Good afternoon Mr. Chairman. I am Dr. Rodney Hammond, Director of the Division of
Violence Prevention of the National Center for Injury Prevention and Control, Centers for
Disease Control and Prevention. I am very pleased to be here today to discuss the public health
perspective on violence and children. I will (1) provide data about youth violence in our
communities and schools; (2) discuss some ways we can intervene now to prevent violence,
highlighting some specific prevention programs that work; and (3) discuss how the public health
approach can contribute to the prevention of violence.
What We Know
Two main objectives in youth violence prevention are to reduce the frequency with which youth
use force or resort to violence, and to reduce the lethality of youth violence which does occur.
While any violence among children is disturbing, we should all be particularly concerned when
that violence becomes lethal. Homicide remains the second leading cause of death for young
Americans between the ages of 15 and 24 and the leading cause of death for African Americans
in this age group. For children ages 10-14 years, homicide is the third leading cause of death.
What has changed most dramatically over the past 20 years has been the emergence of fatal
youth violence -- children killing children. Although there has been a slight decrease in national
youth homicide rates since 1993, the number of young people who die violently remains
unacceptably high, and the recent multiple shootings in schools underscores the importance of
addressing youth violence. There was once a time when parents felt confident that their children
were safe at school, but now lethal violence has begun to appear in schools -- a place where
children unquestionably ought to be safe.
In the past several months, violence in schools has dominated the news and produced fear and
unease in individual citizens and communities. Also in recent months, many have been shocked
at the profile of those involved. In the Jonesboro, Arkansas, Paducah, Kentucky, and Pearl,
Mississippi shootings, all of the perpetrators were white males of an median age of 13.5; all of
the fatalities were white female of an median age of 14.5; and all of the perpetrators and victims
knew each other. Just this past weekend, the news highlighted another tragedy, this time in
Edinboro, Pennsylvania, where a 14 year-old-boy fatally shot a teacher and injured three others
at a school dance.
We have analyzed the data relating to the recent events in Jonesboro, Paducah, and Pearl, and we
also have compiled statistics from all other incidents of lethal violence in schools where multiple
deaths occurred since 1992. Our analysis shows that whereas there were only 2 recorded
multiple-death shooting events in schools between 1992 and 1995 (each involving 2 deaths),
there were 9 multiple homicide events in schools between September 1995 and the present. In
addition to the cases of Jonesboro, Paducah, and Pearl, 6 other schools have experienced violence
involving 2 or 3 deaths.
Our snapshot analysis to date is based on preliminary findings from research that the Centers for
Disease Control and Prevention (CDC) has underway, in collaboration with the National School
Safety Center and the Departments of Education and Justice. In conjunction with the U.S.
Department of Education, we are extending our monitoring of violent, school-associated deaths
in order to document whether multiple-death incidents represent an increasing trend.
Will prevention strategies that show promise in high-risk urban areas be applicable to suburban
and small-town America? While we do not yet have all of the answers needed to prevent all
incidents of school or community youth violence, we do know enough to act now. This is what
we know about the problem of youth violence:
This is a problem of children killing children. What is so shocking about recent events is the
age of the perpetrators and the victims. In recent years the average age of homicide offenders
and victims has grown younger and younger, according to statistics from the Departments of
Justice and Health and Human Services. More and more, instead of settling disputes with a
fist-fight in the school yard children are taking out their frustrations in far more aggressive ways. Data suggest that youth violence has become worse -- not because children are fighting a lot
more -- but because their fighting has become more lethal.
The problem is not limited to inner cities. The recent school shootings in small towns have
countered the stereotype of youth violence as an inner-city, gang-related problem. In fact, while
youth homicide rates in major urban areas have dropped in recent years, rates in mid-sized urban
areas are constant or even increasing in some areas. This pattern may represent the spread of
youth violence from our cities to rural America or this may be a totally different problem. There
are enough differences in the circumstances of these incidents to warrant a closer look.
Violence in schools occurs more than any of us would like to believe. Even a single killing in
or around a school is a devastating event. We need to be assured that schools are safe for our
children. Although violence in school settings represents only a tiny fraction of all youth
violence (less than 1% of violence-related deaths [homicide and suicide] among school-aged
children between 1992 and 1994 occurred in or around schools), the number of multiple killings
in the past 3 years is cause for grave concern. Moreover, we must check the violence occurring
in our communities as well as in our schools. Schools and communities are linked in so many
ways that it is virtually impossible to consider the problem and possible solutions in isolation.
What happens inside and on the way to and from the school reflects what is happening in the
surrounding community.
Homicides are only the tip of the iceberg in terms of youth violence. Understandably,
attention focuses on the terrible tragedy of violent deaths. But there is an underlying layer of
non-fatal violent behavior that should alarm us, both for its own sake and as a precursor to lethal
violence. We do not have all of the information we need to quantify the impact of non-fatal
violence. We do know, according to the CDC's Youth Risk Behavior Survey (YRBS) - a
national survey of high school students, that in 1995, 40% of high school students reported being
in at least one physical fight in the past 12 months, 20% reported carrying a weapon at least once
in the previous 30 days, and more than 7% had carried a gun. More than 8% of the students
reported being threatened or injured with a weapon on school property during the previous 12
months. And 1 out of 20 students was afraid to go to school at least once in the previous 30 days
because of the threat of violence.
These YRBS statistics should be clues that there are "early warning signs" of potentially lethal
violence. Tracking the overall national incidence of threats, weapon carrying, and other clues to
potentially violent behavior is important. In addition, it is important that we respond to threats in
individual school settings. In at least two of the recent school shooting events, verbal threats
reportedly preceded the killings. The threats were not reported to school officials, who might
have intervened.
The majority of school violence occurs among friends or acquaintances not strangers. A
study of 1992-1994 school-associated violence found that 85 of the 105 deaths resulted from
interpersonal disputes -- not random violence inflicted by a stranger. In other words, the young
person's inability to manage anger, resolve inevitable adolescent conflicts, or rebound from a
failed romance or rejection by friends too often fuels a violent, often lethal response. As with so
many adult homicides, these school-related killings can be seen in the context of personal
relationships. In each of the 3 recent multiple school shootings, all of the perpetrators knew the
victims. In 2 cases, the motivation appears to have been revenge for perceived romantic
rejection; in the other, the young man apparently had mocked his peers who were part of a
regular prayer circle. Many promising prevention strategies focus on teaching young people how
to improve their skills in managing anger and interpersonal conflict.
Schools and our society in general are ill-prepared to deal with the problem of school
violence. We need more information to develop response plans, policies, and training to prevent
violence in schools. As a society, we haven't yet developed the capacity to respond to the
problem of kids killing kids, and we are not yet equipped to respond to the phenomenon of
younger children becoming involved, as perpetrators and as victims, in homicides. In shaping an
effective response, we must focus on prevention.
What Can We Do About This Problem Now?
Prevention is possible and we don't have to understand all the reasons why children commit
violence before we take action. We know enough now to invest in solutions that can prevent
future tragedies -- in schools and communities. Violence prevention efforts focus on changing
individuals' attitudes, beliefs, and behaviors; improving the social environment of families,
peers, and the community; or changing the physical environment, such as addressing access of
young people to alcohol and other drugs, as well as unsupervised access to weapons. We can't
expect any single action to solve the problems of youth violence, but over time, these approaches
can make a difference.
Research undertaken by CDC and other respected researchers in the field show that there are
three actions we can take now that could have a tremendous impact on our ability to prevent
school violence: (1) increase efforts to reduce the propensity of young people to use anger or to
resort to any kind of violence as a response to interpersonal problems; (2) use current technology
to generate better information about the nature and scope of the problem and to deliver tools to
parents teachers, and other community members; and (3) prevent the escalation of violent
behavior into lethal actions.
Increase efforts to reduce the propensity of young people to use force or to resort to any
kind of violence as a response to interpersonal problems. Many strategies have promise, such
as parenting programs that focus on parents and young children and school-based training that
enhances students' social and problem-solving skills. Recent evaluations of such programs
confirm that they do have an impact on reducing aggressive behavior and/or violent acts. A
number of youth violence prevention projects supported by CDC have shown encouraging
results. These projects have targeted predominately urban, high-risk youth and may be
applicable to other areas of the country; however, these projects have not been evaluated in rural
settings. Ongoing, follow-up studies on these programs will look to see if these results are
appropriate for replication and continue to show promise over time. Here are some specific
examples:
- Peace Builders in Tucson, Arizona, and Salinas, California, work in elementary schools to
reduce physical and verbal aggression by creating a "culture of peace" within the school.
Throughout the school year, counselors or other specially trained instructors, using various
methods such as modeling, role play, and self-monitoring teach students to interact socially
in a positive way. The main messages are to praise others, avoid insults, seek advice, and
speak up about hurt feelings. The intervention has achieved significant behavioral
improvement. Teachers reported an overall decline in individual problem behaviors such as
fighting and destruction of property belonging to others. The follow up study will look to see
if these results continue to hold up over time as the students progress through middle school.
- The University of Michigan is evaluating a three-level intervention to prevent aggressive and
violent interpersonal behavior among high-risk urban youth, ages 7-13, residing in
high-violence areas of Chicago and Aurora, Illinois. The first level consists of classroom-based
training to increase awareness and knowledge about factors that influence peer and other
social relationships. The next level includes activities in the first level plus training
conducted through small groups and peer relationships for high risk children. And the third
level adds a family intervention for the high-risk children and their families. The results
show that a combination of classroom, small group and family interventions significantly
reduced aggressive behavior among study participants who had demonstrated higher levels of
aggression.
- In Richmond, Virginia, the Youth Violence Prevention Program is a school-based project to
reduce aggressive behaviors among 6th graders. The 16-session curriculum teaches students
how to use alternative methods to deal with violence and how to use adaptive methods to
deal with anger. The program also has a peer mediation program that uses a problem-solving
approach to reinforce the skills students learn in the curriculum. The results show significant
reductions in fight-related injuries requiring medical attention, a lower frequency of threats to
hurt a teacher, and significant improvements in self-esteem. Students in the program had
fewer suspensions for fighting, bringing weapons to school, disruptive behavior, and defiance
of school authority.
- A study of a violence prevention curriculum for elementary school students in Seattle,
Washington, showed a positive impact in reducing aggressive physical acts and increasing
pro-social behavior. The effect was modest, but combined with a growing body of evidence
from other evaluated interventions, should give us hope that, just as violence is a learned
behavior, it can be unlearned.
We have put in place some programs that work, and we know some strategies for reducing youth
violence. However, we need a more complete response to this problem. Parents, teachers,
school administrators and others need to have ready access to the best, most current,
science-based information. They need the skills to identify and help children at risk so that the
tragedies
of our inner cities and the tragedies of Jonesboro, Paducah and Pearl aren't repeated.
Collect and disseminate information about youth violence.. Although we have been able to
gather some information on recent school shootings, we lack comprehensive data on violent
injuries that are consistently collected over time. It is not enough just to count cases of deaths
among young people. Descriptive information about the violent events is needed, such as the
demographic characteristics of the people involved, the relationship between the victim and the
perpetrator, and the severity and cost of the injury. A surveillance system that collects, analyzes,
interprets, and disseminates such data would provide valuable information for school
administrators, law enforcement officials, and other policy-makers. Experience with sound
surveillance systems shows that such systems are effective tools for guiding future prevention
efforts. For example, the Fatality Analysis Reporting System (FARS) has provided vital
information about automobile crashes and helped guide prevention efforts in that area of injury
control. We also need to provide technical assistance and state-of-the-art information about what
works to parents, teachers, and other community members who need to be involved in violence
prevention.
Prevent violent behavior from becoming lethal. While fist fights and playground scuffles are
harmful, we need to embark on a constant vigil to prevent these incidents from becoming fatal.
Over 85% of all violent deaths among children 10-14 years of age involve the use of a weapon.
Between 1993 and 1995, if 10-14 year old children did not have unsupervised access to lethal
weapons, 1,112 children might be alive today and thousands of other children may have been
spared serious injury. Although homicide rates have begun to decrease, the recent school
fatalities illustrate the potential for tragedy when young people have unsupervised access to
lethal weapons. Children's unsupervised access to lethal weapons increases the likelihood that
young people's disputes will result in death, rather than a black eye or injured pride.
In particular, firearms were used in 90% of the deaths resulting from the violent use of a weapon
for 10-14 year old victims in 1993-1995. Firearm-related injuries that did not result in death are
even more numerous. For example, more than 21,000 school-aged children were treated in
emergency departments for firearm-related injuries in 1995. We know that the lethality of
violence among children has increased over time, and statistics show that the increase is
associated with firearms.
What Does Public Health Have to Offer?
Public health can make an important contribution to preventing youth violence. We all
wish there were one simple solution to this problem of school violence. The reality is that
there's no such thing. The problem is complex and the response needs to draw on the best that
all sectors have to offer: education, psychology, social work, criminology, public health,
medicine, and others. It is critical to provide leadership and mobilize these diverse disciplines to
seek creative solutions to the problem of violence, and to translate what we know from science
into sound prevention programs. Public health strategies can contribute significantly.
In public health, we are approaching the problem of youth violence by asking four questions:
- What is the problem? (Surveillance)
- What are the causes? (Research)
- What works to help prevent the problem? (Intervention evaluation)
- How do you do it? (Program implementation)
At CDC, we are addressing the problem of youth violence through the lens of each of these steps.
We are supporting research to identify some of the risk factors for violence among young people,
such as the impact of economic and neighborhood characteristics, access to lethal weapons, and
the influence of ethnic identity on young males. We have recently evaluated 14 youth violence
programs around the country to determine which approaches, or combination of approaches,
appear to be effective. We have briefly described the ongoing evaluations of promising
programs that promote positive social environments for young children and their families. We
also have produced a manual to help communities develop prevention activities -- Prevention of
Youth Violence: A Framework for Community Action -- and are in the process of developing
recommendations for "best practices" that characterize promising violence prevention strategies.
We also are pursuing projects in the following areas:
- School-based Violence Prevention. Schools need to know about effective violence
prevention programs based on our present knowledge. The Best Practices manual that we are
developing can help. There needs to be a way to communicate information about good
programs systematically, including the Best Practices document, when it becomes available.
Many schools have programs that are not based on the best scientific knowledge and are not
being implemented as designed. In partnership with the Departments of Education and
Justice, we are providing schools with guidance in selecting violence prevention programs.
But we are just beginning to fill the needs of the schools.
- Comprehensive School Health Education. Young people must acquire the skills needed to
prevent future injuries and violence. To help state and local educational agencies and schools
promote safety and teach students the skills needed to prevent future injuries and violence,
CDC, in collaboration with other federal and national non-governmental organizations, has
recently begun the process of developing evidence-based injury and violence prevention
guidelines. The guidelines development process has been successfully employed for the
topics of tobacco use prevention, HIV infection prevention, nutrition, and physical activity.
It includes an extensive review and synthesis of the literature on effective program
components and the creation of an expert panel to guide the process.
- Communication Skills Between Parents and Schools. Parents need to see schools as a
resource for help with children who exhibit problem behavior. The schools can link parents
to programs in the community, but there is a gap in getting knowledge to the parents.
Schools can help bridge this gap.
- Parenting Skills. Parenting programs are important because the behavior of adults in the
home can have an enormous influence on children. Parenting skills training can make a
difference in preventing violence and anti-social behavior in children. Many parents need
assistance to develop structured environments, and they need learn how to talk with their children about
the risks of weapons and fighting.
- Outreach to high-risk youth. Many youth are not accessible in traditional settings such as
schools. We need to support the implementation of efforts to identify and recruit high-risk
youth into programs intended to reduce the risk of violence.
These are but a few of the approaches that our society can take to reduce youth violence,
including violence in and around schools. Our job as parents and citizens is to give children the
chance to grow up in safe communities and safe schools. Our job as public health practitioners is
to use science to help understand the patterns, causes, and prevention of violence among young
people. The need to prevent these deaths is urgent, and we have the tools to begin to craft a
response.
The time to take action is now. We must turn our efforts to preventing future injury and loss of
life to our young people. Along with our partners in other federal agencies, such as the
Departments of Justice and Education, the public health community can make a substantial
contribution to preventing violence among children.
Mr. Chairman, this concludes my testimony. I am happy to answer any questions you or other
members of the Subcommittee may have.
