Little research has explored youth retaliatory attitudes in relation to future aggressive behavior. Our study found that assault-injured youth who endorsed retaliatory attitudes at baseline reported more aggression and fighting over time. There were significant relationships between retaliatory attitudes and subsequent aggression and fighting. This suggests that retaliatory attitudes may lead youth to be vigilant or “on guard” resulting in further aggressive behavior. Our findings are consistent with the hypothesis that retaliatory attitudes fuel cycles of youth violence and may promote rumination in youths who endorse retaliatory attitudes. This has implications for identifying high risk youth for prevention efforts.
Endorsing retaliatory attitudes may be related to youths' ability to cope with social uncertainty and threat. Emotional and behavioral self-regulation are well-established risk factors for aggressive behavior.22,23
Specifically, two correlated constructs: irritability and hostile rumination have been proposed to describe the relationship between emotional regulation and behavior responses to perceived threat. Irritability is the tendency to react impulsively at the slightest frustration, whereas hostile rumination is defined as “the tendency to store ill feelings, attributions and desires for vengeance after provocation”.24
Retaliatory attitudes may be more closely related to hostile rumination, whereas irritability may moderate the relationship between retaliatory attitudes and aggression.
Moffitt's developmental taxonomy of antisocial behavior proposes two trajectories – life-course-persistent (LCP) and adolescence-limited (AL).25
In the LCP trajectory, antisocial and violent behavior develops during childhood and persists through adolescence into adulthood, whereas in the AL trajectory youth experiment with antisocial behavior in adolescence which abates in young adulthood. Our study results suggest that identifying youths who endorse retaliatory attitudes may be one strategy for identifying those who are likely to embark on more aggressive developmental trajectories over time including increased aggression and fighting frequency. The fact that there was no association between retaliatory attitudes and weapon-carrying is not surprising since weapon-carrying may be an act of aggression or self-protection.
Our study findings inform intervention and areas for further study. Assault-injury may result from victimization or perpetration and retaliatory attitudes may be related to reactive or proactive aggression. Intervention strategies to prevent youth assault-related injuries may differ based on retaliatory attitudes in this context. Reactive perpetration has been linked to peer rejection, while proactive perpetration is unrelated to victimization.26
Thus, prevention strategies for reactive perpetration might focus on adaptive social behavior and problem solving, while those aimed at preventing proactive perpetration might focus on alternatives to violence. In addition, retaliatory attitudes may be reinforced by parents, peers and the environmental context in which youths develop9, 27
. Thus, efforts to change them may need to incorporate parent, peer and community interventions as well.
Medical professionals in acute care or other settings have an opportunity to identify youths at risk of future assault injury by talking with youths about their fighting history, retaliatory plans, and providing relevant anticipatory guidance (e.g., particularly about avoiding weapon use, and augmenting resilience factors).28
The American Academy of Pediatrics has recommended a system of identification, assessment, and treatment of assault victims in the health care setting in order to reduce the risk of retaliation and reinjury.29
This may include screening for access to guns in the home and other risk factors related to violence, as well as linking youths to intervention and follow-up services. In keeping with the AAP recommendation, this research identifies specific assessment domains (questions regarding attitudes toward retaliation) that may identify youth at highest risk for future aggression.
The emergency department is uniquely positioned to identify and to initiate interventions with assault-injured youth. It has been suggested that the ED provider should 1) identify and assess violently injured youths for risk for retaliatory violence and potential for re-injury or violence-related death and 2) provide youth and their families linkages to counseling services or other resources to prevent future violence.30
Though screening tools have been proposed to assess risk for future injury, there has been little research on predictive validity and none have focused on retaliatory attitudes.30
Finally, while there is a strong evidence base for youth violence prevention outside of the health care setting, there is growing literature on youth violence prevention initiated in the ED. Two recent reviews of youth violence secondary prevention initiatives suggest the potential of case management and brief counseling interventions in reducing future injury and criminal involvement.30, 31
Evidence-based intervention may be best targeted to individuals with retaliatory attitudes, as this study demonstrates their heightened risk for future aggression.
Our study sample represents one ethnic group and the youth were recruited from two hospitals in urban areas. Therefore, these findings may not generalize to youth who represent other ethnic groups and who live in non-urban areas. Another limitation of this study includes the use of youth self-report. We could only evaluate self-reported aggressive tendencies and episodes of aggressive behavior. Individuals who are aggressive may associate with aggressive peers, or live in social contexts where violent or aggressive behavior is common. Given these benchmarks, these individuals may not rate their own behavior as being particularly aggressive. Thus, “objective” behavioral assessments of aggressive behavior or likelihood to respond aggressively may prove informative. We observed that the relationship between retaliatory attitudes and assault-related injury approached statistical significance. Since injury is a relatively rare event, we may not have adequate power to discern a significant relationship. In addition, whether one is injured in a fight may have as much to do with the behavior and characteristics of others in the altercation (e.g., weapon involvement, number of individuals involved) as with the respondent's behavior and attitudes. Finally, the median time between discharge from the ED and enrollment in the study was 51 days. This time span may have impacted responses, particularly those related to retaliatory attitudes. However, it is likely that the delay between injury and enrollment may contribute to an underestimate of the impact of retaliatory attitudes on subsequent violent behavior.
This study demonstrates that endorsing higher levels of retaliatory attitudes at baseline are associated with more aggression and higher frequency of fighting over time. This has important implications for identifying particularly high risk youth for prevention efforts and guiding intervention strategies. Understanding what distinguishes youths who hold retaliatory attitudes is a key aspect of designing interventions to prevent assault injuries.