Interpersonal violence among young people aged eleven to nineteen is a significant public health concern. Adolescent violence involves behaviors ranging from physical fighting to more severe forms of physical assault that can result in serious injury or death. In 1998, homicides in the United States claimed the lives of 2,573 persons between eleven and nineteen years old, making it the second leading cause of death for adolescents that year.
Compared to other industrialized countries, "adolescent violence is greater in the United States, more likely to involve firearms, and more lethal in its consequences" (USDHHS 2001, p. 27). One study showed that from 1990 to 1995 the rates of firearm-related homicide in the United States for youth below age fifteen was nearly sixteen times higher than that of twenty-five other countries combined. While this epidemic has substantially subsided, the adolescent homicide rates in the United States by firearms continues to be high when compared with other countries.
During the period from 1980 through 2000, trend patterns in violence among adolescents showed a steep rise and fall. The decade between 1983 and 1993 was marked by an epidemic of increasingly deadly violence associated with increased firearm use. For example, both total and firearm-related homicide rates increased dramatically, peaking in the mid-1990s, and then declined. Arrest rates for homicide, robbery, and rape among adolescents followed a similar pattern. Although these recent downward trends are encouraging, rates of adolescent violence remain at historically high levels.
PREVALENCE AND DESCRIPTIVE EPIDEMIOLOGY
Based on reports from twelfth-grade students from 1980 to 1998, about three out of ten high school seniors commit a violent act (e.g., take part in a fight) each year. Ten to 15 percent of high school seniors reported physically injuring someone severely enough to require medical care. Involvement in violence varies by gender and, to a larger extent, by race. Adolescent males are more likely to be victims and perpetrators of violence than are adolescent females. In 1998 there were about four and one-half male victims for every female victim of homicide. Males also committed about four violent acts for every one violent act by females. Minorities (e.g., African Americans, Hispanics) are disproportionately victimized by, and arrested for, violence. In 1998, African-American adolescents were six times more likely to be victims of homicide, and between one and a half and four times more likely to commit (or be arrested for) a violent act compared to white adolescents. Differences in the rates of violence across racial and ethnic groups must be viewed in terms of the life circumstances of various groups. For example, minorities are more likely than whites to live in poor neighborhoods, a situation that has been found to increase the likelihood of violence (see "Causes").
Adolescent interpersonal violence costs the United States an estimated $6 billion each year in medical costs alone. Other costs of adolescent violence include the costs for criminal processing, security, public programs for prevention and treatment, property damage, and lost productivity. In total, the monetary costs are nearly $160 billion each year. To these figures, one must add the costs of years of potential life lost, and the psychological trauma resulting from violent injuries.
There is no single cause of violence among adolescents. Many risk factors have been found to increase the likelihood of violence during adolescence. Important influences include a history of early aggression in childhood, being exposed to family or neighborhood violence, poor relations with parents, drug and alcohol use, having delinquent peers, gang membership, poor school performance, and residing in a poor community with diminished economic opportunities. Some factors, termed "protective factors," help to reduce the chances of violence during adolescence. These include personal intolerance toward violent behavior and commitment to school. Other possible protective factors include a supportive relationship with parents (or other adults), and having friends who disapprove of violence. Individual characteristics (e.g., being male), as well as family (e.g., poor parent-child relations), school (e.g., academic failure), and peer group (e.g., gang membership) influences interact in complex ways with environmental conditions (e.g., neighborhood crime) to produce violent behavior. Family influences are most important before age twelve, whereas peer influences are most important during later adolescence.
Although many violence prevention programs have not been properly studied or have been studied and shown to be ineffective, there are programs and strategies that work to reduce violence among adolescents. Some of these programs focus on youth in general (universal or primary prevention), whereas others are designed for youth with several risk factors (secondary prevention), or even youth that are already violent (tertiary prevention).
According to the U.S. Surgeon General's Youth Violence Report, primary and secondary strategies, such as programs that build individual skills and competencies (e.g., self-control, problem solving) or skills of the parent(s), that improve the social climate of the school, and that encourage positive peer relations, are highly effective approaches to prevent the onset of adolescent violence and related risk factors. Evidence also suggests that mentoring programs (pairing a young person with a supportive, nonjudgmental role model) are a viable strategy for reducing violent behaviors in certain settings. Strategies previously believed to be effective that do not work to curb violence among youth include peer-led programs (e.g., peer counseling) and nonpromotion of youth to succeeding grades.
For already violent youth, boot camps (modeled after military basic training), shock programs that allow youth to have brief encounters with inmates who describe the brutality of prison life (e.g., "Scared Straight" programs), waivers from juvenile to adult courts, and firearm training do not deter violent behavior. In fact, some of these strategies may actually lead to higher rates of arrests and expose youth to personal harm. On the other hand, tertiary prevention programs that enhance family interaction and communication, reduce school dropout rates, change antisocial beliefs and behaviors, and provide skills training and individually tailored comprehensive services are among the most effective. Prevention efforts on all levels should use model programs that have demonstrated their effectiveness so that resources are not wasted on ineffective or harmful interventions and strategies.
LA MAR HASBROUCK
Centers for Disease Control and Prevention (1997). "Rates of Homicide, Suicide, and Firearm-Related Death Among Children: 26 Industrialized Countries." Morbidity and Mortality Weekly Report 46:101–105.
Children's Safety Network (CSN) Economic and Insurance Resource Center, Pacific Institute for Research and Evaluation (PIRE) (2000). State Costs of Youth Violence. Available at http://www.csneirc.org/pubs/tables/youth-viol.htm.
Elliott, D. S.; Hamburg, B. A.; and Williams, K. R. (1998). Violence in American Schools. New York: Cambridge University Press.
Office of Statistics and Programming, National Center for Injury Prevention and Control (2001). CDC WISQARS [Electronic Database]. Available at http://www.cdc.gov/ncipc/osp/data.htm.
Snyder, H. N., and Sickmund, M. (1994). Juvenile Offenders and Victims: 1999 National Report (NCJ 178257). Washington, DC: U.S. Department of Justice, Office
Thornton, T. N.; Craft, C. A.; Dahlberg, L. L.; Lynch, B. S.; and Baer, K. (2000). Best Practices of Youth Violence Prevention: A Sourcebook for Community Action. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
U.S. Department of Health and Human Services (2001). Youth Violence: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services. Available at http://www.surgeongeneral.gov/library/youthviolence/
Wasserman, G. A., and Miller, L. S. (1998). "The Prevention of Serious and Violent Juvenile Offending." In Serious and Violent Juvenile Offenders: Risk Factors and Successful Interventions, ed. R. Loeber and D. P. Farrington et al. Thousand Oaks, CA: Sage Publications.