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Abstract
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Violence and its consequences are a major issue to be addressed by the health care community. The magnitude and characteristics of the problem cry out for new, creative approaches and provide for some insight into the direction that needs to be taken. Some of the components related to violence are societal in scope and will require long-term strategies well beyond the immediate realm of the health care system. Others provide direction that more clearly present a role for health providers and public health planners. Although there will be no easy answers or solutions to this problem, it is essential that support be developed for experimental efforts. The health community cannot ignore this problem and can in fact make a real contribution to its resolution through prevention, treatment, and research.
VioLit summary:
OBJECTIVE:
The purpose of this article by Spivak et al. is to review characteristics and the etiology of violence and intentional injury among adolescents. A discussion of the role of clinicians and public health in combatting the problem is included.
METHODOLOGY:
A non-experimental review of literature on homicide and intentional injury was employed for this study. Because most of the literature located was homicide literature and intentional injury literature was so rare, much of the information was derived from the homicide literature for both topics.
FINDINGS/DISCUSSION:
For the first section of the article, the authors first gave an overview of societal and cultural factors associated with homicide/intentional injury and then reviewed individual factors. Societal/cultural factors that were pertinent were race, SES, gender, age, and pressures associated with adolescence. Blacks were overrepresented in homicide statistics; 44% of the victims were black. 80% of the homicides occurred between persons of the same race. As such, the authors contended that little violence was actually instigated directly by racism. SES was found to be a greater predictor of homicide and, in fact, the overrepresentation of blacks as offenders and victims disappeared when SES is taken into account; blacks were overrepresented among the lower SES groups. Lower SES was also found to play a role in intentional injury. Homicide rates were highest in urban areas characterized by low SES, high population density, poor housing, and high unemployment. 77% of the homicide victims were male; females were more represented in intentional injury. Differences in weapon- carrying behavior and social expectations were thought to contribute to females' lower rate of more serious injuries and homicide, though it was speculated that female media heroes who are violent will increase the gap. Adolescence was associated with high risk because of rapid psychological and physical changes that occur in the transition to adulthood. Major developmental tasks were described that predispose teenagers to violence; these included 1) narcissistic period of self-development, 2) development of sexual identity that includes a period of identification of sexual extremes, 3) development of a moral and personal value system through experimentation, and 4) preparation for future employment and responsibilities. Individual factors were also reviewed. 60% of victims and assailants knew each other, and 20% of victims and assailants were members of the same family. 50% of homicides were precipitated by arguments while 15% were committed in the course of committing another crime. 50% of victims had elevated blood alcohol levels. The key to prevention, the authors concluded, may be in greater understanding of the behavioral components that contribute to violence. The availability of firearms has been found to have a major impact on homicide rates; troubling in particular because many youth in schools carry weapons at least occasionally. A Boston study found 37% of males and 17% of females carried a weapon to school at some point in the school year. There has been evidence that violence is a learned response to stress and conflict; such learning could take place in the home and through violent television. Early exposure to family violence, incomplete schooling, illiteracy, depression, chronic alcohol and drug use, and low self-esteem were found to be among risk factors for both being an assailant and a victim of homicide. Such organic factors as severe head trauma were also found by some to be associated with violent behavior.
AUTHORS' RECOMMENDATIONS:
The authors recommended, in general, that medical and public health settings have a great potential for primary prevention and avoidance of later problems related to violence. Few intervention programs were found that actually responded to the problem itself. Efforts to handle the identifiable risk factors should, the authors suggested, be implemented in these ways: l) primary prevention of violence as a response to anger and conflict, 2) screening for and early identification of high risk individuals, 3) increased availability of secondary level services for the high risk population, and 4) improved rehabilitative services. Collaboration was advocated between the medical and public health communities and other appropriate human service, mental health, education, community, and criminal justice institutions. The possibilities discussed for individual clinicians were working with parents, direct discussion with adolescents about anger and violence that legitimizes anger while offering other options, early identification of youth at high risk for violent behavior, and actively working with development and availability of intervention services for violent behavior. Additionally, the authors expressed a need to modify the response of health care professionals to youth with intentional injuries that goes beyond the treating of the injury without attention to the circumstances of the injury or the underlying issues and behaviors that may have led to the injury; routine and adequate assessment were seen as critically important and should include circumstances, relationship to the assailant, use of drugs or alcohol, presence of underlying emotional or psychosocial risk factors, history of intentional injuries or violent behaviors, predisposing biologic risk factors, and intent to seek revenge. The public health system, in general, was seen to be an important factor in change. Community awareness, attempts to manipulate the environment to reduce risk, and improved secondary prevention and intervention services were suggestions. Broad societal issues that the authors wanted to see addressed were poverty, racism, improved control of weapons, efforts to reduce substance abuse in this country, and changing of media programming toward more nonviolent heroes. The medical and public health communities would contribute to this level of strategy as well, the authors believed. A call for more research was also made, particularly for intentional injuries research.
EVALUATION:
This study takes a unique approach to the issue of homicide/intentional injury. In the examination of victim characteristics, the public health approach treats violence with a disease model. In doing so, this approach acknowledges the interactional components of the offense that come from both sides. The key issues were covered. The prediction about increased female homicide rates is not a new one, and it is also a prediction that has not come true despite many changes in gender relations. The suggestions offered were direct; however, there was only general discussion and not particular suggestions as to how an individual might incorporate some of the strategies laid out. Additionally, particularly the societal changes, suggestions included major changes that others have tried to effect, but none have been successful. However, this does not necessarily lead us to give up the dream of conquering such things as poverty and racism. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado)
N1 - Call Number: F-441, AB-441
KW - Public Health Approach
KW - Homicide Victim
KW - Homicide Offender
KW - Homicide Causes
KW - Homicide Prevention
KW - Injury Causes
KW - Injury Prevention
KW - Literature Review
KW - Violence Prevention
KW - Violence Causes
KW - Sociocultural Factors
KW - Socioeconomic Factors
KW - Prevention Recommendations
KW - Juvenile Violence
KW - Juvenile Offender
KW - Juvenile Victim
KW - Public Health Personnel
Language: en |