Heather Champion
Robert Sege
Violence is a pervasive problem in American society. Adolescents are particularly likely to be affected by interpersonal violence, as victim, perpetrator, and witness. Despite the welcome decline in the incidence of fatal youth violence since the peak rates of the mid-1990s, recent mortality data still show that homicide and suicide cause more deaths than all natural causes combined among children older than 1 year. Homicide is the second leading cause of death among young people aged 10 to 24 years overall, and is the leading cause of death for African-Americans in this age-group. Violence takes many forms including homicide, physical assault, and other violent crimes, sexual assault, battering in intimate relationships, and suicide. This chapter focuses on interpersonal violence.
Violent behavior is a complex phenomenon that is stimulated by multiple individual, family, community, and societal factors including gender, exposure to violence, and neighborhood disorganization. The most common misconception is that intentional violence is a premeditated event that randomly affects people unknown to the assailant. The opposite is true, with most violent encounters being impulsive acts occurring among friends and acquaintances and within families. Therefore, the distinction between victim and perpetrator is not always apparent. Among males of all ethnic groups, the most common relationship between offender and victim is that of a friend or acquaintance. In approximately 25% of youth homicides, the victim is the initiator of violence. Emergency Department based studies in Boston, Philadelphia, and Washington DC all demonstrated that most violence-related injuries that required medical treatments were the results of arguments between young people who knew each other. For adolescent female victims, the most common perpetrator is a boyfriend, mirroring the situation for female adults, for whom the most common perpetrator is a family member or intimate partner. Ninety percent of female homicide victims are murdered by males.
The consequences of violent behavior are made more lethal by the presence of a firearm, particularly a handgun. Violence results in death, disability, emotional trauma, and tremendous financial cost for our society. Its presence affects all of us, both as citizens and health care providers, and confronts health care providers with particular challenges. This chapter outlines the epidemiology, etiology, risk and protective factors, prevention strategies, and clinical implications of interpersonal violence.
Epidemiology
Homicide
The United States has the highest homicide rate in the world among industrialized countries. The homicide rate for youth aged 18 to 24 years dropped from 25.7 per 100,000 in 1993 to 15.5 per 100,000 in 1999 with a further reduction to 14.72 per 100,000 in 2004 (Table 77.1) (Web-based Injury Statistics Query and Reporting System [WISQARS], www.cdc.gov/ncipc/wisqars). Of particular significance, the homicide rate for African-American males aged 18 to 24 years, the highest risk group for death from homicide, dropped from 191.7 per 100,000 in 1993 to 106.8 per 100,000 in 1999 with a further reduction to 97.01 per 100,000 in 2004. The rate of homicides for juveniles 14–17 also fell from a high of 13.3 per 100,000 in 1993 to 5.1 per 100,000 in 2004.
By 2004, the juvenile arrest rate for homicide fell by 77%, reaching the lowest level since the 1960s. In 2004, juveniles were involved in 5% of murder arrests, involving 1,110 young people, one third the number arrested in 1993. Despite this significant downward trend in homicide rates after 10 years of increasing rates, homicide is the second leading cause of death among 15- to 19-year-olds and the leading cause of death among black youth. The United States is the only industrialized country to have a homicide rate of >5 per 100,000 among young men (age 16–24 years); many countries have a rate <1 per 100,000. In 2004, 5,292 youth aged 10 to 24 were murdered, with 80% being killed with firearms. The Department of Justice reports that youth aged 12 to 17 years were twice as likely as adults to be victims of serious violent crime and 3 times as likely to be victims of simple assault (Snyder and Sickmund, 1999).
Teenage males outnumber females as victims of homicide by a factor of >6:1. Young males are more likely to be victims of violent crimes of all categories, except sexual assault and intimate partner violence. Ninety-four percent of youth younger than 18 years who are convicted of murder are males. Of the 5,292 homicides reported in the 10 to 24 age-group in 2004, 85% (4,518) were males and 15% (774) were females.
Physical Assault and Other Violent Crime
The 2005 Centers for Disease Control's (CDC's) National Youth Risk Behavior Survey (YRBS) has consistently
P.985
found that one third of male high school students (35.9%) had been in one or more physical fights during the previous 12 months. Fights were more common among adolescent boys than adolescent girls (43% versus 28%). Rates were higher among black (43%) and Hispanic (41%) males than whites (33%). Almost 4% of students reported receiving medical attention (which may have been a school nurse) for injuries sustained during a fight.
|
TABLE 77.1 |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
After a decade long rise in crime from 1983 to 1994, in 2004, the tenth consecutive year of decline, arrests for serious violent crimes (murder, forcible rape, robbery, and aggravated assault) were reduced by 48% (Snyder, 2006). Despite the drop in arrest rates and self-reported rates for homicide, robbery, and rape, arrest rates for aggravated assault remained high at almost 70% above the 1983 level. The arrest rates for simple assault increased from 106% for males and 290% for females from 1980 to 2004.
According to the National Crime Victimization Survey, in 1998 among 12- to 19-year-olds, 1 per 150 was the victim of a robbery, 1 in 13 was the victim of a violent crime, 1 in 16 was the victim of an assault, and 1 in 76 the victim of aggravated assault (Criminal Victimization in the U.S., 2001). Ethnic discrepancies exist for nonlethal violent crime victimization as well. Forty-two per 1,000 Blacks and 32 per 1,000 whites reported experiencing violent crimes in 1999. Native Americans experienced violent crime at more than twice the national average.
Sexual Assault
Female adolescents have the highest risk of any age-group for being subjected to sexual assault. According to a recent CDC study, approximately 9% of women and 1.9% of men report being sexually assaulted before 18 years of age (Tjaden and Thoennes, 2000). The 2005 YRBS found female students (11%) more likely to have been forced to have sexual intercourse compared to male students (4%). Rates of forced sex were higher among black (9%) students than white (7%) students.
Dating Violence
The 2005 YRBS reports that in the 12 months preceding the survey, 9% of students nationwide had been hit, slapped, or physically hurt on purpose by a boyfriend, girlfriend, or date. The prevalence of dating violence was higher among black (12%) students than Hispanic (10%) or white (8%) students. Rates among males and females were comparable within race/ethnicity. Most survey studies conducted in the last decade indicate that males report being victims about as frequently or more than females (Malik et al., 1997), but that females are at increased risk for more severe injuries.
Suicide
In the 12 months preceding the 2005 YRBS, 13% of students nationwide reported a plan to attempt suicide and 8% reported an attempted suicide. Overall, the prevalence of having made a suicide plan was higher among white
P.986
and Hispanic students than black students (13%, 15%, and 10%, respectively). Completed suicide rates among adolescents are highly correlated with household handgun ownership rates.
Risk Factors Associated with Violence
Several key risk factors for violence and violence-related injuries have been identified. They are complex, interdependent, and influenced by individual, family, and societal variables and include access to firearms and weapon carrying; gang involvement; exposure to violence at home including violent discipline; domestic violence and child abuse; and exposure to media violence, alcohol, and other drug use.
In 2004, 6,540 youths aged 15 to 24 were involved in firearm-related deaths, a decline of over 44% since 1994. Among 15- to 24-year-olds, there were 4,127 homicides using a firearm, 2,104 suicides using a firearm, and 172 accidental firearm deaths (WISQARS). In 2004, 80.6% of homicide victims aged 10 to 24 were killed with a firearm.
Carrying of weapons increases the risk of violent behavior and violence-related injury by providing a false sense of security that contributes to impulsive behavior. The principal effect of having a gun is worsening of the outcomes of violent encounters. Fistfights or assaults result in deaths, retaliation for perceived slights may result in a death, attempted rapes, robberies, and suicidal gestures are completed. The single most important factor in all kinds of firearm-related injuries is the accessibility to firearms themselves; recent studies have demonstrated the relationship between firearms ownership rates and overall homicide rate (Miller et al., 2002). In addition to the substantial risk of homicide associated with firearms availability, access to firearms is also strongly associated with suicide deaths (Miller et al., 2001).
P.987
arrest as a juvenile by >50%, arrest as an adult by 38%, and arrest for a violent crime by 38%, compared with a matched comparison group (Widom, 1992). Child abuse prevention is a critical component of violence prevention.
Resilience
Protective Factors
Protective factors are individual or environmental factors that buffer or moderate the risk of violence. The Surgeon General's Report on Youth Violence reviews several proposed individual-level protective factors including an intolerant attitude toward deviance (including violent behavior), high IQ, female gender, positive social orientation, perceived sanctions for transgression; family-level factors including a warm, supportive relationship with parents or other adults, and parental monitoring or supervision of activities; and school- or community-level protective factors including commitment to school, involvement in school activities, and having friends who behave conventionally. Only two of these factors have been shown to buffer the risk of youth violence—an intolerant attitude toward deviance and a commitment to school.
Recent studies using the National Longitudinal Survey of Youth have demonstrated the importance of protective factors, including community, family, and individual factors. At the community level, youth reported less violence involvement if they felt connected to school, to adults outside their families, and if they felt safe in their neighborhoods. Lower levels of violence were reported by teens who felt connected to their families, shared activities with their parents, and felt that they could talk about their problems with their parents. Interestingly, religiosity was a protective factor for girls, but not for boys. At all levels of risk, the effects of these protective factors—which the authors describe as “connectedness”—strongly reduce the likelihood of violence (Resnick et al., 2004).
A cross-sectional study in Vermont demonstrated an inverse relationship between the number of protective factors and health risk behaviors, including violence (Murphey et al., 2004). School-based programs that increase social connection reduce the incidence of violence and are more effective than traditional risk-based programs. In the office setting, parents and providers both have strong preferences for asset- or strength-based counseling and assessment (Sege et al., 2006). The American Academy of Pediatrics has just released a new violence-prevention program, Connected Kids: Safe, Strong Secure, which is primarily based on the promotion of resilience.
Other Factors: Schools
The U.S. Department of Education reported 188,000 fights or physical attacks not involving weapons, 11,000 fights involving weapons, and 4,000 incidents of sexual assault in schools during the 1996 to 1997 school year. Nevertheless, school remains by far the safest place for children. Vital statistics estimate that fewer than 1% of child and adolescent homicides occur in school (WISQARS), and the overwhelming proportion of assaults that do occur in school are relatively minor in severity. For perspective, about twice the number of Americans are killed by lightning each year as are killed on school campuses.
School is a critical environment for young people to learn socially appropriate and constructive behaviors and methods of addressing conflict. Adolescents who fail at school, or leave for any reason, are at vastly increased risk for violence-related injury compared with teens who attend school. Homicide is, in the scope of violent events, relatively rare, and other violent encounters such as fights and robberies are much more common. Young people who emerge as bullies, develop uncontrolled rage, engage in threatening language or behavior, carry weapons, or engage in frequent fighting or other antisocial activity must be identified, preferably helped, to reduce their antisocial behaviors, and if necessary, placed in settings where they are not a threat to other young people. When young people do engage in a violent act, it is unusual for them to have been no preceding signs. All of the events that have involved multiple homicides on campuses and in communities by youth have one thing in common—the young perpetrators had easy access to firearms, on some occasions, automatic firearms.
Assessment of Risk
To implement interventions which decrease the risk of violence, it is recommended that health care providers assess the risk of the youth's involvement with violence, including taking a thorough history of the teen's involvement with violence as an aggressor, a victim, a witness to violence in the community, a nonviolent problem solver, or a participant in gender role–related violence. In assessing risk, as with other situations, one must be cognizant of the developmental stage of the youth, and the clustering of risk factors. For example, among males there is a strong
P.988
association between cigarette smoking and weapons carrying. Complete assessment should include focused attention on connectedness of the teen to school and community. The mnemonic device FISTS (Fighting-Injuries-Sex-Threats-Self-defense) can be used as a guide in the collection of a violence-related medical history (Table 77.2).
|
TABLE 77.2 |
||||||||
|
Youth at low risk do not report recent fights, are in school, and do not report use of illicit drugs or alcohol. Moderate-risk youth may report one to two fights in the last year, or associated risk factors on the FISTS screen or occasional drug or alcohol use. High-risk individuals are not in school, or they report two or more fights in the last year. Moderate-risk and high-risk individuals may need further counseling or referral.
Prevention and Intervention
Recently, there has been a proliferation of violence-prevention programs. Programs tend to be funded for relatively short periods and limited in scope, so longitudinal effects on participants and broader societal measures of violent incidents are not valid measures. Promising approaches begin as early in life as possible, are sustained over time, and enhance nurturing and nonviolent parenting methods. Resources for successful prevention programs are included in the Internet resources at the end of this chapter.
Primary Prevention Interventions
Primary prevention strategies are either directed at the entire population or focused on selected populations at greatest risk. Any serious strategy of violence prevention must include efforts directed at young children, during which time basic values and approaches to frustration and conflict are learned. Particular issues to be addressed include familial violence, corporal punishment, child abuse, and early exposure to media violence, which are known to correlate with later violent behavior of children and adolescents. Recent research has suggested that effective primary prevention programs will be directed toward the promotion of resilience, as well as risk reduction. Effective strategies include the following:
P.989
In addition, curricula for conflict resolution have been developed for use in secondary schools. Specific curricula approaches that appear to be effective are as follows:
Effective primary prevention programs must be developmentally appropriate and comprehensive in approach (particularly those involving teenagers) and must include multiple components, reinforcing nonviolent behaviors in various contexts such as the family, school, peer groups, and the media. These approaches attempt to provide access to ongoing relationships with nonviolent, caring adult mentors, particularly for those teens from stressed or single-parent families. By reducing risk factors, children and adolescents are empowered to resist effects of detrimental life circumstances.
While many of these programs are community based, office-based counseling may also be effective. The American Academy of Pediatrics (AAP) Connected Kids program offers clinical resources and public education materials to support violence prevention in the primary care setting.
Firearms
Fundamental to a public health approach to prevention is a change in environmental risk factors. Access to firearms is the principal environmental risk factor for lethal violence. Removal of firearms from the environment of adolescents through legislation, strict enforcement of existing laws, and removal of firearms from the home environment is essential in the prevention of the grave consequences of violent behavior. It should be recognized that a serious consideration of the adolescent emotional developmental characteristics must lead one to the conclusion that educational interventions alone are unlikely to be successful with many children and adolescents (American Academy of Pediatrics, Committee on Injury and Poison Prevention, 2000).
Recommendations include the following:
Secondary Prevention Interventions
Although the causes of juvenile violence are not completely understood and programs designed to prevent delinquency have not been thoroughly evaluated, successful approaches to intervention appear to have the following characteristics:
P.990
Secondary interventions may be directed at teens who have been identified after their risk behaviors have become apparent. These interventions support adolescents identified as at risk in making a successful transition through school and into employment; they help nurture relationships with supportive adults (Elliot, 1994). They may include the following:
Children and youth hospitalized for violence-related injuries are at particular risk. Hospital based psychoeducational approaches to risk reduction have not been as effective as once hoped; it appears that long-term improvement in outcome depends on linkages with community resources. Several cities have adopted promising programs that link injured youths with community-based service organizations that offer ongoing programs that positively engage these patients, and, when needed, provide concrete services and support (Marcelle and Melzer-Lange, 2001).
Tertiary Intervention
Tertiary intervention takes place after a teen has become embroiled in violent activities and may occur largely through the juvenile justice system. When the juvenile justice system was created approximately 100 years ago, it was intended to be a “kind and just parent,” acknowledging that children were inherently different from adults, less culpable for their acts, more amenable to rehabilitation, and that a community-based, comprehensive approach was the most effective way to achieve rehabilitation. By 1915, almost all states had a juvenile court and the model spread internationally. The original goals of the juvenile court were to shield children from adults, protect the privacy of children, and allow adolescents to enter the workforce without a police record. During the 1990s, despite the fact that crime rates had been dropping significantly, these goals were rapidly eroded. Many states passed legislation making sentences more punitive, facilitating transfers of juveniles to adult court, and corroding protections of confidentiality. In effect, these measures blur the distinctions between adult and juvenile offenders (National Academy Press, Juvenile Crime, Juvenile Justice. (2001) Commission on Behavioral and Social Sciences and Education. National Research Council, Commission on Behavioral and Social Sciences and Education, 1993). These policies rely less and less on rehabilitation and increasingly attempt to manage juveniles through the adult criminal justice system. More than 90% of children involved in the juvenile justice system are nonviolent offenders, with most offences involving property or substance offenses such as theft, burglary, and drugs. On any given day, >90,000 children are in juvenile detention or correctional facilities; in addition, more than an estimated 9,000 adolescents younger than 18 years are in adult jails (Snyder and Sickmund, 1999). This is a cause for concern, because children held in adult jails are 8 times more likely than those held in juvenile facilities to commit suicide, 5 times more likely to be sexually assaulted, and twice as likely to be beaten by prison staff (Forst et al., 1989).
The effectiveness of punishment on antisocial behavior is of significant debate, and there is no clear evidence that punishment either improves behaviors or reduces the recidivism rate. Research that exists tends to indicate that incarceration efforts of the judicial system tend to actually worsen the outcomes for young people. Evidence for the effectiveness of incarceration in reducing later illegal activity does not exist. Incarcerated adolescents have a 50% to 70% chance of being arrested within 2 years of release. Juvenile justice policies are frequently not designed based on prevention research but in a legislative response to particular aberrant and well-publicized events. For example, boot camps have been widely adopted as a model for treatment of incarcerated teens, with no evidence of effectiveness at all; in fact, studies indicate that teens who have participated in boot camps have a 75% recidivism rate, even worse than incarceration. In addition, recent investigations into some of the 50 boot camps operating around the country have revealed widespread abuse and neglect (Children's Defense Fund, 2001).
The disproportionate incarceration of minority adolescents, particularly Latino and African-American teens, has been a source of grave concern for many years. Research indicates that this overrepresentation is a product of actions occurring through the entire juvenile justice system, from the decision to make the initial arrest, the decision to hold a youth in detention, the decision to refer a case to juvenile court, the prosecutor's decision to prosecute a case, to the actual judicial decision, and the subsequent penalty (Building Blocks for Youth, 2000). At every step of the process, minority adolescents are more likely to be treated in a way that inflates the charges and magnifies their chances of incarceration, including the incarceration of minority adolescents as adults, than are white teens for the same offenses (Males and Macallair, 2000). Minority adolescents are 8.3 times more likely than their white counterparts to be sentenced by an adult court to imprisonment in a California Youth Authority facility. The juvenile justice system has a budget of approximately $10 billion nationally; most is used for incarceration.
Family-focused, community-based, supervised programs involving offending teens have markedly lower recidivism rates. There is much room for continued research and modification of public policy regarding our approach as a society to young people who are apprehended for illegal activities (Mendel, 2000). Parenthetically, health care for teens in juvenile confinement is a serious concern because incarcerated teens have a greater than average number of health problems that may worsen during confinement, and only 1% of eligible juvenile justice facilities have been accredited as meeting existing voluntary standards for providing health care.
Web Sites
http://www.aap.org/vipp.
http://www.cjcj.org/. Justice Policy Institute.
http://www.colorado.edu/cspv/. Center for the Study and Prevention of Violence.
http://www.buildingblocksforyouth.org. Building Blocks for Youth.
http://www.aypf.org. American Youth Policy Forum.
P.991
Federal Resource Sites
http://www.albany.edu/sourcebook/toc.html. Source book on juvenile crime statistics.
http://www.cdc.gov/HealthyYouth/YRBS. Center for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Youth Risk Behavior Surveillance.
http://www.cdc.gov/ncipc/factsheets/yvoverview.htm. Center for Disease Control and Prevention, Factsheet on youth violence.
http://www.cdc.gov/ncipc/wisqars/. Center for Disease Control and Prevention, National Center for Injury Prevention and Control, Web-based Injury Statistics Query and Reporting System (WISQARS).
http://www.juvenilenet.org. The Corrections Connection Network, Juvenile Info Network.
http://www.ojp.usdoj.gov/bjs/welcome.html. Department of Justice, Bureau of Justice Statistics.
http://www.ojjdp.ncjrs.org. Office of Juvenile Justice and Delinquency Prevention.
http://www.safeyouth.org. National Youth Violence Prevention Resource Center.
http://www.surgeongeneral.gov/library/youthviolence. Youth Violence: A report of the Surgeon General.
References and Additional Readings
American Academy of Pediatrics, Center to Prevent Handgun Violence. Steps to prevent firearm injury. Elk Grove, IL: The Academy of Pediatrics; 1994.
American Academy of Pediatrics, Committee on Communications. Media violence. Pediatrics 1995;95:949.
American Medical Association. Adolescents as victims of family violence. JAMA 1993;270:1850.
American Psychological Association. Violence and youth: psychology's response. Washington, DC: American Psychological Association; 1993.
American Academy of Pediatrics, Committee on Injury and Poison Prevention. Firearm-related injuries affecting the pediatric population. Pediatrics 2000;105:888.
American Academy of Pediatrics, Committee on Communications. Children, adolescents, and television (RE0043). Pediatrics 2001;107(2):423.
Amnest J, Mercy J, Gibson D, et al. National estimates of nonfatal firearm related injuries: beyond the tip of the iceberg. JAMA 1995;273:1749.
Anderson RN, Smith BL. Deaths: leading causes for 2001. Natl Vital Stat Rep 2003;52(9):1.
Autphenne V, Gluckin A, Iverson E. Teen relationship abuse, regional needs assessment, Children's Hospital Los Angeles, Division of Adolescent Medicine; 1998.
Building Blocks for Youth. And justice for some. Available at www.buildingblocksforyouth.org, 2000.
Bureau of Justice Statistics. Violent crime in the United States, 1990. Washington, DC: U.S. Department of Justice; 1991.
Bureau of Justice Statistics. Homicide trends in the U.S.: Intimate Homicide 1998–2001. Washington, DC: U.S. Department of Justice. Available at www.ojp.usdoj.gov/bjs/homicide/intimates.htm, 2001.
Centers for Disease Control and Prevention. Weapon carrying among high school students—United States, 1990. MMWR Morb Mortal Wkly Rep 1991;40:681.
Centers for Disease Control and Prevention. Violence-related attitudes and behaviors of high school students—New York city, 1992. JAMA 1993;270:2032.
Centers for Disease Control and Prevention. Rates of homicide, suicide, and firearm-related death among children in 26 industrialized countries. MMWR Morb Mortal Wkly Rep1997; 46:101.
Centers for Disease Control and Prevention. Deaths: Final Data for 1998 MMWR Natl Vital Stat Rep. 2000;48(11).
Centers for Disease Control and Prevention. Surveillance for Fatal and Nonfatal Injuries—United States, 2001. MMWR 2004:53(SS-7).1–57
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2005) [cited 2006 Apr 25]. ~ Available from URL: www.cdc.gov/ncipc/wisqars.
Centers for Disease Control and Prevention. Youth risk behavior surveillance—United States, 2005. MMWR 2006;55 (SS-5):1. Available at: http://www.cdc.gov/HealthyYouth/yrbs/index.htm, accessed June 13, 2006.
Centerwall BS. Homicide and the prevalence of handguns: Canada and the United States, 1976 to 1980. Am J Epidemiol 1991;134:1245.
Children's Defense Fund. Yearbook 2000, the state of America's children. Washington, DC: CDF Publication; 2001.
Clancy TV, Misick LN, Covington D, et al. The financial impact of intentional violence on community hospitals. J Trauma 1994;37:1.
Coben JH, Weiss HB, Dearwater SR. A primer on school violence prevention. J Sch Health 1994;64:309.
Cotten NU, Resnick J, Browne DC, et al. Aggression and fighting behavior among African-American adolescents: individual and family factors. Am J Public Health 1994;84:618.
Criminal Victimization in the U.S. 1999, Bureau of Justice Statistics, U.S. Department of Justice. http://www.ojp.usdoj.gov/bjs/cvict.htm, 2001.
Department of Health and Human Services (US). Youth Violence: A report of the Surgeon General [online] 2001.
Dolins JC, Christoffel KK. Reducing violent injuries: priorities for pediatrician advocacy. Pediatrics 1994;94:638.
DuRant RH, Cadenhead C, Pendergrast RA, et al. Factors associated with the use of violence among urban black adolescents. Am J Public Health 1994;84:612.
Elliot D. Youth violence: an overview, 1994. Colorado: Center for the Study and Prevention of Violence; 1994. Available at www.colorado.edu/cspv.
Eron LD. Media violence. Pediatr Ann 1995;24:84.
Fingerhut LA, Ingram DD, Feldman JJ. Firearm homicide among black teenage males in metropolitan counties. Comparison of death rates in two periods, 1983 through 1985 and 1987 through 1989. JAMA 1992;267:3054.
Fingerhut L, Kleinman J. International and interstate comparisons of homicide among young males. JAMA 1990;263:3292.
Forst M, Fagan J, Vivona T. Youth in prisons and training schools: perceptions and consequences of the treatment/custody dichotomy. Juv Fam Ct J 1989;40:1.
Garbarino J, Dubrow N, Kostelny K, et al. Children in danger: coping with the consequences of community violence. San Francisco: Jossey Bass Publishers; 1992.
Garrett D. Violent behaviors among African-American adolescents. Adolescence 1995;30:209.
Golding AM. Leading article—understanding and preventing violence: a review. Public Health 1995;109:91.
P.992
Goodwillie S. Voices from the future, our children tell us about violence in America. Children's express. New York: Crown Publishers; 1993.
Groves BM, Zuckerman B, Marans S. Silent victims. Children who witness violence. JAMA 1993;269:262.
Hammond WR, Yung B. Psychology's role in the public health response to assaultive violence among young African-American men. Am Psychol 1993;48:142.
Harms PD, Snyder HN. Trends in the murder of juveniles: 1980–2000. Washington, DC: Office of Juvenile Justice and Delinquency Prevention; 2004.
Hausman AJ, Spivak H, Prothrow-Stith D. Adolescents' knowledge and attitudes about and experience with violence. J Adolesc Health 1994;15:400.
Huizinga D, Loeber R, Thornberry TP. Recent findings from the program of research on the causes and correlates of delinquency. (U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention, NCJ 159042). Washington, DC: U.S. Government Printing Office; 1995.
Jaffe PG. Children of battered women. Newbury Park: Sage Publications Inc; 1990.
Johnson EM, Belfer ML. Substance abuse and violence: cause and consequence. J Health Care Poor Underserved 1995;6:113.
Kellam SG, Prinz R, Sheley J. Preventing school violence: plenary papers of the 1999 conference on criminal justice research and evaluation-enhancing policy and practice through research, May 2000., National Institute of Justice. U.S. Department of Justice; 2000.
Kellerman AL, Rivarra FP, Somes G, et al. Suicide in the home in relation to gun ownership. N Engl J Med 1992;327:467.
Males M, Macallair D. The color of justice: an analysis of juvenile adult court transfers in California, Center of Juvenile and Criminal Justice, 2000. www.buildingblocksforyouth.org.
Malik S, Sorenson S, Aneshensel C. Community and dating violence among adolescents: perpetuation and victimization. J Adolesc Health 1997;21:291.
Marcelle DR, Melzer-Lange MD. Project UJIMA: working together to make things right. Wis Med J 2001;100(2):22.
Mendel R. Less hype, more help: reducing juvenile crime, what works and what doesn't. American Youth Policy Forum; 2000. Available at www.aypf.org. American Youth Policy Forum.
Miller M, Azrael D, Hemenway D. Firearm availability and unintentional firearm deaths. Accid Anal Prev 2001;33:477.
Miller M, Azrael D, Hemenway D. Rates of household firearm ownership and homicide across US regions and states, 1988–1997. Am J Public Health 2002;92(12):1988.
Moffitt T. Partner violence among young adults. Presentation to the National Institute of Justice; 1997.
Mondragon D. Clinical assessment of gang violence risk through history and physical exam. J Health Care Poor Underserved 1995;6:209.
Murphey DA, Lamonda KH, Carney JK, et al. Relationships of a brief measure of youth assets to health-promoting and risk behaviors. J Adolesc Health 2004;34(3):184.
National Research Council, Commission on Behavioral and Social Sciences and Education. Commission on Behavioral and Social Sciences and Education. National Academy Press, Juvenile Crime, Juvenile Justice. (2001).
National Research Council. Understanding and preventing violence. Washington, DC: National Academy Press; 1993.
O'Donnell L, Cohen S, Hausman A. Forum on youth violence in minority communities. Evaluation of community-based violence prevention programs. Public Health Rep1991;106:276.
Panel on High-Risk Youth, National Research Council. Losing generations: Adolescent in high-risk settings. Washington, DC: National Academy Press; 1993.
Patterson GR, DeBaryshe D, Ramsey E. A developmental perspective on antisocial behavior. Am Psychol 1989;44: 331.
Prothrow-Stith D. Violence prevention, curriculum for adolescents. Teenage health teaching modules. Newton, MA: Education Development Center; 1987.
Prothrow-Stith D. Deadly consequences. New York: Harper-Collins; 1991.
Prothrow-Stith DB. The epidemic of youth violence in America: using public health prevention strategies to prevent violence. J Health Care Poor Underserved 1995;6:95.
Rachuba L, Stanton B, Howard D. Violent crime in the United States: an epidemiologic profile. Arch Pediatr Adolesc Med 1995;149:953.
Resnick M, Ireland M, Borowsky I. Youth violence perpetration: what protects? What predicts. J Adolesc Health 2004; 35:424–e1.
Rivara FP, Farrington DP. Prevention of violence: role of the pediatrician. Arch Pediatr Adolesc Med 1995;149:421.
Rodriguez MA, Brindis CD. Violence and latino youth: prevention and methodological issues. Public Health Rep 1995; 110:260.
Ropp L, Visintainer P, Uman J, et al. Death in the city: an American childhood tragedy. JAMA 1992;267:2905.
Rosenberg ML. Academic medical centers have a major role in preventing violence. Acad Med 1993;68:268.
Sege R, Dietz W. Television viewing and violence in children: the pediatrician as agent for change. Pediatrics 1994;94:600.
Sege RD, Flanigan E, Levin-Goodman R, et al. American academy of pediatrics' connected kids program case study. Am J Prev Med 2005;29(5 Suppl 2):215.
Sege RD, Hatmaker-Flanigan E, De Vos E, et al. Anticipatory guidance and violence prevention: results from family and pediatrician focus groups. Pediatrics 2006;117(2):455.
Sege RD, Hoffman JS. Training health professionals in youth violence prevention overview of extant efforts. Am J Prev Med 2005;29(5 Suppl 2):175.
Sege RD, Licenziato VG, Webb S. Bringing violence prevention into the clinic the Massachusetts medical society violence prevention project. Am J Prev Med 2005;29(5 Suppl 2):230.
Seltzer F. Trend in mortality from violent deaths: unintentional injuries, United States, 1960–1991. Stat Bull Metrop Insur Co 1995;76:19.
Sheley J. Controlling violence: what schools are doing—preventing school violence: plenary papers of the 1999 conference on criminal justice research and evaluation. Washington, DC: National Institute of Justice; 2000: Available at www.ojp.usdoj.gov/nij.
Sheley JF, McGee ZT, Wright JD. Gun-related violence in and around inner-city schools. Am J Dis Child 1992;146:677.
Singer MI, Anglin TM, Song LY, et al. Adolescents' exposure to violence and associated symptoms of psychological trauma. JAMA 1995;273:477.
Slaby RG, Stringham P. Prevention of peer and community violence: the pediatrician's role. Pediatrics 1994;94:608.
Sloan JH, Kellermann AL, Reay DT, et al. Handgun regulations, crime, assaults, and homicide: a tale of two cities. N Engl J Med 1988;319:1256.
Snyder HN. Juvenile arrests 2004. Washington, DC: U.S. Department of Justice, Juvenile Justice Bulletin, Office of Juvenile Justice and Delinquency Prevention; 2006. Available at www.ncjrs.org. Dec.
P.993
Snyder HN, Sickmund M. Juvenile offenders and victims; 1999 national report. Washington, DC: U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention; 1999. September
Strasburger VC, Grossman D. How many more Columbines? What can pediatricians do about school and media violence. Pediatr Ann 2001;30:87.
Tjaden P, Thoennes N. Full report of the prevalence, incidence, and consequences of violence against women. Washington, DC: U.S. Department of Justice; 2000. November, Available at www.ojp.usdoj.gov/nij.
Tomes H. Research and policy directions in violence: a developmental perspective. J Health Care Poor Underserved 1995;6:146.
Tremblay RE, Pihl RO, Vitaro F, et al. Predicting early onset of male antisocial behavior from preschool behavior. Arch Gen Psychiatry 1994;51:732.
Tremblay RE, Nagin DS, Seguin JR, et al. Physical aggression during early childhood: trajectories and predictors. Pediatrics 2004;115:e43.
U.S. Advisory Board on Child Abuse and Neglect. A nation's shame: fatal child abuse and neglect in the United States. Washington, DC: U.S. Congress; April 1995.
U.S. Department of Justice. Crime in the United States, uniform crime reports. Washington, DC: Federal Bureau of Investigation; 1992; August 30.
Waller JA, Skelly JM, Davis JH. Characteristics, costs, and effects of violence in Vermont. J Trauma 1994;37:921.
Webster DW, Wilson ME. Gun violence among youth and the pediatrician's role in primary prevention. Pediatrics 1994; 94:617.
Weil DS, Hemenway D. Loaded guns in the home: analysis of a national random sample of gun owners. JAMA 1992;267:3033.
White MP. A comprehensive approach to violence prevention. J Health Care Poor Underserved 1995;6:254.
Widom C. The cycle of violence. Washington, DC: National Institute of Justice, U.S. Department of Justice, 1992. October.
Wilson-Brewer R, Spivak H. Violence prevention in schools and other community settings: the pediatrician as initiator, educator, collaborator, and advocate. Pediatrics1994;94:623.