STREET VIOLENCE

Violence is the "intentional use of physical force against another person or against oneself, which either results in, or has a high likelihood of resulting in, injury or death" (Rosenberg, O'Carroll and Powell 1992, p. 3071). Violence is typically categorized according to the relationship between the victim and the perpetrator, as well as the location in which it takes place.

In general, street violence refers to the use of physical force by individuals or groups within public spaces, the result of which may involve injury or death. This definition is quite broad and includes the forms of violence that are most often addressed by public health practitioners and researchers, particularly gang and youth violence, which often take place in the street or other open areas.

Although statistics for violent crimes do not always specify the location of the incident, approximately one third of violent crimes occur in a street or open area. School-related violence has gained widespread media attention and concern; however, many violent acts committed by adolescents take place off of school property. In 1999, over one-third (35%) of U.S. high school students had been in a physical fight, while only one in seven students had a physical fight on school property. Homicides of school-age individuals are even less likely to take place on school property. Between 1992 and 1994, less than 1 percent of homicides of school-age persons occurred on school property, with the majority occurring on streets.

Street violence takes a variety of different forms, including actual or threatened homicide, rape and sexual assault, robbery (with or without injury), and assault. Although not all street violence is gang related, the relationship of gangs to homicide makes street violence a public health issue. Over 94 percent of U.S. cities with populations over 100,000 have street gangs, and many smaller and more rural cities report street gang activity. Membership in a street gang increases the risk of violent death by 60 percent.

Recognition of violence, including street violence, as a public health priority is relatively recent. In 1979, the Surgeon General's report Healthy People included interpersonal violence as one of fifteen priority areas for improving the health of the U.S. population. More objectives for improving the public's health through reducing violence have been included in the updated versions, Healthy People 2000 (Public Health Service, 1991) and Healthy People 2010 (Public Health Service, 2000). These objectives target health status (e.g., reduce homicide rates), risk reduction (e.g., reduce weapons carrying and physical fighting among adolescents), and services (increase the proportion of schools that offer conflict-resolution programs).

Violence, particularly among youth, is a public health priority because it causes premature death, injury, and disability. Homicide is the second leading cause of death for people aged 15 to 24 years, and is the leading cause of death for African– American males aged 15 to 24 years.

Street violence may also result in serious nonfatal injury and temporary or permanent disability. Among youth, violence is a leading cause of nonfatal injuries, second only to motor vehicle accidents. In 1994, an estimated 1.4 million people were treated in hospital emergency departments for violence-related injuries. Nearly one-half of all the injuries treated occurred in public buildings or on the street. Of all of the injuries treated, one-third were cuts or stab wounds and 5 percent were gunshot wounds. Severe injuries to children due to intentional shootings also typically occur in streets or other open areas.

Street violence also results in financial burdens. Injuries may result in days missed from work or school, causing victims to lose wages and/or academic progress. Injuries resulting in permanent disability may further affect the social, emotional, and economic consequences for victims. Society too, bears the financial burden of violencerelated injuries. Acute care and rehabilitation for injuries can cost thousands of dollars, and not all patients have adequate money or insurance to cover the costs. Unpaid medical costs are passed on to hospitals and taxpayers.

STREET VIOLENCE PREVENTION

Public health utilizes three levels of prevention: primary, secondary, and tertiary. Primary prevention strategies aim to prevent a problem (i.e., violent acts) before it occurs. The goal of secondary prevention is to prevent further injury. Tertiary prevention aims to limit the extent of disability after an injury has taken place. Criminal justice strategies for violence prevention are often in the secondary category. By removing individuals who have already become violent, criminal justice attempts to reduce the likelihood of further injuries or deaths caused by the already violent person. Public health strategies, specifically primary prevention strategies, make an essential contribution to criminal justice efforts because they may keep individuals from committing violent acts in the first place.

The public health approach utilizes health-event surveillance and epidemiology to determine who are the victims and perpetrators of violencerelated injuries and where and when violencerelated injuries occur. The answers to these questions tell public health researchers and practitioners where to direct prevention efforts.

Adolescents currently have the highest and most rapidly increasing rates of lethal and nonlethal violence. As youth are at much greater risk of being victims or perpetrators of street violence, they are an important audience for violence prevention programs. Further, because males, African–American and Hispanic youth, and residents in poor urban neighborhoods are more likely to engage in and be victims of street violence, prevention programs are also developed specifically for these populations.

In order to develop effective prevention programs and policies, public health must first determine what factors cause individuals to commit violent acts. Public health surveillance and epidemiology identify risk characteristics. However, not all individuals with these characteristics engage in violence. Public health researchers use a variety of theories from different disciplines (e.g., psychology, sociology, criminology) and scientific research to determine what factors either increase or decrease the risk that individuals will commit violent acts and what factors are possible to change through prevention programs. Psychosocial (proviolence attitudes, low self-control) and behavioral (drug selling, weapons carrying) characteristics may also increase youths' risk for engaging in violent behaviors such as street violence.

Characteristics of social and physical environments are also a factor in street violence. Social environments include exposure to violence or violence-promoting attitudes through families, peers, schools, neighborhoods, and even media (e.g., television). Adolescents who have been victims or witnesses of violence are more likely to engage in violent behaviors. In addition, children raised by individuals with poor parenting skills, those living in high-crime and dangerous urban neighborhoods, and those exposed to or involved in gangs are more likely to engage in violent behaviors. Young people living in urban areas may be more likely to engage in gang-and nongang-related violence because in areas with poor economic and educational opportunities, violence may become a way to gain respect and status.

Some violence-prevention programs target children and adolescents identified as having aggressive behaviors and attitudes and try to change these behaviors and attitudes before they develop into more violent behaviors. These programs attempt to promote self-esteem, problem solving, and development of nonviolent attitudes and interpersonal skills in high-risk children and adolescents.

While prevention strategies targeting individuals are important, they may fail to reach some individuals. It is not always easy to identify which individuals will later engage in violent behaviors. Other public health strategies for reducing violence focus on community or even societal level changes as well as individuals. These changes affect everyone, not just those successfully identified as being at high-risk. As availability of firearms has been associated with the risk of violence, policies that reduce the overall availability of weapons on the street may help reduce firearm injuries and deaths. Changes in the physical structures (e.g., improved lighting, limitations in through-traffic) can also reduce rates of violent street crimes within neighborhoods. Policies that promote economic and educational opportunities may help young people resist the pressures to join gangs in order to achieve self-esteem and respect in dangerous high-crime neighborhoods.

Some of the most promising prevention programs attempt to change a variety of factors; that is, they attempt to intervene not only with individuals, but also with families, schools, and neighborhoods. For instance, the Seattle Social Development Project promotes positive development of children and youth by training teachers and parents in classroom and family management strategies that promote problem solving, effective communication, conflict resolution skills, self-esteem, and autonomy. The program is designed to promote children's bonding to schools and parents (or other positive adult role models), so they will be better able to resist pressures to engage in a variety of health-compromising behaviors, including violence. Children who participated in this program throughout elementary and middle school were found to be less likely than those who did not participate to have engaged in violent behaviors by the time they were eighteen years old.

Prevention of street violence requires the collaboration and cooperation of public health professionals with those in other academic disciplines, law enforcement, and social policy positions. Prevention programs need to be rigorously evaluated to determine the most effective strategies to prevent individuals from engaging in street violence. In addition, legal and policy strategies could reinforce public health efforts to help alleviate the human, social, and economic costs of street violence.

Ralph DiClemente

Catlainn Sionean

(see also: Adolescent Violence; Crime; Gun Control; Healthy Communities; Healthy People 2010; Homicide; School Health; Social Determinants; Urban Health; Violence; Youth Risk Behavior Surveillance System )

Bibliography

Anderson, E. (1999). Code of the Street: Decency, Violence, and the Moral Life of the Inner City. New York: W. W. Norton.

Centers for Disease Control and Prevention (2000). Morbidity and Mortality Weekly Report. CDC Surveillance Summaries. June 9, 2000.

Hawkins, J. D.; Catalano, R. F.; Kosterman, R.; Abbott, R.; and Hill, K. G. (1999). "Preventing Adolescent Health-Risk Behaviors by Strengthening Protection During Childhood." Archives of Pediatrics and Adolescent Medicine 153:226–234.

Herrenkohl, T. I.; Maguin E.; Hill, K. G.; Hawkins, J. D., Abbott, R. D.; and Catalano, R. F. (2000). "Developmental Risk Factors for Youth Violence." Journal of Adolescent Health 6(3):176–186.

Hutson, H. R.; Anglin, D.; Kyriacou, D. N.; Hart, J.; and Spears, K. (1995). "The Epidemic of Gang-Related Homicides in Los Angeles County from 1979 through 1994." Journal of the American Medical Association (13):1031–1036.

Kachur, S. P.; Steenes, G. M.; Powell, K. E.; Modzeleski, W.; Stephens, R.; Murphy, R. et al. (1996). "School-Associated Violent Deaths in the United States, 1992 to 1994." Journal of the American Medical Association (22):1729–1733.

Li, G.; Baker, S. P.; DiScala, C.; Fowler, C.; Ling, J.; and Kelen, G. D. (1996). "Factors Associated with the Intent of Firearm-Related Injuries in Pediatric Trauma Patients." Archives of Pediatrics & Adolescent Medicine 150(11):1160–1165.

Public Health Service (U.S.) (1991). Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: Government Printing Office.

Public Health Service (U.S.). Department of Health and Human Services (2000). Healthy People 2010 (Conference Edition in Two Volumes). Washington, DC: Government Printing Office.

Rachuba, L.; Stanton, B.; and Howard, D. (1995). "Violent Crime in the United States. An Epidemiologic Profile." Archives of Pediatrics & Adolescent Medicine 149(9):953–960.

Rand, M. R. (1997). Violence-Related Injuries Treated in Hospital Emergency Departments. Bureau of Justice Statistics Special Report, NCJ-156921. Washington, DC: U.S. Department of Justice.

Resnick, M. D.; Bearman, P. S.; Blum, R. W.; Bauman, K. E.; Harris, K. M.; Jones, J. et al. (1997). "Protecting Adolescents from Harm: Findings from the National Longitudinal Study on Adolescent Health." Journal of the American Medical Association 278(10):823–832.

Rosenberg, M. L.; and Fenley, M. A., eds. (1991). Violence in America: A Public Health Approach. London: Oxford University Press.

Rosenberg, M. L.; O'Carroll, P. W.; and Powell, K. E. (1992). "Let's Be Clear: Violence Is a Public Health Problem." Journal of the American Medical Association 267(22):3071–3072.

Zavoski, R. W.; Lapidus, G. D.; Lerer, T. J.; Burke, G.; and Banco, L. I. (1999). "Evaluating the Impact of a Street Barrier on Urban Crime." Injury Prevention 5(1):65–68.