Witnessing a violent death and smoking, alcohol consumption, and marijuana use among adolescents

Background: Witnessing violence has been linked to maladaptive coping behaviors such as smoking, alcohol consumption, and marijuana use. However, more research is required to identify mechanisms in which witnessing violence leads to these behaviors. Purpose: To examine the association between witnessing a violent death and smoking, alcohol consumption, and marijuana use among adolescents; To identify whether depression was a mediator within this relationship; To determine if those who had adult support in school were less likely to engage in risky health behaviors. Methods: Data were collected from a sample of 1,878 urban students, from 18 public high schools participating in the 2008 Boston Youth Survey. In 2012, we used multilevel log-binomial regression models and propensity score matching to estimate the association between witnessing a violent death and the smoking, alcohol consumption, and marijuana-use. Results: Analyses indicated that girls who witnessed a violent death were more likely to smoke (RR=1.06, 95% CI=1.00,1.12) consume alcohol (RR=1.08, 95% CI=0.98,1.18) and use marijuana (RR=1.09, 95% CI=1.02, 1.17). Among boys, those who witnessed a violent death were significantly more likely to smoke (RR=1.23, 95% CI=1.14,1.33), consume alcohol (RR=1.30, 95% CI=1.17,1.44), and use marijuana (RR=1.35, 95% CI=1.23, 1.48). When depression was included, estimates were attenuated. Among girls who witnessed a violent death, having an adult at school for support was protective against alcohol consumption. When we used Propensity Score Matching, findings were similar among boys only. Conclusion: This study adds insight into how witnessing violence can lead to adoption of adverse health behaviors.