Consequences of Exposure to War Violence: Discriminating Those with Heightened Risk for Aggression from Those with Heightened Risk for Post-Traumatic Stress Symptoms.

Chronic exposure to ethnic-political and war violence has deleterious effects throughout childhood. Some youths exposed to war violence are more likely to act aggressively afterwards, and some are more likely to experience post-traumatic stress symptoms (PTS symptoms). However, the concordance of these two outcomes is not strong, and it is unclear what discriminates between those who are at more risk for one or the other. Drawing on prior research on desensitization and arousal and on recent social-cognitive theorizing about how high anxious arousal to violence can inhibit aggression, we hypothesized that those who characteristically experience higher anxious arousal when exposed to violence should display a lower increase in aggression after exposure to war violence but the same or a higher increase in PTS symptoms compared to those low in anxious arousal. To test this hypothesis, we analyzed data from our 4-wave longitudinal interview study of 1051 Israeli and Palestinian youths (ages at Wave 1 ranged from 8 to 14, and at Wave 4 from 15-22). We used the 4 waves of data on aggression, PTS symptoms, and exposure to war violence, along with additional data collected during Wave 4 on the anxious arousal participants experienced while watching a very violent film unrelated to war violence (N = 337). Longitudinal analyses revealed that exposure to war violence significantly increased both the risk of subsequent aggression and PTS symptoms. However, anxious arousal in response to seeing the unrelated violent film (measured from skin conductance and self-reports of anxiety) moderated the relation between exposure to war violence and subsequent psychological and behavioral outcomes. Those who experienced greater anxious arousal while watching the violent film showed a weaker positive relation between amount of exposure to war violence and aggression toward their peers but a stronger positive relation between amount of exposure to war violence and PTS symptoms.

Serious violent behavior and antisocial outcomes as consequences of exposure to ethnic-political conflict and violence among Israeli and Palestinian youth.

We examine whether cumulative-past and concurrent exposure to ethnic-political violence among Israeli and Palestinian youth predict serious violent behavior and antisocial outcomes toward the in-group and the out-group. We collected four waves of data from 162 Israeli Jewish and 400 Palestinian youths (three age cohorts: 8, 11, and 14 years old) and their parents. The first three waves were consecutive annual assessments, and the fourth was conducted 4 years after the third wave, when the three age cohorts were 14, 17, and 20 years old, respectively. Based on social-cognitive-ecological models of the development of aggression (Dubow et al., 2009, Clinical Child and Family Psychology Review, 12, 113-126; Huesmann, 1998) and models of the development of beliefs about the "other," (Bar-Tal, 2004, European Journal of Social Psychology, 34, 677-701; Tajfel & Turner, 1986), we predicted that serious violent outcomes directed toward both the in-group and the out-group would be related to both concurrent and to persistent-past exposure to ethnic political violence. Bivariate regression models (prior to including covariates) indicated that both early cumulative exposure to ethnic-political violence during childhood and adolescence and concurrent exposure during late adolescence/early adulthood predicted all six serious violent and antisocial outcomes. When we added to the models the covariates of ethnic subgroup, age, sex, parents' education, and youths' prior physical aggression, concurrent exposure to ethnic-political violence was still significantly associated with a greater likelihood of concurrently perpetrating all six serious violent and nonviolent forms of antisocial behavior, and earlier cumulative exposure remained significantly related to three of these: severe physical aggression, participating in violent demonstrations, and our overall index of violent/antisocial behavior.

Factors related to negative feelings experienced by emergency department patients and accompanying persons: an Israeli study.

BACKGROUND: Studies on hospital violence have emphasized the importance of staff- service recipient interaction in leading to violent incidents. These incidents are the extreme result of service recipients' frustration and anger in their interaction with staff. The aim of this study was to analyze factors related to negative experiences of emergency department (ED) patients and accompanying persons in Israeli hospitals. METHODS: Structured interviews with 692 participants in seven major general Israeli hospitals: 322 patients and 370 accompanying persons. RESULTS: Negative feelings while in the ED were reported by 23.6% of patients and 20.5% of accompanying persons. Eight aggregate variables relating to staff-patients/accompanying persons interaction were identified: 1. General attitudes of staff and quality of ED experience; 2. Staff attitudes towards patients; 3. Staff attitudes towards accompanying persons; 4. Waiting; 5. Quality of perceived medical care; 6. Information provided to patients and accompanying persons; 7. Information provided to patients, as reported by accompanying persons; and 8. Severity of medical problem. Among patients, the only significant aggregate variable related to anger and frustration was perceived quality of care. Among accompanying persons, the three significant contributors to negative feelings were: 1. Staff's general attitudes; 2. Attitudes towards patients; and 3. Severity of patients' medical problem. Analysis of specific items within the variables revealed that, whereas patients' negative feelings were related to nurses' perceived negative attitudes those of accompanying persons were related to the doctors' perceived negative attitudes. In addition, patients' negative feelings were related to low severity of medical problem, whereas accompanying persons' negative feelings were related to patients' low severity of pain. CONCLUSIONS: The study reveals the importance of including both patients and accompanying persons in the analysis of staff-service recipient interactions in EDs. The results are discussed in terms of patients' and accompanying persons' different perspectives. Three practical implications of the results are put forward, aiming at reducing patients/accompanying persons-staff frictions in the EDs, thus decreasing the potential of violent outbursts against ED staff: (1) implementing a framework based on "patient-centeredness" for the restoration of patient's sense of agency and empowerment; (2) broadening the scope of laws concerning patient's rights to include their families and other accompanying persons; and (3) implementing courses on interpersonal and human service skills, as well as teaching skills of handling emotional stressors experienced by both the staff and service recipients.

Children's exposure to violent political conflict stimulates aggression at peers by increasing emotional distress, aggressive script rehearsal, and normative beliefs favoring aggression.

We examine the hypothesis that children's exposure to ethnic-political conflict and violence over the course of a year stimulates their increased aggression toward their own in-group peers in subsequent years. In addition, we examine what social cognitive and emotional processes mediate these effects and how these effects are moderated by gender, age, and ethnic group. To accomplish these aims, we collected three waves of data from 901 Israeli and 600 Palestinian youths (three age cohorts: 8, 11, and 14 years old) and their parents at 1-year intervals. Exposure to ethnic-political violence was correlated with aggression at in-group peers among all age cohorts. Using a cross-lagged structural equation model from Year 1 to Year 3, we found that the relation between exposure and aggression is more plausibly due to exposure to ethnic-political violence stimulating later aggression at peers than vice versa, and this effect was not moderated significantly by gender, age cohort, or ethnic group. Using three-wave structural equation models, we then showed that this effect was significantly mediated by changes in normative beliefs about aggression, aggressive script rehearsal, and emotional distress produced by the exposure. Again the best fitting model did not allow for moderation by gender, age cohort, or ethnic group. The findings are consistent with recent theorizing that exposure to violence leads to changes both in emotional processes promoting aggression and in the acquisition through observational learning of social cognitions promoting aggression.

The Longitudinal Effects of Chronic Mediated Exposure to Political Violence on Ideological Beliefs About Political Conflicts Among Youths.

This study examines the effects of chronic (i.e., repeated and cumulative) mediated exposure to political violence on ideological beliefs regarding political conflict. It centers on these effects on young viewers, from preadolescents to adolescents. Ideological beliefs refers here to support of war, perception of threat to one's nation, and normative beliefs concerning aggression toward the out-group. A longitudinal study was conducted on a sample of Israeli and Palestinian youths who experience the Israeli-Palestinian conflict firsthand (N = 1,207). Two alternative hypotheses were tested: that chronic exposure via the media increases support for war and aggression and elevates feeling of threat, or that chronic exposure via the media strengthens preexisting beliefs. Results demonstrated that higher levels of exposure were longitudinally related to stronger support for war. Regarding normative beliefs about aggression and threat to one's nation, mediated exposure reinforced initial beliefs, rendering the youths more extreme in their attitudes. These results mostly support the conceptualization of the relation between media violence and behaviors as "reciprocally determined" or "reinforcing spirals." The results are also discussed in light of the differences found between the effect of exposure to political violence firsthand and exposure via the media.

The Effects of Mediated Exposure to Ethnic-Political Violence on Middle East Youth's Subsequent Post-Traumatic Stress Symptoms and Aggressive Behavior.

This study introduces the concept of chronic (i.e., repeated and cumulative) mediated exposure to political violence and investigates its effects on aggressive behavior and post-traumatic stress (PTS) symptoms in young viewers. Embracing the risk-matrix approach, these effects are studied alongside other childhood risk factors that influence maladjustment. A longitudinal study was conducted on a sample of youth who experience the Israeli-Palestinian conflict firsthand (N = 1,207). As hypothesized, higher levels of chronic mediated exposure were longitudinally related to higher levels of PTS symptoms and aggression at peers independently of exposure to violence in other contexts. In the case of aggressive behavior, structural equation analysis (SEM) analyses suggest that, while it is likely there are causal effects in both directions, the bigger effect is probably for exposure to violence stimulating aggression than for aggression stimulating exposure to violence. Both the longitudinal effects on aggression and PTS symptoms were especially strong among youth who demonstrated initially higher levels of the same type of maladjustment. These results support the conceptualization of the relation between media violence and behaviors as "reciprocally determined" or "downward spirals" and highlight the contribution of the risk-matrix approach to the analysis of childhood maladjustment.

Exposure to violence across the social ecosystem and the development of aggression: a test of ecological theory in the Israeli-Palestinian conflict.

Bronfenbrenner's (1979) ecological model proposes that events in higher order social ecosystems should influence human development through their impact on events in lower order social ecosystems. This proposition was tested with respect to ecological violence and the development of children's aggression via analyses of 3 waves of data (1 wave yearly for 3 years) from 3 age cohorts (starting ages: 8, 11, and 14) representing three populations in the Middle East: Palestinians (N = 600), Israeli Jews (N = 451), and Israeli Arabs (N = 450). Results supported a hypothesized model in which ethnopolitical violence increases community, family, and school violence and children's aggression. Findings are discussed with respect to ecological and observational learning perspectives on the development of aggressive behavior.

Personnel exposure to violence in hospital emergency wards: a routine activity approach.

This study analyzes violence against personnel in the emergency wards of all 25 general hospitals in Israel using a self-report questionnaire (N=2,356). Informed by the routine activity theory, the hypotheses related to the major concepts of this approach: exposure, target suitability, guarding and proximity to offenders. A General Exposure to Violence Index (GEVI) was constructed, based on the participants' reports about type and frequency of their victimization to violence during the preceding year. The multiple regression analysis for explaining the GEVI was composed of 15 independent variables relating to participants' professional and personal characteristics as well as to structural features of hospitals. As predicted, higher exposure to violence was related to security or nursing staff and positions of authority; high weekly workload; working in a profession other than that of training; inability of coping with verbal violence; having no access to an emergency button, and working in settings restricting the number of accompanying persons to one only. Unexpectedly, previous training in coping with violence was related to higher victimization. Younger age, male gender and being of European/American origin (mainly from the former Soviet Union) was also related to higher risk of victimization. The results support the utility of the routine activities approach in explaining differences in emergency ward personnel victimization. The findings also indicate, however, the need to add domain-specific contextual analyses to this approach to reach a fuller understanding of the behaviors under discussion. Implications of the finding to coping with violence against emergency ward personnel are discussed, and suggestions are put forward for further study in this field.