differences by race and ethnicity and sex highlight the need to implement comprehensive evidence-based prevention strategies in locations that are disproportionately affected by violence.

Findings from the 2021 YRBS indicate that students from most racial and ethnic minority groups were more likely to witness community violence and to report gun carrying than their White peers. The differential exposure by race and ethnicity might increase disparities in other types of morbidity and mortality from substance use or other health outcomes (e.g., chronic disease) because of stress and adversity. Racial and ethnic minorities experience higher rates of violence, which have been explained by discrimination and racism, concentrated poverty, high crime rates, and economic or residential instability (7).

Furthermore, findings revealed a substantially higher prevalence of community violence exposure among students who carried a gun compared with those who did not. Gun carrying might be associated with experiences of racism, discrimination, feeling the need to protect oneself because of increased exposure to community violence, mistrust in the criminal justice and other government systems, and poor or inadequate community-level protective factors (5). Results also showed differences in exposure to community violence for youths who identified as lesbian, gay, or bisexual. These youths were more likely to witness community violence than those identifying as heterosexual. Sexual minority youths have been found to be at greater risk for substance use, suicide risk, and victimization (8). These factors might create an environment where sexual minority students are more likely to witness interpersonal violence because they often are the victim (9).

This report also found important associations between witnessing community violence, substance use, and suicide risk. Youths who witnessed community violence were more likely to report carrying a gun, considering or attempting suicide, and engaging in current and lifetime substance use behavior compared with youths who had not witnessed it. Witnessing community violence, particularly repeatedly, has been associated with poor mental health, including posttraumatic stress disorder (PTSD) and major depression, with greater exposures to traumatic events increasing the likelihood of PTSD (10,11). Exposure to ACEs, which includes polyvictimization (i.e., exposure to multiple types of violence) is associated with increased risk for short- and long-term mental and physical health problems, including suicide risk, risky sexual behaviors, and substance use disorders, and increased risk for early death (12).

Addressing risk and protective factors common to multiple forms of violence and substance use might be an effective and efficient way to prevent violence. Family-based strategies include promoting home environments that support healthy development through parenting skill and relationship programs (https://www.cdc.gov/violenceprevention/communicationresources/pub/technical-packages.html#technicalPackages). Multiple community-level, evidence-based strategies for preventing youth violence include modifying physical environments (e.g., mitigating abandoned housing), engaging youths through street outreach, mentoring programs, and changing community norms (https://www.cdc.gov/violenceprevention/communicationresources/pub/technical-packages.html#technicalPackages).

Schools offer a unique opportunity to help reduce youth violence. Schools have direct contact with approximately 50 million students for at least 6 hours a day over a 13-year period and have a role in promoting social, physical, and intellectual development (https://nces.ed.gov/programs/digest/d20/tables/dt20_103.20.asp?current). School-based violence prevention programs typically focus on skill-building to solve problems nonviolently, conflict resolution, and emotional control. Environmental school strategies include those that increase youths’ feelings of connectedness to the school environment and to school staff and prosocial peers. Youths who report feeling connected to school are less likely to engage in violent behaviors and substance use and are more likely to report positive mental health or well-being (13,14). CDC’s What Works in Schools approach includes a safe and supportive environments strategy (https://www.cdc.gov/healthyyouth/whatworks/what-works-safe-and-supportive-environments.htm) to help students feel more connected to trusted adults at school and at home. Connectedness is a protective factor that might help prevent or reduce substance use, poor mental health, violence, and suicide.

The community and social context is important for the implementation of violence prevention efforts. For example, across communities and other settings, protective factors include youths’ feeling connected to persons in these settings, and having safe spaces where they can talk with trusted adults might promote healthy development and buffer the potentially negative influence of other risks (5). However, building connectedness might be challenging when structural inequities such as racism and discrimination are pervasive, and disadvantaged youths are most at risk for experiencing violence. Knowledge gaps remain about how to best address structural inequities (i.e., discrimination and economic adversity) that drive disparities in violence. Strategies such as tax credits for families with children, safe and affordable housing, paid parental leave, livable wages, and economic support for developmentally appropriate child care might help mitigate certain inequities (https://www.cdc.gov/violenceprevention/communicationresources/pub/technical-packages.html#technicalPackages).

Another important approach to reducing the number of suicides and other types of violent deaths is mitigating access to lethal means among those at risk for harming themselves or others. For example, recent reviews suggest that counseling paired with the provision of a safety device can increase secure storage of firearms and that child access prevention laws have been associated with lower rates of youth firearm self-injury, including suicide (14,15). Additional research could strengthen and guide programs, policies, and practices for the primary prevention of violence, suicide, and substance use.