"You get caught up": The role of opportunity in decision-making around youth violence

Background: Violent injury represents a major cause of morbidity and mortality among adolescents and young adults. Methods: We employed a community-based participatory research (CBPR) approach and the photovoice method to enhance understanding of violent behaviors among youth at high risk of involvement in violence. Using a problem tree analysis technique, youth participants at high risk of involvement in violence identified roots of violence as topics for photo-taking and focus group discussion. Our team of university and community partners analyzed the qualitative data using the constant comparative method. Results: Participants' discussions reflect four themes: 1) Youth negotiate typical tasks of adolescent development and desire respect; 2) Youth recognize pervasive risks to their safety within their communities; 3) Youth describe both limited availability of safe and healthy opportunities as well as extensive availability of unsafe and unhealthy opportunities in their social and economic context; 4) As youth consider how to achieve respect in an unsafe setting with limited opportunities, they express ambivalence concerning choices and health behaviors. Conclusions: While participants understand the health and safety risks associated with some opportunities for respect present in their lives, they recognize that many achieve peer-group respect through involvement in unsafe or unhealthy behavior and perceive limited alternative opportunities to gain respect. Healthy alternative opportunities must compete with the Street as means of achieving respect and financial independence for youth at risk of violence.