In a review of progress on Healthy People 2000 objectives for Violent and Abusive Behavior, the Centers for Disease Control and Prevention (CDC) led a discussion of selected objectives to achieve a "Safe America."

7.1 Data for 1995 (9.4 per 100,000) indicate a further decline in the age-adjusted homicide rate per 100,000 people from the peak of 10.8 in 1991. The year 2000 target is 7.2. Preliminary 1995 data (115.6 per 100,000) for black males aged 15-34 indicate movement toward the target of 72.4.

7.2 Preliminary data for 1995 show an age-adjusted suicide rate of 11 per 100,000, a decline from baseline levels. The year 2000 target is 10.5. Data for 1994 all special populations except white males aged 65 and older show movement away from the targets.

7.3 For firearm-related deaths, preliminary age-adjusted data for 1995 (13.5 per 100,000) show a decrease from the 1994 rate and the 1990 baseline (14.6). The year 2000 target is 11.6. Data for 1994 for Blacks (35.5 per 100,000) indicate that rates are still above the 1990 baseline (33.4) and the target (30).

7.4 The incidence of maltreatment of children younger than age 18 was 41.9 per 1,000 children in 1993, an 85 percent increase from the baseline. The year 2000 target is 22.6.

7.5 The year 2000 target is to reduce physical abuse directed at women by male partners to no more than 27 incidents per 1,000 couples. The original data source is no longer available. However, data from the Bureau of Justice Statistics' National Crime Victimization Survey suggests an increase in physical abuse rates.

7.6 Data from the Crime Victimization Survey indicate there were 12.7 assault injuries among people aged 12 and older in 1994. Because the survey was redesigned in 1992, the data are no longer comparable to the baseline and the year 2000 target.

7.7 Data on rape and attempted rape of females aged 12 and older are no longer comparable to the year 2000 target and the baseline, due to the 1992 redesign of the Crime Victimization Survey. Data for 1994 indicate rates of 270 per 100,000 females aged 12 and older and 527 per 100,000 for females aged 12-34.

7.8 The rate of injurious suicide attempts among adolescents aged 14-17 was 2.8 percent in 1995. The year 2000 target is 1.8 percent. The 1995 rate for female adolescents aged 14-17 has increased from 2.5 percent in 1991 to 3.4 percent in 1995. The target is 2 percent.

7.9 In 1995, there were 128 incidents of physical fighting among adolescents aged 14-17 per 100 students per month. The year 2000 target is 110. The rate for black males aged 14-17 was 181 per 100 students per month, a decrease from the 1991 baseline of 207. The target is 160.

7.10 There has been a decrease from the 1991 baseline of 107 in the incidence of weapon-carrying by adolescents aged 14-17. The 1995 rate was 81 per 100 students per month, which surpasses the year 2000 target of 86. There has also been a decrease from 134 in 1991 to 85 in 1995 in the rate for black adolescents aged 14-17. The target of 105 has been met.

7.11 The 1995 National Health Interview Survey indicates that 20 percent of people who reported owning a firearm stored the weapon unlocked or loaded. These data provide a baseline for this objective on inappropriate storage of weapons.

7.13 By 1995, 48 States had implemented systems to review unexplained deaths of children. The year 2000 target of 45 has been met.

7.15 The National Coalition Against Domestic Violence provided the 1987 baseline that 40 percent of battered women and their children were turned away from emergency housing, due to lack of space. There is no identified data source for updates.

7.16 The School Health Policies and Programs Study reports that 58.3 percent of middle, junior and senior high schools taught conflict resolution as a required course in 1995. This new baseline for the objective exceeds the year 2000 target of 50 percent.

7.18 The National Center for Institutions and Alternatives (NCIA) reports that one State met NCIA guidelines in 1996 for suicide prevention in jails, a decrease from the 1992 baseline of 2 States. However, the Bureau of Justice Statistics reports that 79.5 percent of jails have suicide prevention policies and training for staff.

7.19 The year 2000 target for the enactment of laws requiring proper firearms storage to minimize access by minors is 50 States and the District of Columbia. The number reached 15 in 1996, an increase from the 1989 baseline of one.

Data sources are not available for establishing baselines and tracking objectives 7.12, 7.14 and 7.17. All information about the objectives is based on data compiled by the CDC National Center for Health Statistics.

HIGHLIGHTS

• At the 1996 World Health Assembly, 190 nations acknowledged violence as a public health problem.
• In the United States, recent data show declines in homicide--particularly for those involving firearms--suicide, and weapon-carrying among high school youth.
• New York City has achieved a 25 percent reduction in violent crimes, including homicide. An important element in this success was a campaign against non-violent crime.
• In Boston, parole officers routinely ride with the police in patrol cars. Their success in identifying parole violators has helped lead to a reduction in violent crime. Another contributing factor to the lowering of crime rates in that city is that half of the schools provide training in conflict resolution.
• In the age group 15-34, firearms are the leading cause of injury deaths, exceeding the number of deaths from auto accidents. In 10 States and the District of Columbia, they are the leading cause of injury deaths for the total population.
• The rate of firearm injuries can be reduced by employing a public health model similar to that which led to a reduction in injuries from motor vehicle crashes. This entails close cooperation among police, crime laboratories and hospitals.
• Studies have shown that asking questions about suicide does not increase the likelihood that patients will attempt suicide.

A number of projects were highlighted:

• In Dayton, Ohio, the school-based Positive Adolescent Choices Training (PACT) program focuses on black adolescents who are at high risk of becoming perpetrators or victims of violence. Adolescents in the program have shown reductions in violent confrontations and improvements in managing conflict.
• In the Healthy Families America program, prenatal home visits by counsellors are linked to better birth outcomes and decreased rates of child abuse.
• In Houston, Texas, the Black Male Initiative has achieved a large measure of success in preventing violence among minority youth and young adults through an intergenerational approach--college students mentor high school students, high school students mentor middle school students, middle school students mentor elementary school pupils, and elementary school pupils mentor Head Start children.
• The Milwaukee Women's Center initiated a public awareness campaign designed to decrease violence against women. Milwaukee Transit Company buses display the Center's messages about family and intimate partner violence. The number of calls to domestic violence hotlines and agencies have increased, including calls from men admitting they need help.
• In rural New Mexico, tribal leaders and other members of the Jicarilla Apache Tribe have engaged in a suicide prevention effort in schools and a public education campaign to make the community aware of the problem. The number of suicide attempts has dropped and no suicides were recorded in 1995.

FOLLOW-UP

• Reach a better understanding of the impact of intimate partner violence through studies that help to quantify the magnitude of the problem.
• Determine ways to improve the reporting of domestic violence by establishing consensus about definitions and refining methods for collecting data.
• Examine the relative contribution of social norms, law enforcement and the public health approach in violence prevention.
• Determine the impact of conflict resolution training and other school-based curricula dealing with violence prevention.
• Address the rising rates of black adolescent male suicide by improving techniques for identifying people likely to attempt suicide and connecting them to counselling programs.
• Conduct longitudinal studies to examine the intergenerational impact of violence, e.g., the phenomenon that abused boys and those who have observed abuse in their families grow up more likely to be abusers of their wives and children.
• Explore the feasibility and estimate the cost of a firearms injury reporting system.

PARTICIPANTS
Administration for Children and Families
Association of State and Territorial Health Officials
Centers for Disease Control and Prevention
Department of Justice
Georgia Department of Public Health
Indian Health Service
Jicarilla Apache Tribe
Medical College of Wisconsin
Milwaukee Women's Center
National Committee for the Prevention of Child Abuse
New Hampshire Department of Public Health
Office of the Assistant Secretary for Planning and Evaluation
Office of Disease Prevention and Health Promotion
Office of Minority Health
Office of Public Health and Science
Office of the Surgeon General
Office on Women's Health
Regional Health Administrator, Region III
Substance Abuse and Mental Health Services Administration
Texas Southern University
Violence Prevention Training Institute
Wright State University

Philip R. Lee, M.D.
Assistant Secretary for Health

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