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Chapter 6
A Vision for the Future

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 6
A Vision for the Future

In the late 1990s, people in the United States were stunned by a series of tragic shootings at schools that were planned and carried out by youths. These shocking, widely reported events prompted the preparation of this Surgeon General’s report on youth violence. Yet these shootings were not characteristic of youth violence nationally. Moreover, at the time of the shootings, youth violence in the United States appeared to be on a downward trend.

Serious youth violence—that is, physical assault by a child or adolescent that carries a significant risk of injuring or killing another person—began to emerge as a social and public health problem of sizable proportions in the 1980s. Arrests of youths for index crimes (robbery, aggravated assault, rape, and homicide) peaked in 1993 after a decade of climbing rapidly, leading some observers to express doubt that anything could be done to halt the epidemic of youth violence. By 1999, after 6 years of sustained decline nationwide, arrests of youths for robbery, rape, and homicide began to resemble the pre-epidemic arrest rates of 1983. A striking exception to this trend was arrests for aggravated assault, which remained 70 percent above 1983 rates.

While arrest records and victimization reports indicated that youth violence was generally declining, other sources of information presented a different picture. In approaching youth violence as a public health problem, this report has looked beyond arrest and other criminal justice records to several national surveys in which high school–age youths report in confidence on their violent behavior. These self-reports reveal that the propensity for and actual involvement of youths in serious violence have not declined with arrest rates. Rather, they have remained at the peak rates of 1993, a troublesome finding. In January 2001, as this report goes to press, the first indications of a long-awaited downturn in self-reported violent behavior are being countered by signs from the FBI’s Uniform Crime Reports database that the decline in arrests of youths for violent crimes has bottomed out and, for some index crimes, has begun to climb again.

Clearly, the dynamics and magnitude of youth violence remain fluid and complex. Nevertheless, research in the past several decades has developed a wealth of information about the causes of youth violence and how to prevent it. Numerous studies have identified and examined specific risk factors for violence—the personal and environmental features of young people’s lives that increase the statistical probability of their engaging in violent behaviors. Research also has begun to identify protective factors that appear to buffer the effects of risk factors. While this information has been accumulating, researchers, youth service practitioners, and others have been designing, implementing, and evaluating a variety of programs and strategies to reduce or prevent the occurrence of youth violence. The best of these interventions target populations of young people identified as being particularly at risk of becoming involved in a violent lifestyle.

Many effective intervention programs exist to reduce and prevent youth violence. The United States is well past the point where anyone can claim that "nothing works" to prevent youth violence or to modify the destructive life courses of youths who are either engaged in or appear to be headed for lifestyles characterized by violence. At the same time, however, many purported youth violence prevention programs used today are untested, and some are known to be ineffective or even deleterious to a child or adolescent’s healthy, safe development.

The courses of action highlighted below are potential next steps. These are not formal policy recommendations. Instead, they represent a vision for the future built on information we possess today. They are intended for policy makers, service and treatment providers, people affiliated with the juvenile justice system, researchers, and most important, the people of the United States. This vision for the future is presented with the hope that it will engage an expanding number of citizens in the challenge of redressing the problem of youth violence.


Scientific research is an essential underpinning of the public health approach to the problem of youth violence. Years of extensive research have revealed the scope of the problem, and we are beginning to understand how to intervene effectively to reduce and prevent violence. Yet most violence prevention programs used in schools, communities, and the justice system today have not been subjected to systematic scientific evaluation, so their effectiveness—or lack of effectiveness—is unknown. Given evidence that some well-intentioned prevention and intervention programs have proved to be harmful, it is imperative that all programs be scientifically evaluated. Research must also be prepared to address areas of emerging concern. One that has become increasingly clear is the need for studies to investigate intimate violence, or dating violence, among youths to identify patterns that predict continuation of such behaviors into adulthood and to design new types of interventions targeting this form of violent behavior. Another area of concern requiring research is the impact of violent interactive media, such as computer games, on serious violent behavior.

This Surgeon General’s report is issued at a time of unprecedented scientific opportunity in numerous disciplines—developmental psychology, sociology, criminology, epidemiology, neuroscience, and many other fields. No single research specialty holds the key to understanding, treating, and preventing violence. Rather, they must work together. One of the greatest challenges to researchers today is finding new ways to use the tools, strategies, and insights from these diverse fields of research to reveal the many factors that may lead a young person toward—or protect a young person from—involvement in violence. A related need is to invest in cross-level research designs that will enable researchers to examine individual, family, and community factors simultaneously.

Research frequently examines questions and issues that crop up in the daily lives of millions of people—the relationship of media depictions of violence to violent behavior is a key example; the impact of strategies to discourage firearm use is another. Such familiarity often increases the likelihood that a person will hold strong opinions regarding the effect of television or popular music, or the presence and use of weapons, on violent behavior. Appropriately designed and conducted research offers a factual basis, rather than opinion, for proposing and debating social policy. It is therefore critical to devise ways of giving people with diverse interests (including parents, teachers, and others) a voice in identifying urgent research questions and to inform them about the conclusions drawn from research.


The carrying and use of guns by youths in violent encounters have declined dramatically since 1993, the peak of the violence epidemic. To accelerate that decline, we must seek to understand more completely the reasons for it. Are youths’ decisions not to carry or use guns in violent encounters related to any specific strategies put in place to discourage firearm use, or did the drop in firearm use result from other factors or conditions? Clearly, important questions remain about precisely what has happened in communities nationwide to reduce the frequency with which adolescents carry guns. While some research has addressed these questions (Blumstein & Wallman, 2000), further studies are imperative—data documenting the continuing magnitude of violent behaviors suggest that a return to lethal violence is likely if adolescents once again carry and use guns in violent encounters.


In the 1990s, faced with the epidemic of violence and largely unaware that research had found some violence prevention programs to be effective—as well as often buying into the "just desserts" philosophy—the only option some legislators saw was to lock up violent youths to protect society. New evidence makes a compelling case that intervention programs can be cost-effective and can reduce the likelihood that youths will become repeat offenders. Given this evidence, it is in the country’s interest to place as many violent youths as possible in these programs, thus correcting the imbalance that now favors use of the criminal justice system over effective intervention programs. Reclaiming youths from a violent lifestyle has clear advantages over warehousing them in prisons and training schools.

Effective programs are not available in many communities. Special efforts must be undertaken to increase awareness of these programs, provide technical assistance and information about them, and devise incentives for states and communities to invest in tested programs. At present, states and communities are squandering substantial amounts of money on untested programs or programs known to be ineffective. Policy makers must be encouraged to focus existing resources on programs that work; evidence of effectiveness might be required, for example, as a condition of receiving Federal or local funding. An informed public is also critical in building support for effective alternatives to incarceration.


Experience has shown repeatedly that intervention programs shown to be effective in their original sites do not yield uniform outcomes when replicated elsewhere. Upon examination, program evaluators often find that subtle modifications have been introduced into the model program. Lack of a particular category of personnel in a given location, for example, may prompt a program director to substitute professionals or paraprofessionals without proper credentials. Face-to-face training sessions that initially encouraged interaction between a program originator and new staff may be supplanted by videotaped tutorials. The frequency of participants’ contacts with a program may be lessened or program duration abbreviated.

Legislators, agency administrators, and program directors should be encouraged to identify incentives for ensuring that the integrity of a model program is not compromised when it is replicated.


The major challenge in implementing effective intervention programs on a national scale is guaranteeing a well-trained staff that understands the intervention and its limitations. Staff must be adequately trained to deliver a particular intervention in the specific settings for which it was designed. Yet because the supply of appropriately trained individuals who are available to work in the variety of settings in which violence prevention programs operate is limited, operational entropy often sets in. Establishing formal training programs and university certification programs will help ensure the quality of interventions.


Identifying specific youth violence interventions as effective in this report will probably stimulate demand for these programs. Youth advocacy organizations have an opportunity to educate citizens on how to interact effectively with their local educational and juvenile justice systems, with appropriate sectors of the elected government, and with private organizations involved in youth violence prevention.

Media campaigns and public service announcements offer a means of increasing public awareness. News or documentary television programs featuring model programs have had a measurable impact both on the funding of the programs and on the volume of requests from sites throughout the country for information about the programs. The 1938 film Boys Town, with Spencer Tracy and Mickey Rooney, proved highly beneficial to the reputation and funding opportunities available to Boys Town. Conceivably, featuring model youth violence prevention programs in popular films today could have an equivalent effect.


The move to a public health focus on violence involves new players and new collaborative partnerships among criminologists, psychologists, psychiatrists, sociologists, neuroscientists, and others. Physicians and other general medical service providers have important roles to play, but they are not yet sufficiently involved. Preparation of the Surgeon General’s report underscored the risks of disciplinary compartmentalization in the study of youth violence.

There is no common place where information needed by all parties interested in the problem of youth violence can be exchanged. A rich literature on research and services appears in the specialty journals of various disciplines, in professional newsletters, in the mass media, and increasingly on the World Wide Web. Lack of interaction between academic research centers and the community-based agencies responsible for implementing youth violence prevention programs or providing medical services to victims (many of whom are also perpetrators) can result in significant costs.

A periodic, highly visible national summit that receives wide popular as well as specialized media coverage would offer a way of disseminating information on new research findings, effective programs and strategies, best practices, and related information for diverse audiences.


The proportion of law enforcement agencies nationwide that report arrests to the FBI’s Uniform Crime Reports (UCR) program has been declining. In 1999, participating agencies represented only 63 percent of the U.S. population. The accuracy of national estimates would be enhanced if this reporting rate were improved. In addition to expanding the participation rate, opportunities for improvement might entail:

  • Including arrest rates for all racial and ethnic groups. Hispanics in particular are not represented in systematic data collection systems.
  • Encouraging law enforcement agencies to participate in the National Incident-Based Reporting System. Developed by the UCR, the incident-based reporting system provides a much richer data set for tracking violent crime than the aggregated data available in the current UCR. Another potentially useful, innovative data set is the National Violent Death Reporting System proposed by the Centers for Disease Control and Prevention. This data set would help in monitoring the magnitude and characteristics of youth violence on a timely basis so that programmatic and policy responses can be more effectively planned and evaluated.
  • Develop a standard set of questions for national self-report surveys (such as Monitoring the Future) that include serious violent offenses. Annual data from these surveys should be obtained from all adolescents age 11 through 17, not just high school seniors. At present, variation among surveys in the age of respondents, data obtained, and frequency of data collection severely limit any composite picture that might result. Data collection efforts must make use of the best methodology available and include follow-up questions on each reported violent event to determine weapon use, drug or alcohol involvement at the time of the event, seriousness of injury, victim’s relationship to offender, number of youths involved in the attack, and other details. Such data enable researchers to correct for the overreporting in the simple checklist used in most surveys.


Youth Violence: A Report of the Surgeon General offers compelling testimony that the safety and well-being of children and adolescents are issues of the utmost importance and urgency to individuals and organizations throughout the United States. The report has drawn on the expertise of countless persons in diverse private organizations in local, state, and Federal government agencies; in schools; and most important, in families—all of whom are dedicating immense energy and caring to countering the most common threat to the lives of young Americans. Thanks to these efforts and to the insights and actions of young people themselves, it is clear today that youth violence is not an intractable problem; rather, it is a behavior that we can understand, treat, and prevent. This final chapter has offered courses of action intended to help inform the decisions that we must make as we strive to ensure that every child has the opportunity to grow and mature safely, healthily, and happily.


Blumstein, A., & Wallman, J. (2000). The crime drop in America. Cambridge, United Kingdom: Cambridge University Press.

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