Physical fighting among Egyptian adolescents: social and demographic correlates among a nationally representative sample

Introduction

Interpersonal violence among adolescents has become an increasingly important global public health concern in recent years (Sugimoto-Matsuda & Braun, 2013). Nearly one third of adolescents from North America and Europe reported being in a physical fight within a year to a year and a half prior to being surveyed (Eaton et al., 2012; Walsh et al., 2013), and in the Middle East and Sub-Saharan Africa, more than half of adolescents report involvement in physical fighting (Gofin, Palti & Mandel, 2000; Rudatsikira et al., 2007). Prevalence rates of physical fighting and other forms of interpersonal violence in low- and middle-income countries–particularly those experiencing social and political unrest–remain elevated and, in some instances, are increasing (Krug et al., 2002). In response to this concerning trend, there has been a call for concerted public health efforts to reduce violence among adolescents worldwide (Krug et al., 2002; OECD, 2011).

One component of these efforts has included research aimed at discerning individual and social factors associated with adolescent involvement in violent behavior. From this research, several common risk factors have been determined, among them including drug, alcohol or tobacco use; poor behavior control; emotional distress; and poor parental supervision/involvement (DHHS, 2001). The majority of this research, however, has been conducted with adolescent samples from high-income countries leaving important knowledge gaps in low- and middle-income country settings (LMIC).

Additionally, not all adolescents exhibit violent behavior, indicating that there may be other, micro-level factors that are exerting influence either as risk or protective factors. A better understanding of individual and social correlates of violence among adolescents in LMICs is important to violence prevention in these countries. With rates of non-fatal injuries resulting from violent behavior starting to increase during mid-adolescence (age 14 years) and violence peaking during late adolescence (Odero & Kibosia, 1995; Butchart, Kruger & Nell, 1997; DHHS, 2001), violence prevention programs geared towards adolescents are critical to protecting the well-being of this demographic.

The present study reports the results of analyses conducted on data collected from a school-based survey administered to Egyptian adolescents. Epidemiologic data on individual and social correlates of physical violence in Egyptian adolescents is limited (Youssef, Attia & Kamel, 1999; Ez-Elarab et al., 2007). We sought to add to the existing literature on youth violence in Egypt by examining physical fighting among Egyptian adolescents. The aims of the study were twofold: (1) to determine which individual and social factors were associated with an increased likelihood of adolescents participating in physical fights and (2) whether the presence of known protective factors mediated involvement in physical fighting.

Methods

Results

Within the recall period, 31% (n = 1, 593) of participants reported being involved in two or more physical fights, a majority of which were males (67%). The mean age of the sample was 13.2 years old (SD = 0.95). Thirty-two percent of respondents reported signs of depression, with 10% indicating loneliness and 10% percent anxiety. Food insecurity was found in 5.4% of the sample and more than half (53%) of all participants reported being bullied during three or more days during the recent 30-day period.

Table 2 shows the crude distribution of selected factors according to physical fighting category. The bivariate analyses revealed that within all but three of the selected variables, significant differences existed between participants who had been involved in physical fights and those who were not. No significant differences existed with regard to food insecurity among the physical fighting categories or physical activity.

Table 3 shows the distribution of variables by sex. The age and sex adjusted analysis (Table 4) revealed significant associations for all selected variables with the exception of age, social network variables and physical activity. As in the model which adjusted for all covariates, female sex (OR = 0.41; CI = 0.36–0.46) and having helpful peers (OR = 0.63; CI = 0.54–0.74) were associated with fewer reports of fighting activity. Having understanding parents (OR = 0.67; CI = 0.56–0.81) was found to be significantly protective. None of the social network variables were found to be associated with fighting behavior. As in the previous model being bullied, loneliness, anxiety, signs of depression, truancy and sedentary behavior were associated with higher rates of fighting.

After adjusting for all associated covariates in the first model (Table 5), and compared to those who did not report being involved in physical fighting, those who had been involved in physical fights were younger (OR = 0.90; CI = 0.84–0.97) and less likely to be male (OR = 0.38; 0.32–0.43). Being bullied was significantly associated with an increase in fighting involvement (OR = 2.44; CI = 2.12–2.83) as was missing days of school (OR = 1.26; CI = 1.05–1.52). Those who reported signs of depression were also more likely to have reported being involved in fighting behavior (OR = 1.29; CI = 1.11–1.50). Having fewer close friends appeared to indicate an effect which was protective, but the result was only statistically significant for those who reported having only one friend (OR = 0.75; CI = 0.60–0.92). Having helpful peers in school (OR = 0.75; CI = 0.62–0.90) had a protective effect while sedentary behaviors (OR = 1.43; CI = 1.21–1.69) were positively associated with being involved in fighting behavior.

Discussion

The present study contributes to knowledge on the subject of youth violence among Egyptian youth by examining social and demographic correlates for physical fighting. Study findings may be particularly useful and timely within the context of recent political changes in Egypt and the surrounding region; the charged atmospheres that accompany political revolutions and lack of safety measures in schools may exacerbate existing youth violence, likely making it an emergent public health issue in the region.

Overall our analyses yielded results that coincide with previously known risk and protective factors for youth involvement in interpersonal violence. Additionally, the reported prevalence rate of physical fighting among our sample of Egyptian adolescents (31%) was similar to reported rates in high-income (Eaton et al., 2012; Fraga et al., 2011) and other low- and middle-income countries globally (Alikasifoglu et al., 2004; Rudatsikira, Muula & Siziya, 2008). Well-studied risk factors such as signs of depression, truancy, and bullying victimization were associated with involvement in physical fighting in our sample of Egyptian adolescents. The commonly and globally observed trend of males being more involved in physical fighting was also found in our study (Sousa et al., 2010; Walsh et al., 2013). Protective factors such as understanding parents and helpful peers were also found to be significant for Egyptian adolescents. Two of our findings were notable for their novelty within the context of the more researched risk and protective factors for youth violence.

The finding of sedentary behavior’s association with involvement in physical fighting adds to a small body of literature on physical activity and sedentary behavior and their effect on violent behavior in youth (Nelson & Gordon-Larsen, 2006; Iannotti et al., 2009; Morris & Johnson, 2010). As evidenced by the paucity of extant literature on the topic, the association between level of physical activity and involvement in physical fighting has not been extensively researched, but repeated significant findings among these handfuls of studies suggest this potential risk factor may deserve more attention from public health researchers.

Of particular importance is determining what about sedentary behavior contributes to violent behavior. Current hypotheses center on the type of sedentary activities youth are engaging in, with emphasis on video and computer gaming. Exposure to video or computer games with violent content has been linked to aggression (Anderson, 2004). Gaming, however, is not as ubiquitous in Egypt as it is in high-income countries; the high prices of gaming consoles and games make them unattainable to the majority of the population: access is often limited to public gaming centers (Garratt, 2012). Therefore, the gaming hypothesis is likely irrelevant to Egyptian youth. A more likely explanation for this correlation in Egyptian adolescents lies in the current political situation in Egypt. The contentious and highly-charged political atmosphere could be forcing sedentary behavior upon this age group: studies show that adolescents living in areas characterized by turmoil are more likely to engage in sedentary behavior (Kim et al., 2010; Carson & Janssen, 2012). While this does not explain the nature of the interaction between sedentary behavior and physical fighting, it does provide a potential starting point for addressing this behavior in Egyptian adolescents in a culturally-sensitive manner, most notably creating opportunities for adolescents to engage in appropriate physical activities in a safe environment.

The protective effect of having fewer friends–and, more specifically, having only one friend–seems counterintuitive, especially considering that loneliness (also a symptom of depression) was found to be associated with increased likelihood of participating in physical fighting in our sample. However, perhaps having fewer friends, and thus, a smaller social circle, reduces the likelihood of youth becoming exposed to other youth who may be involved in risky and delinquent behaviors; associating with delinquent peers is a known risk factor for youth violence (Haynie, 2001; Haynie, 2002). Another explanation for this finding could be the quality of the youths’ friendships: fewer, but more supportive and exemplary friends could have a more positive effect on youth than a wider yet less meaningful social network.

While not a specific aim of the present study, the high rates of reported signs of depression and bullying victimization give cause for considerable concern, particularly since both were found to be strongly associated in our sample–at all levels of analysis–for involvement in physical fighting. An explanation for the high rates of reported signs of depression could be that most Egyptian adolescents are without hope for a bright future with appropriate education, descent work and marriage opportunities. Our findings would suggest that culturally-appropriate tertiary interventions designed to alleviate depressive symptoms and help adolescents cope with bullying victimization may help reduce the likelihood of involvement in physical fighting. In conjunction with these efforts, primary and secondary prevention programs designed to prevent and reduce bullying would be advantageous as well and most likely create supportive school environments; this may increase the likelihood of having helpful peers, which was an observed protective factor for involvement in physical fighting.

Conclusions

Little is known about the epidemiology of youth violence in Egypt. Our research adds insight into this public health issue, reporting trends in physical fighting among Egyptian adolescents. Prevalence rates appear to be similar to those reported in high-income countries and other low- and middle-income countries. The well-known risk factors of depression and bullying victimization are prominent among Egyptian adolescents; while the lesser understood risk factor of sedentary behavior is present as well. Protective factors center on social aspects such as understanding parents and helpful peers. Interventions aimed at attenuating depressive symptomatology and creating supportive school environments, as well as providing access to physical activities in a safe environment, may help reduce the prevalence of violent behavior in Egyptian adolescents.