Youth Violence: A Report of the Surgeon General

Chapter 1

OVERVIEW OF THE REPORT'S CHAPTERS

The Surgeon General's report on youth violence reviews a vast, multidisciplinary, and often controversial research literature. Chapters 2 through 5 address, respectively, the extent and magnitude of youth violence; the developmental characteristics of, or paths to, youth violence; personal and environmental factors that may either place a child or adolescent at risk of violent behavior or protect a young person from succumbing to those risk factors; and violence intervention and prevention programs. The final chapter in the report identifies areas of opportunity for future efforts to combat and prevent youth violence.

This section provides a brief overview of each chapter, while the following section presents a summary of key conclusions drawn from each.

Chapter 2 examines the magnitude of and trends in youth violence over the last two decades. It describes two different, but complementary ways of measuring violence—official reports and self-reports. Official arrest data offer an obvious means of determining the extent of youth violence. Indeed, a surge in arrests for violent crimes marked what is now recognized as an epidemic of youth violence from 1983 to 1993. Arrests were driven largely by the rapid proliferation of firearms use by adolescents engaging in violent acts and the likelihood that violent confrontations would—as they did—produce serious or lethal injuries. Today, with fewer young people carrying weapons, including guns, to school and elsewhere than in the early 1990s, violent encounters are less likely to result in homicide and serious injury and therefore are less likely to draw the attention of police. By 1999, arrest rates for homicide, rape, and robbery had all dropped below 1983 rates. In contrast, arrest rates for aggravated assault remained higher than they were in 1983, having declined only 24 percent from the peak rates in 1994.

Another way of measuring violence is on the basis of confidential reporting by youths themselves. Confidential surveys find that 10 to 15 percent of high school seniors report having committed an act of serious violence in recent years. These acts typically do not come to the attention of police, in part because they are less likely to involve firearms than in previous years. Over the past two decades, self-reported violence by high school seniors increased nearly 50 percent, a trend similar to that found in arrests for violent crimes. But this proportion has not declined in the years since 1993—it remains at peak levels. Chapter 2 considers how and to what extent arrest data and self-report data vary, including variations by sex and race or ethnicity. In the aggregate, the best available evidence from multiple sources indicates that youth violence is an ongoing national problem, albeit one that is largely hidden from public view.

Chapter 3 examines routes that may lead a young person into violence. Viewed from a developmental perspective, violence stems from a complex interaction of individuals with their environment at particular times in their lives. Longitudinal research has enabled investigators to describe the emergence of violence in terms of two, and possibly more, life-course trajectories. Chapter 3 discusses the early-onset and late-onset emergence of violence, which occur before and after puberty, respectively. These trajectories offer insights into the likely course, severity, and duration of violence over the life course and have practical implications for the timing of intervention programs and strategies. The chapter reviews research on the co-occurrence of serious violence and other problems, including drug use and mental disorders. Finally, it underscores the importance—and the paucity—of research on factors associated with the cessation of youth violence or its continuation into adulthood.

Extensive research in recent decades has sought to identify various personal characteristics and environmental conditions that either place children and adolescents at risk of violent behavior or that seem to protect them from the effects of risk. Risk and protective factors, which are the focus of Chapter 4, can be found in every area of life. They exert different effects at different stages of development, they tend to appear in clusters, and they appear to gain strength in numbers. As the chapter notes, risk probabilities apply to groups, not to individuals. Although risk factors are not necessarily causes, a central aim of the public health approach to youth violence is to identify these predictors and determine when in the life course they typically come into play. Such information enables researchers to design preventive programs that can be put in place at just the right time to be most effective.

The chapter examines risk from the perspectives of both childhood and adolescence and, within each of these developmental periods, considers risk factors occurring in the individual, family, school, peer group, and community domains. Childhood risk factors for violence in adolescence include involvement in serious (but not necessarily violent) criminal acts and substance use before puberty, being male, aggressiveness, low family socioeconomic status/poverty, and antisocial parents—all either individual or family risk factors. The influence of family is largely supplanted in adolescence by peer influences, thus risk factors with the largest predictive effects in adolescence include weak social ties, ties to antisocial or delinquent peers, and belonging to a gang. Having committed serious (but not necessarily violent) criminal offenses is also an important risk factor in adolescence.

Identifying and understanding how protective factors influence behavior is potentially as important to preventing and stopping violence as identifying and understanding risk factors. Several protective factors have been proposed, but to date only two have been found to buffer the risk of violence—an intolerant attitude toward deviance and commitment to school. Protective factors warrant, and are beginning to receive, more research attention.

Despite past contentions that "nothing works" to prevent youth violence, the evidence presented in Chapter 5 demonstrates that prevention efforts can be effective against both early- and late-onset violence in the general youth population, high-risk youths, and even youths who are already violent or seriously delinquent. The chapter highlights 27 specific programs that, based on existing data, help prevent youth violence. The most effective of these programs combine components known to prevent violence by themselves, particularly social skills training for youths and interventions that include parents or entire families.

Chapter 5 also highlights important limitations in the current research on youth violence prevention. Little is known about the scientific effectiveness of hundreds of programs now being used in U.S. schools and communities. This situation is disconcerting, given that many well-intentioned youth violence prevention programs have been found ineffective or harmful to youths. Even less is known about how to implement effective programs on a national scale without compromising their results.

The information presented in Chapter 5 shows that youth violence prevention not only works, it can also be cost-effective. In a number of cases, the long-term financial benefits of prevention are substantially greater than the costs of the programs themselves. These promising findings indicate that prevention plays an important role in providing a safe environment for youths.

Finally, Chapter 6 presents several options for future action. First, the scientific base must continue to be expanded. Effective interventions exist, but only continued research can document those programs that meet a standard of effectiveness and those that do not—and should therefore be discarded. The chapter identifies the following courses of action:

Continue to build the science base
Accelerate the decline in gun use by youths in violent encounters
Facilitate the entry of youths into effective intervention programs rather than incarcerating them
Disseminate model programs with incentives that will ensure fidelity to original program design when taken to scale
Provide training and certification programs for intervention personnel
Improve public awareness of effective interventions
Convene youths and families, researchers, and private and public organizations for a periodic youth violence summit
Improve Federal, state, and local strategies for reporting crime information and violent deaths

CHAPTER CONCLUSIONS

Chapter 2

The decade between 1983 and 1993 was marked by an epidemic of increasingly lethal violence that was associated with a large rise in the use of firearms and involved primarily African American males. There was a modest rise in the proportion of young persons involved in other forms of serious violence.
Since 1994, a decline in homicide arrests has reflected primarily the decline in use of firearms. There is some evidence that the smaller decline in nonfatal serious violence is also attributable to declining firearm use.
By 1999, arrest rates for violent crimes—with the exception of aggravated assault—had fallen below 1983 levels. Arrest rates for aggravated assault remain almost 70 percent higher than they were in 1983, and this is the offense most frequently captured in self-reports of violence.
Despite the present decline in gun use and in lethal violence, the self-reported proportion of young people involved in nonfatal violence has not declined from the peak years of the epidemic, nor has the proportion of students injured with a weapon at school declined.
The proportion of schools in which gangs are present continued to increase after 1994 and has only recently (1999) declined. However, evidence shows that the number of youths involved with gangs has not declined and remains near the peak levels of 1996.
Although arrest statistics cannot readily track firearm use in specific serious crimes other than homicide, firearm use in violent crimes declined among persons of all ages between 1993 and 1998.
The steep rise and fall in arrest rates for homicide over the past two decades have been matched by similar, but less dramatic changes in some of the other indicators of violence, including arrest rates for all violent crimes and incident rates from victims' self-reports. This pattern is not matched by arrests for selected offenses, such as aggravated assault, or incident rates and prevalence rates from offenders' self-reports.
Young men—particularly those from minority groups—are disproportionately arrested for violent crimes. But self-reports indicate that differences between minority and majority populations and between young men and young women may not be as large as arrest records indicate or conventional wisdom holds. Race/ethnicity, considered in isolation from other life circumstances, sheds little light on a given child's or adolescent's propensity for engaging in violence.
Schools nationwide are relatively safe. Compared to homes and neighborhoods, schools have fewer homicides and nonfatal injuries. Youths at greatest risk of being killed in school-associated violence are those from a racial or ethnic minority, senior high schools, and urban school districts.

Chapter 3

There are two general onset trajectories for youth violence—an early one, in which violence begins before puberty, and a late one, in which violence begins in adolescence. Youths who become violent before about age 13 generally commit more crimes, and more serious crimes, for a longer time. These young people exhibit a pattern of escalating violence through childhood, and they sometimes continue their violence into adulthood.
Most youth violence begins in adolescence and ends with the transition into adulthood.
Most highly aggressive children or children with behavioral disorders do not become serious violent offenders.
Surveys consistently find that about 30 to 40 percent of male youths and 15 to 30 percent of female youths report having committed a serious violent offense by age 17.
Serious violence is part of a lifestyle that includes drugs, guns, precocious sex, and other risky behaviors. Youths involved in serious violence often commit many other types of crimes and exhibit other problem behaviors, presenting a serious challenge to intervention efforts. Successful interventions must confront not only the violent behavior of these young people, but also their lifestyles, which are teeming with risk.
The differences in patterns of serious violence by age of onset and the relatively constant rates of individual offending have important implications for prevention and intervention programs. Early childhood programs that target at-risk children and families are critical for preventing the onset of a chronic violent career, but programs must also be developed to combat late-onset violence.
The importance of late-onset violence prevention is not widely recognized or well understood. Substantial numbers of serious violent offenders emerge without warning signs in their childhood. A comprehensive community prevention strategy must address both onset patterns and ferret out their causes and risk factors.

Chapter 4

Risk and protective factors exist in every area of life—individual, family, school, peer group, and community. Individual characteristics interact in complex ways with people and conditions in the environment to produce violent behavior.
Risk and protective factors vary in predictive power depending on when in the course of development they occur. As children move from infancy to early adulthood, some risk factors will become more important and others less important. Substance use, for example, is a much stronger risk factor at age 9 than it is at age 14.
The strongest risk factors during childhood are involvement in serious, but not necessarily violent criminal behavior, substance use, being male, physical aggression, low family socioeconomic status or poverty and antisocial parents—all individual or family characteristics or conditions.
During adolescence, the influence of family is largely supplanted by peer influences. The strongest risk factors are weak ties to conventional peers, ties to antisocial or delinquent peers, belonging to a gang, and involvement in other criminal acts.
Risk factors do not operate in isolation—the more risk factors a child or young person is exposed to, the greater the likelihood that he or she will become violent. Risk factors can be buffered by protective factors, however. An adolescent with an intolerant attitude toward deviance, for example, is unlikely to seek or be sought out by delinquent peers, a strong risk factor for violence at that age.
Given the strong evidence that risk factors predict the likelihood of future violence, they are useful for identifying vulnerable populations that may benefit from intervention efforts. Risk markers such as race or ethnicity are frequently confused with risk factors; risk markers have no causal relation to violence.
No single risk factor or combination of factors can predict violence with unerring accuracy. Most young people exposed to a single risk factor will not become involved in violent behavior; similarly, many young people exposed to multiple risks will not become violent. By the same token, protective factors cannot guarantee that a child exposed to risk will not become violent.

Chapter 5

A number of youth violence intervention and prevention programs have demonstrated that they are effective; assertions that "nothing works" are false.
Most highly effective programs combine components that address both individual risks and environmental conditions, particularly building individual skills and competencies, parent effectiveness training, improving the social climate of the school, and changes in type and level of involvement in peer groups.
Rigorous evaluation of programs is critical. While hundreds of prevention programs are being used in schools and communities throughout the country, little is known about the effects of most of them.
At the time this report was prepared, nearly half of the most thoroughly evaluated strategies for preventing violence had been shown to be ineffective—and a few were known to harm participants.
In schools, interventions that target change in the social context appear to be more effective, on average, than those that attempt to change individual attitudes, skills, and risk behaviors.
Involvement with delinquent peers and gang membership are two of the most powerful predictors of violence, yet few effective interventions have been developed to address these problems.
Program effectiveness depends as much on the quality of implementation as the type of intervention. Many programs are ineffective not because their strategy is misguided, but because the quality of implementation is poor.

PREPARATION OF THE REPORT

To address the troubling presence of violence in the lives of U.S. youths, the Administration and Congress urged the Surgeon General to develop a report on youth violence, with particular focus on the scope of the problem, its causes, and how to prevent it. Surgeon General Dr. David Satcher requested three agencies, all components of the Department of Health and Human Services, to share lead responsibility for preparing the report. The agencies are the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Under Dr. Satcher's guidance, these agencies established a Planning Board comprising individuals with expertise in diverse disciplines and professions involved in the study, treatment, and prevention of youth violence. The Planning Board also enlisted individuals representing various Federal departments, including particularly the Department of Justice (juvenile crime aspects of youth violence), the Department of Education (school safety issues), and the Department of Labor (the association between youth violence and youth employment, and out-of-school youth). Invaluable assistance was obtained as well from individual citizens who have founded and operate nonprofit organizations designed to meet the needs of troubled and violent youths. Most important, young people themselves accepted invitations to become involved in the effort. All of these persons helped to plan the report and participated in its prepublication reviews.

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