Factors associated with externalized anger among early adolescents in rural Appalachia: A conceptual proposition with implications for violence prevention.

Adolescent violence is understudied as a public health challenge for rural adolescents. Anger expression, also referred to as externalized anger, is a risk factor for adolescent violent behavior. Survey data from 1649 early adolescents in the Young Mountaineer Health Study (YMHS) cohort were used to identify correlates of externalized anger drawing on an adapted socioecological model. Correlates examined included: Relative family income; family affluence; neighborhood characteristics (safety, ties, collective efficacy); family living arrangements; social support from adults at home and school; and harsh parenting. Gender was utilized as an effect modifier. We employed two Poisson regression models for main effects and gender interaction effects. Parameter estimates were exponentiated and interpreted as Rate Ratios (RR). Significant main effects included perceived neighborhood safety (RR = 0.98, 95 % CI = 0.97-0.99), support from adults at home (RR = 0.98, 95 % CI = 0.97-0.99) and school (RR = 0.99, 95 % CI = 0.98-0.99), and harsh parenting (RR = 1.06, 95 % CI = 1.05-1.07). Several gender differences emerged in the interaction model. Boys reported significantly lower anger compared to girls (RR = 0.90, 95 % CI = 0.86-0.94). In the gender-based interaction model harsh parenting was more strongly associated with externalized anger among boys (RR = 1.03, 95 % CI = 1.01-1.06). Implications are discussed for future research on the relationship between externalized anger and violence prevention among rural adolescents.