Youth violence, perpetrated both by and against young people, results in enormous physical, emotional, social, and economic consequences. Although youth violence has declined significantly in recent years, much work remains to reduce this public health burden. Homicide is the second leading cause of death among 15- to 24-year-olds overall. In this age group, homicide is the number one cause of death among African Americans, the second leading cause of death among Hispanic Americans, and the third leading cause of death among American Indians. In 1999, 4,998 youths ages 15 to 24 were murdered—an average of 14 per day. This represents approximately one third of all homicide victims that year. Among the homicide offenders in 2000 whose age was known by authorities, approximately 48% were age 24 or younger, and 9% were younger than 18. Guns are a factor in most youth homicides. In 1999, 81% of homicide victims ages 15 to 24 were killed with firearms.

Violence is also an important cause of nonfatal injuries among young people. Between 1992 and 1998, young people ages 12 to 24 were 14 times more likely than adults 50 and older to be injured as a result of a violent crime. Although nonfatal acts of violence are relatively common on school property, most acts of serious and fatal violent crime occur outside of school. For instance, less than 1% of all violent deaths among school-age children occur in schools. These data highlight the need for prevention programs that address risk for violent behaviors both on and off school property, including school-, family-, and community-based programs.

 
The Injury Center’s Niche in Preventing Youth Violence

For many years, the predominant approach to youth violence was reactive; disproportionate attention and resources were given to the medical treatment of injured victims and the apprehension and incarceration of violent offenders. A public health approach brings emphasis and commitment to identifying policies and programs to prevent youth violence. It derives from a tradition of collaboration among a broad spectrum of scientific disciplines, organizations, and communities to solve the problem of violence. In particular, the health sector, including emergency departments and community health agencies, plays a prominent role as a source of data and a potential site for interventions to prevent future violence. The public health approach also highlights the potential utility of applying a variety of scientific tools (e.g., the tools of epidemiology, behavioral and social sciences, and engineering) explicitly toward identifying effective prevention strategies. In these key ways, the perspective and methods of public health complement those of criminal justice and other sectors in understanding and responding to violence.

CDC’s Injury Center is dedicated to studying interpersonal and self-directed violence, including youth violence, intimate partner violence, child maltreatment, and suicidal behavior. Research has documented strong links among youth violence, family violence, and suicidal ideation. The Injury Center’s inclusive focus on a range of violence-related injuries provides a unique opportunity to better understand and address the linkages between youth violence and other forms of violence.

The Injury Center’s violence prevention research is intended to have practical implications and immediate relevance for prevention. For example, studies about risk and protective factors are conducted to guide prevention programs and policies. The Injury Center’s evaluation studies focus on determining not only how well programs work but also on identifying the processes through which they have an impact. This information is crucial to dissemination efforts so that schools and communities can implement programs effectively.

Several other federal agencies, including the Departments of Education and Justice, the National Institute for Occupational Safety and Health, and the National Institutes of Health study the causes and consequences of youth violence and work to prevent it. The Injury Center routinely collaborates with these and other agencies to study youth violence and to ensure that research findings are applied to practice. For example, recent partnerships with the Departments of Education and Justice have facilitated studies about school-associated violent deaths and nonfatal injuries from violent crimes such as assault, robbery, and rape. The Injury Center’s research on violence-related injuries across contexts (e.g., school, family, community), roles (i.e., victim or perpetrator), and proximal causes (e.g., intoxication, bullying, robbery), combined with its emphasis on prevention strategies, complements and extends the violence-prevention activities of other federal agencies and community-based organizations.

 
The Injury Center’s Research Priorities in Preventing Youth Violence

Every research priority in this agenda is important. After considering input from experts in the field, Injury Center staff identified the seven most important priorities, those that warrant the greatest attention and intramural and extramural resources from the Injury Center over the next three to five years. They are designated with asterisks.
 

Priorities

A.* Evaluate dissemination strategies for the most effective youth violence prevention programs.

Research has identified several individual-, family-, and school-based approaches that effectively reduce youth violence and aggression, some of which have also demonstrated effectiveness in different settings and with different populations. Youth violence prevention research should move beyond conducting efficacy and effectiveness studies to conducting research that identifies ways to disseminate the most effective strategies while maintaining the benefits of original programs. Studies should investigate factors that influence a program’s acceptability, adoption, safety, and costs. These issues are critical for implementing programs with "fidelity," that is, in the manner in which they are thought to be most effective. As described in the Surgeon General’s report on youth violence, "more research is needed on how to implement youth violence prevention programs with fidelity...how to monitor program fidelity...and how to increase community and agency capacity for implementing these programs."

Although dissemination research in youth violence prevention is underdeveloped, researchers and community organizations that have collaborated to develop and evaluate programs are increasingly seeking opportunities to facilitate wider dissemination of effective programs. Researchers should study methods to improve adoption of proven youth violence prevention programs. Necessary steps are to identify programs and strategies that rigorous evaluation has demonstrated to be effective and then to assess current practice to discover where research and practice diverge. Research about bridging this gap in dissemination practice is critical to improving the ability to disseminate the most effective violence prevention strategies.

Several recent documents, including CDC’s Best Practices of Youth Violence Prevention and Youth Violence: A Report of the Surgeon General, highlight the benefits of parenting programs. The substantial evidence for the link between parenting practices and youth risk for violence, as well as the increasing evidence that parenting practices are modifiable, supports the need for research investigating prevention strategies that affect families on a broad level.

Research in this area would further knowledge about family-level interventions that reduce youth violence and would provide strategies for influencing families and parenting. This line of research would build on the knowledge gained from evaluating existing parenting interventions to support the development and evaluation of public health–oriented parenting programs. These programs should be comprehensive and population based, and they should include multiple levels of intervention. For early childhood interventions, research should include long-term evaluations of their impact on youth violence.

Many communities and schools are implementing violence prevention strategies with little empirical evidence of their effectiveness. Research is needed to examine the effectiveness of these programs in "real-world" circumstances. It is also important to evaluate emerging community-based programs to prevent youth violence as well as programs that effectively prevent other problem behaviors such as drug abuse, which may influence youth risk for violent victimization or perpetration. The potential to identify effective programs for preventing multiple problems, for example drug abuse and violence, provides an opportunity for cross-agency collaboration. It may also be cost effective—schools and community-based organizations can address more than one problem with the same time and resources. Research should provide information about the cost effectiveness of prevention programs and generate tools for schools and communities to use to evaluate the effectiveness of their programs.

Research should evaluate the preventive impact of the most promising programs for which efficacy data are available, as well as programs that lack efficacy data but are being implemented widely. Ongoing monitoring of the practices, interventions, and policies that communities and schools adopt is essential.

Firearms are used in the majority of youth homicides. In addition, many youths carry and use firearms to intimidate their peers and may or may not intend to harm others. While much is known about the prevalence and correlates of inappropriate gun carrying among youth and the consequences of youth gun use, less is known about the factors associated with youth access to firearms and use of firearms to threaten or injure others. Research about gun carrying is needed to improve existing strategies, to develop novel strategies, and to evaluate whether strategies actually prevent inappropriate gun carrying and use and reduce firearm-related injuries.

Most of the research about risk and protective factors for youth violence has been limited to characteristics such as behavior and attitudes of the youths themselves or of their families. A significant gap in knowledge exists about the role of the larger social environment in youth violence and its prevention. For example, while the strong negative association between socioeconomic indicators and youth violence is well documented, little is known about the mechanisms linking low socioeconomic status to youth violence. Understanding these mechanisms will be extremely important in improving existing community programs and developing new programs for low-income communities. Other sociocultural and community factors that require greater research attention include the role of illicit drug markets, the nature and quality of public housing, the role of formal and informal social networks, the role of social norms, and the relationship between social capital and community rates of youth violence. Research should also examine the interaction between physical and social environments and assess how modifications in the physical environment influence behavior and risk for violence.

Certain communities are disproportionately affected by youth violence. By addressing factors in the larger social and physical environments, interventions will be better able to reduce the racial, ethnic, and social disparities for youth safety that exist in many communities. This work has important implications for policies designed to reduce injury and adverse health outcomes other than youth violence. It also is an area of research that is not currently being addressed by other funding agencies but that is directly relevant to CDC’s focus on community and population-based health.

Research about factors that buffer or moderate the effects of risk factors for youth violence is very important to the development of effective prevention strategies. To date, research about the causes of youth violence has been focused almost exclusively on understanding factors that place children and youths at greater risk for violence. While researchers have made substantial progress in identifying risk factors, a significant gap remains in understanding the factors that mitigate risks.

Improved understanding of protective factors has immediate implications for ongoing youth violence prevention efforts in schools and communities. For example, as information becomes available about how parents in low-income communities can protect their children from violence, it can be immediately communicated through existing parenting programs and public service announcements. Research about modifiable protective factors has important implications for prevention and is not being addressed elsewhere.

G.* Clarify the relationships between youth violence and other forms of violence and determine implications for prevention.

Research has consistently shown that different forms of violence—that is, child maltreatment, intimate partner violence, youth interpersonal violence, and suicide—are interrelated. For example, victims of early child maltreatment may become perpetrators of violence later in life. Another example emerging from recent acts of violence in school settings suggests that being a victim of bullying and violence may be a risk factor for suicidal behavior and violence perpetration. Most prevention strategies focus on specific forms of violence or other health-risk outcomes. Because many school-based violence prevention specialists are seeking programs with fewer individual curriculum modules and more integrated approaches to youth risk behavior, prevention strategies that are effective in multiple areas could be very valuable.

The Injury Center’s experience studying suicide, family violence, and youth violence provides a unique environment for understanding the shared and independent factors that contribute to the different forms of violence. Research about the relationships among various forms of violence can guide the development and evaluation of prevention programs that reduce multiple forms of violence. Efforts to include multiple forms of violence in studies of risk and protective factors or evaluation studies are urgently needed to improve researchers’ understanding of the specificity of youth violence prevention strategies and the ability to generalize their results. Given the limited funding available to prevent youth violence, strategies should address multiple forms of violence whenever feasible.

Prevention programs may require modification to be effective with groups other than the original target groups for whom the programs were designed. Research should test ways to adapt programs to strengthen their impact within various groups. Such research can provide useful operational definitions of cultural issues and identify limits for generalizing youth violence prevention programs across subgroups of the population. Research should identify strategies for overcoming limitations and for maximizing the impact of scarce prevention resources. The knowledge gained from this research will likely be relevant to other violence- and injury-related prevention efforts.

I. Assess the cost-effectiveness of youth violence prevention programs and their components.

Prevention science should be accountable and responsive to public health issues, and so it is necessary to evaluate not only the effectiveness of programs, but also the cost to the public to implement those programs on a broad scale. In programs with more than one component (e.g., classroom curricula, media campaigns), information about the costs, required resources, and relative contribution of individual components could be used to improve program efficiency. Researchers should build on ongoing effectiveness research and test new methods for determining the cost-effectiveness of prevention programs.

J. Develop and evaluate media-based public health strategies to prevent youth violence.

Prevention strategies that incorporate a broad array of media and are based on a public health approach to violence prevention may influence the behaviors of large audiences of youths and/or families. Research should investigate how to develop effective messages and how to identify the most appropriate audiences and venues for campaigns. Prevention campaigns serve two goals—to convey prevention messages directly to their audiences and to provide information about available programs. Both outcomes should be evaluated. The results of these evaluations will likely be relevant to similar strategies for preventing other forms of violence and other injuries.

K. Evaluate the impact of public policy on youth violence.

Researchers should study the effects of broad policy shifts, such as welfare reform, as well as policies directed specifically at youths, such as curfews. The specific policies evaluated will depend on the types of policies that emerge from federal, state, and local agencies. This policy research can be applied to a range of violence-related outcomes and will likely have relevance beyond youth violence prevention.

L. Evaluate how violence portrayed in the media affects youth violence.

Little consensus exists on the influence of various forms of media—including television, film, radio, music, print, and the Internet—on the risk for violent victimization or perpetration, especially severe forms of violence. Because of the pervasive presence of the media, developing methodologically sound approaches to evaluate its influence and building consensus on these approaches are important activities. The results of such research should inform policies and programs to decrease youth susceptibility to violence portrayed in the media.

M. Evaluate the impact of directly witnessing violence on violent behavior.

A relatively large subgroup of youths has witnessed violence. A better understanding of the consequences of exposure to violence will help guide programs designed to support these youths. Research should examine how exposure to violence affects the risk of perpetrating violence, including the potential for contagion effects (e.g., learned response, imitation), with the goal of identifying factors that may reduce the impact of witnessing violence. It should also investigate the effect that witnessing violence has on young people’s perceptions of vulnerability, attitudes and norms about violence, and emotional and social health.

N. Identify situational factors that contribute to incidents of violence.

Researchers know relatively little about how the factors immediately associated with an incident of violence, such as the behavior of bystanders, the lack of adult supervision, the presence of alcohol or weapons, and other physical factors, interact with individual-level factors to influence risk for violent behavior. Research should build upon information about the circumstances under which interpersonal conflicts are most likely to result in injury or death. The results of this research should be incorporated into existing prevention efforts and help generate novel strategies to address situational factors.

O. Increase the understanding of violent behavior and victimization among young women.

Research should identify the causes of violence and victimization among young females; examine patterns of perpetration over the female life course; and develop and evaluate interventions intended for young females. Interventions should be sensitive to cultural variations in the risk factors for violence among this population.

When it is appropriate in ongoing research, the Injury Center will test for gender differences in the risk and protective factors studied and gender-specific effects of the prevention strategies tested. Although females are included in these other etiologic and efficacy studies, it is important to consider the unique needs of females who are at risk for being victimized or victimizing others. As the results from other research indicate that specific gaps remain in the knowledge about gender differences, this line of research may be given a higher priority.

This page last reviewed September 07, 2006.

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