Youth Violence: A Report of the Surgeon General
Youth violence is a high-visibility, high-priority concern
in every sector of U.S. society. No community, whether affluent or poor,
urban, suburban, or rural, is immune from its devastating effects. In
the decade extending from roughly 1983 to 1993, an epidemic of violent,
often lethal behavior broke out in this country, forcing millions of young
people and their families to cope with injury, disability, and death (Cook
& Laub, 1998). This epidemic left lasting scars on victims, perpetrators,
and their families and friends. It also wounded entire communities and,
in ways not yet fully understood, the United States as a whole.
Since 1993, when the epidemic peaked, youth violence has declined significantly
nationwide, as signaled by downward trends in arrest records, victimization
data, and hospital emergency room records. But the problem has not been
resolved. Another key indicator of violence--youths' confidential reports
about their violent behavior--reveals no change since 1993 in the proportion
of young people who have committed physically injurious and potentially
lethal acts. Moreover, arrests for aggravated assault have declined only
slightly and in 1999 remained nearly 70 percent higher than pre-epidemic
levels. In 1999, there were 104,000 arrests of people under age 18 for
a serious violent crime--robbery, forcible rape, aggravated assault, or
homicide (Snyder, 2000). Of these, 1,400 were for homicides committed
by adolescents (Snyder, 2000) and, on occasion, even younger children
(Snyder & Sickmund, 1999). But viewing homicide arrests as a barometer
of all youth violence is quite misleading, as is judging the success of
violence prevention efforts solely on the basis of reductions in homicides.
Arrest records give only a partial picture of youth violence. For every
youth arrested in any given year in the late 1990s, at least 10 were engaged
in some form of violent behavior that could have seriously injured or
killed another person, according to the several national research surveys
in which youths report on their own behavior. Thus, despite reductions
in the lethality of violence and consequent arrests, the number of adolescents
involved in violent behavior remains disconcertingly high, underscoring
the urgency of this report.
This is no time for complacency. The epidemic of lethal violence that
swept the United States from 1983 to 1993 was fueled in large part by
easy access to weapons, notably firearms. If the sizable numbers of youths
still involved in violence today begin carrying and using weapons as they
did a decade ago, this country may see a resurgence of the lethal violence
that characterized the violence epidemic.
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
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.
This report--the first Surgeon General's report on youth violence--is
a product of extensive collaboration. It reviews a massive body of research
on where, when, and how much youth violence occurs, what causes it, and
which of today's many preventive strategies are genuinely effective. Like
other reports from the Surgeon General, this report reviews existing knowledge
to provide scientifically derived bases for action at all levels of society.
Suggesting whether and how the areas of opportunity listed in the final
chapter might lend themselves to policy development to reduce youth violence
is beyond the report's purview.
Focus on Violence by Youths
The research described here focuses on physical assault by a youth that
carries a significant risk of injuring or killing another person. It includes
a wealth of studies into the many individual, family, school, peer group,
and community factors associated with serious violence--aggravated assault,
robbery, rape, and homicide--in the second decade of life, when most such
violence emerges.1 Thus, the young people who are the focus of this report
are principally children and adolescents from about age 10 through high
school. Appropriate interventions during as well as before this period
stand a good chance of helping redirect violent young people toward healthy
and constructive adult lives. The window of opportunity for effective
interventions opens early and rarely, if ever, closes.
The Developmental Perspective
This report views violence from a developmental perspective. To understand
why some young people become involved in violence and some do not, it
examines how youths' personal characteristics interact over time with
the social contexts in which they live. This perspective considers a range
of risks over the life course, from prenatal factors to factors influencing
whether patterns of violent behavior in adolescence will persist into
adulthood. The developmental perspective has enabled scientists to identify
two general onset trajectories of violence: one in which violent behaviors
emerge before puberty, and one in which they appear after puberty. The
early-onset trajectory shows stronger links between childhood factors
and persistent, even lifelong involvement in violent behavior. Identifying
such pathways to violence can help researchers target interventions to
the periods in development where they will be most effective.
The Public Health Approach
This report reflects the responsibilities and spirit of the Surgeon General's
public health mission: to protect and improve the Nation's health. The
designation of youth violence as a public health concern invites an approach
that focuses more on prevention than on rehabilitation. Primary prevention
identifies behavioral, environmental, and biological risk factors associated
with violence and takes steps to educate individuals and communities about,
and protect them from, these risks. Central to this process is the principle
that health promotion is best learned, performed, and maintained when
it is ingrained in individuals' and communities' daily routines and perceptions
of what constitutes good health practices.
The public health perspective provides a framework for research and intervention
that draws on the insights and strategies of diverse disciplines. Tapping
into a rich, but often fragmented knowledge base about risk factors, prevention,
and public education, the public health perspective calls for critically
examining and reconciling what are frequently contradictory conclusions
about youth violence. Thus, the approach taken in the current report,
which blends offender-based research with public health concepts of prevention
and intervention, constitutes an effort to bridge the gap between criminology
and the social and developmental science approaches on the one hand, and
conventional public health approaches on the other.
The public health approach can help reduce the number of injuries and
deaths caused by violence just as it reduced the number of traffic fatalities
and deaths attributed to tobacco use (CDC, 1999). Broader than the medical
model, which is concerned with the diagnosis, treatment, and mechanisms
of specific illnesses in individual patients, the public health approach
offers a practical, goal-oriented, and community-based strategy for promoting
and maintaining health. To identify problems and develop solutions for
entire population groups, the public health approach:
- Defines the problem, using surveillance
processes designed to gather data that establish the nature of the problem
and the trends in its incidence and prevalence;
- Identifies potential causes, through epidemiological
analyses that identify risk and protective factors associated with the
- Designs, develops, and evaluates the effectiveness
and generalizability of interventions; and
- Disseminates successful models as part
of a coordinated effort to educate and reach out to the public (Hamburg,
1998; Mercy et al., 1993).
|The chapters in this report are
keyed to each of these components of the public health approach.
Myths about Youth Violence
An important reason for making research findings widely available is to
challenge false notions and misconceptions about youth violence. Ten myths
about violence and violent youth are listed and debunked. Examples of these
Most future offenders can be identified in early childhood.
Child abuse and neglect inevitably lead to violent behavior later in
African American and Hispanic youths are more likely to become involved
in violence than other racial or ethnic groups.
A new, violent breed of young superpredators threatens the United States.
Getting tough with juvenile offenders by trying them in adult criminal
courts reduces the likelihood that they will commit more crimes.
Nothing works with respect to treating or preventing violent behavior.
Most violent youths will end up being arrested for a violent crime.
|These false ideas are intrinsically
dangerous. Assumptions that a problem does not exist or failure to recognize
the true nature of a problem can obscure the need for informed policy or
for interventions. An example is the conventional wisdom in many circles
that the epidemic of youth violence so evident in the early 1990s is over.
Alternatively, myths may trigger public fears and lead to inappropriate
or misguided policies that result in inefficient or counterproductive use
of scarce public resources. An example is the current policy of waiving
or transferring young offenders into adult criminal courts and prisons.
Major Research Findings and Conclusions
This report reviews a vast, multidisciplinary, and often controversial research
literature. In the process, it seeks to clarify the discrepancies between
official records of youth violence and young people's own reports of their
violent behaviors. It identifies factors that increase the risk, or statistical
probability, that a young person will gravitate toward violence and reviews
studies that have begun to identify developmental pathways that may lead
a young person into a violent lifestyle. Also explored is a less well developed
area of research--the factors that seem to protect youths from the effects
of exposure to risk factors for violence. Finally, the report reviews research
on the effectiveness of specific strategies to reduce and prevent youth
The most important conclusion of this report is that youth violence is not
an intractable problem. We now have the knowledge and tools needed to reduce
or even prevent much of the most serious youth violence, with the added
benefit of reducing less dangerous, but still serious problem behaviors
and promoting healthy development. Scientists from many disciplines, working
in a variety of settings with public and private agencies, are generating
needed information and putting it to use in designing, testing, and evaluating
intervention programs. However, after years of effort and massive expenditures
of public and private resources, the search for solutions to the issue of
youth violence remains an enormous challenge. Some traditional as well as
seemingly innovative approaches to reducing and preventing youth violence
have failed to deliver on their promise, and successful approaches are often
eclipsed by random violent events such as the school shootings that have
occurred in recent years in communities throughout the country. Thus,
the most urgent need is a national resolve to confront the problem of youth
violence systematically, using research-based approaches, and to correct
damaging myths and stereotypes that interfere with the task at hand.
More specific major findings and conclusions are summarized below by chapter.
Trends in Youth Violence (Chapter 2)
Two distinctly different, complementary ways of measuring violence are used
by scientists--official reports and self-reports. Official arrest data are
an obvious means of determining the extent of youth violence, and a surge
in arrests for violent crimes marked the epidemic of youth violence between
1983 and 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, 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. Arrest rates for aggravated assault, however,
were nearly 70 percent higher than they were in 1983, having declined only
24 percent from the peak rates in 1994.
Youth violence can also be measured on the basis of confidential reporting
by youths themselves. Confidential surveys find that 13 to 15 percent of
high school seniors report having committed an act of serious violence in
recent years (1993 to 1998). These acts typically do not come to the attention
of police, in part because they are less likely than in years past to involve
firearms. Over the past two decades, the number of violent acts by high
school seniors increased nearly 50 percent, a trend similar to that found
in arrests for violent crimes. But neither this incident rate nor the proportion
of high school seniors involved in violence has declined in the years since
1993--they remain at peak levels. 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.
Major Findings and Conclusions
- 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
- Despite the present decline in gun use
and in lethal violence, the self-reported proportion of young people
involved in nonfatal violence has not dropped 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
- 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.
to Youth Violence (Chapter 3)
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.
In the early-onset trajectory, violence begins before puberty, whereas in
the late-onset trajectory it begins after puberty, at about age 13. These
two trajectories offer insights into the likely course, severity, and duration
of violence over the life span and have practical implications for the timing
of intervention programs and strategies. Some research has examined the
co-occurrence of serious violence and other problems, including drug use
and mental disorders, and some has looked at factors associated with the
cessation of youth violence or its continuation into adulthood. Both of
these areas need--and warrant--more study.
Major Findings and Conclusions
- 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 in adolescence without warning
signs in childhood. A comprehensive community prevention strategy must
address both onset patterns and ferret out their causes and risk factors.
and Protective Factors (Chapter 4)
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 can be found
in every area of life. Exerting different effects at different stages of
development, they tend to appear in clusters, and they appear to gain strength
in numbers. These 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 to
determine when in the life course they typically come into play. Armed with
such information, researchers are better equipped to design well-timed,
effective preventive programs. Identifying and understanding how protective
factors operate 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 effects
of exposure to specific risks for violence: an intolerant attitude toward
deviance, including violence, and commitment to school. Protective factors
warrant, and are beginning to receive, more research attention.
Major Findings and Conclusions
- 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 attributes
- 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.
Youth Violence (Chapter 5)
Research clearly demonstrates that prevention programs and strategies
can be effective against both early- and late-onset forms of violence in
general populations of youths, high-risk youths, and even youths who are
already violent or seriously delinquent. Chapter 5 highlights 27 specific
youth violence prevention programs that are not only effective at preventing
youth violence but cost-effective as well. In a number of cases, the long-term
financial benefits of prevention are substantially greater than the costs
of the programs. These promising findings indicate that youth violence prevention
has an important role to play in overall efforts to provide a safe environment
Despite these positive findings, current research on youth violence prevention
has important limitations. For example, relatively little is known about
the scientific effectiveness of hundreds of youth violence programs currently
in use in schools and communities in the United States. This situation invites
concern because in the past, many well-intentioned youth violence prevention
programs were found to have been ineffective or to have had negative effects
on youths. Even less is known about the best strategies for implementing
effective programs on a national scale without compromising their results.
Major Findings and Conclusions
- 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
- 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
- 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
- Program effectiveness depends as much
on the quality of implementation as on the type of intervention. Many
programs are ineffective not because their strategy is misguided, but
because the quality of implementation is poor.
for the Future (Chapter 6)
The most important conclusion of this report is that an array of intervention
programs with well-documented effectiveness is now in place to reduce and
prevent youth violence. Such programs are the outcome of a large body of
research that has examined the paths and trajectories that lead some youths
toward lives marred by violence. Multiple studies have identified and examined
specific risk factors--personal and environmental features of young people's
lives that heighten the statistical probability of their engaging in violent
behaviors. Research has also begun to identify protective factors that appear
to buffer the effects of exposure to risk. While this information has been
accumulating, researchers, youth service practitioners, and others have
been actively engaged in designing, implementing, and evaluating a variety
of interventions to reduce and prevent the occurrence of youth violence.
The best of these interventions target specific populations of young people,
as defined by particular constellations of risk and life experience.
Chapter 6 highlights courses of action for the
Nation to consider. Given the focus of the report, particular emphasis is
placed on consideration of research opportunities and needs. Although effective
interventions exist today, only through continued research will all intervention
programs be shown to meet a standard of effectiveness--or be discarded.
Although the research options and other courses of action suggested here
are not formal policy recommendations, they offer a vision that may inform
the generation of policies that will build on information we possess today.
They are intended for policy makers, service and treatment providers, individuals
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. The following are
possible 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
- 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.
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