Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Public Health

Major Professor

Karen Liller, Ph.D.

Co-Major Professor

Martha Coulter, Dr.PH.

Committee Member

Henian Chen, Ph.D., M.D.

Committee Member

Dinorah Martinez Tyson, Ph.D.

Committee Member

Abraham Salinas-Miranda, Ph.D., M.D.


Photovoice, Structural Equation Modeling, Syndemic Theory, Violence


Introduction: Youth perceived safety is not only linked to crime and violence in a neighborhood but is also associated with health risk behaviors and certain neighborhood characteristics. The purpose of this mixed-methods study was to measure the co-occurring effects of individual and community risk factors by conducting a secondary data analysis using structural equation modeling (SEM) and to explore reasons for youth feeling safe/unsafe in their community using photovoice methodology.

Methods: Syndemic theory/model served as the theoretical framework to guide this mixed-methods study with a convergent parallel design. The quantitative strand (first manuscript) utilized an existing dataset collected from middle and high students in Florida (N=25,147). A total of four SEM models were conceptualized based on syndemic theory and analyzed in Mplus 8 using weighted least squares (WLS) estimation to assess how individual and community risk factors mutually affect youth’s perceived safety. The measurement of the first three SEM models was based on confirmative factor analysis (CFA), while the final model was built on a second-order factor analysis. Each model’s goodness of fit was assessed.

For the qualitative strand (second manuscript), photovoice was used, with a training session, two photo-taking sessions, and two follow-up photo discussions. Recruitment was conducted online through social media and in-person through community-based agencies and flyer posting. All participants (N=6), aged 12-18, chose to use their personal phones for photo taking instead of disposable cameras. Photo discussion and analysis were guided by the revised SHOWeD framework.

Results: Based on the quantitative results, 7.3% of youth reported to feel unsafe in their community while 92.7% reported safe or somewhat safe. Alcohol use was the most frequently reported individual risk behavior (26.5%), while drug selling (20.7%) and drug use/addiction (20.3%) were most likely to be considered as large problems in the youth’s neighborhoods. The initial SEM model did not indicate a good fit of the data. Models 2 and 3 fit the data well but were not statistically appropriate. The final model not only indicated a good fit of the data, but also properly handled the measurement errors of all indicators and more importantly identified a theorized construct of a syndemic factor underlying two latent sub-constructs with a second order factor analysis. In the final SEM model, the syndemic factor that represented all individual and community risk indicators had a very strong negative correlation with youth’s safety perceptions (β=-0.98).

For the photovoice findings, a total of 120 photos were collected from six youth participants, with 64 photos illustrating safe perceptions, 54 showing unsafe feelings, and two addressing both safe and unsafe feelings. The reasons that made youth feel safe included safe physical environments and community cohesion, family cohesion and home security system, traffic safety, and public safety. The unsafe themes included traffic concerns, bad community environments, human trafficking, kidnapping, sexual offenders, gun-related concerns, school bullying, hacking, and hurricanes.

In this study, the quantitative results provided evidence on the interconnections among factors at a population level, while the qualitative findings explored multiple reasons for youth feeling safe or unsafe. Qualitative findings and quantitative results were integrated in the data interpretation and report writing to provide a holistic insight into youth perceived safety.

Conclusions: Multiple individual risk factors and disadvantaged community conditions interact with each other and mutually affect youth’s perceptions of community safety. By exploring the reasons for youth feeling safe/unsafe in their community and identifying interconnections, this study will help to develop more comprehensive strategies to improve perceived safety for children and adolescents.

Public Health Implications: This mixed-method study provides implications for violence prevention and safety promotion, from the perspectives of individuals and communities. Future research should include comprehensive strategies focused on the interconnected risk factors to gain maximum prevention effects and therefore, improve youth’s perceived safety. Furthermore, public health polices and related service programs aiming to reduce targeted risk factors should be developed in order to prevent violence and improve community safety.