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|  | **Chapter 1:**Introduction
Scope, Focus, and Overarching Themes

Secondary Areas of Concern

Youth Violence: The Public Health Approach

Myths About Youth Violence

Sources of Data and Standards of Evidence
- Data Sources  Standards of Scientific Evidence for Multidisciplinary ResearchLevel of Evidence
Overview of the Report's Chapters
Chapter Conclusions
Chapter 2
- Chapter 3  Chapter 4Chapter 5
Preparation of the Report
References
Chapter 1                                        Introduction
The decade between 1983 and 1993 was marked by an unprecedented surge of violence,                         often lethal violence, among young people in the United States. For millions of youths and                         their families, a period of life that should have been distinguished by good health and great                         promise was instead marred by injuries, disability, and death (Cook & Laub, 1998). This                         epidemic of violence not only left lasting scars on victims, perpetrators, and their families and                         friends, it also wounded communities and, in ways not yet fully understood, the country as a whole.

Since 1993, the peak year of the epidemic, there have been some encouraging signs that youth                         violence is declining. Three important indicators of violent behavior—arrest records,                         victimization data, and hospital emergency room records—have shown significant downward trends                         nationally. These official records reveal only a small part of the picture, however.

A fourth key indicator of violence—confidential reports by youths themselves—reveals that the                         proportion of young people who acknowledge having committed serious, potentially lethal acts of                         physical violence has remained level since the peak of the epidemic. In 1999, for instance, there                         were 104,000 arrests of persons under age 18 for robbery, forcible rape, aggravated assault, or                         homicide (Snyder, 2000); of those arrests, 1,400 were for homicides perpetrated by adolescents                         (Snyder, 2000) and, occasionally, even younger children (Snyder & Sickmund, 1999). Yet in any                         given year in the late 1990s, at least 10 times as many youths reported that they had engaged in                         some form of violent behavior that could have seriously injured or killed another person.

The high prevalence of violent behavior reported by adolescents underscores the importance of this report at this time.

Americans cannot afford to become complacent. Even though youth violence is less lethal today                         than it was in 1993, the percentage of adolescents involved in violent behavior remains alarmingly                         high. The epidemic of lethal violence that swept the United States  was fueled in large part by                         easy access to weapons, notably firearms—and youths' self-reports of violence indicate that the                         potential for a resurgence of lethal violence exists. Yet viewing homicide as a barometer of all                         youth violence can be quite misleading. Similarly, judging the success of violence prevention efforts                         solely on the basis of reductions in homicides can be unwise.

This report, the first Surgeon General's report on youth violence in the United States, summarizes                         an extensive body of research and seeks to clarify seemingly contradictory trends, such as the                         discrepancies noted above between official records of youth violence and young people's self-reports                         of violent behaviors. It describes research identifying and clarifying the factors that increase the risk,                         or statistical probability, that a young person will become violent, as well as studies that have begun to                         identify developmental pathways that may lead a young person into a violent lifestyle. The report also                         explores the less well developed research area of factors that seem to protect youths from viewing                         violence as an acceptable—or inevitable—way of approaching or responding to life events. Finally, the report                         reviews research on the effectiveness of specific strategies and programs designed to reduce and prevent youth violence.

As these topics suggest, the key to preventing a great deal of violence is understanding where and when                         it occurs, determining what causes it, and scientifically documenting which of many strategies for prevention                         and intervention are truly effective. This state-of-the-science report summarizes progress toward those goals.

The most important conclusion of the report is that the United States is well past the "nothing works" era with                         respect to reducing and preventing youth violence. Less than 10 years ago, many observers projected an                         inexorably rising tide of violence; the recent, marked reductions in arrests of young perpetrators and in                         victimization reports appear to belie those dire predictions. We possess the knowledge and tools needed to                         reduce or even prevent much of the most serious youth violence. Scientists from many disciplines, working in                         a variety of settings with public and private agencies, are generating needed information and putting it to use                         in designing, testing, and evaluating intervention programs.

The most urgent need now is a national resolve to confront the problem of youth violence systematically, using                         research-based approaches, and to correct damaging myths and stereotypes that interfere with the task at                         hand. This report is designed to help meet that need.

The report makes it clear that after years of effort and massive expenditures of public and private                         resources, the search for solutions to the problem of youth violence remains an enormous challenge                         (Lipton et al., 1975; Sechrest et al., 1979). Some traditional as well as seemingly innovative approaches to                         reducing and preventing youth violence have failed to deliver on their promise, and successful approaches                         are often eclipsed by random violent events such as the recent school shootings that have occurred in                         communities throughout the country.

Youth violence is a high-visibility, high-priority concern in every sector of U.S. society. We have come to understand that young people in every community are involved in violence, whether the community is a small town or central city, a neatly groomed suburb, or an isolated rural region. Although male adolescents, particularly those from minority groups, are disproportionately arrested for violent crimes, self-reports indicate that differences between minority and majority populations and between male and female adolescents may not be as large as arrest records indicate or conventional wisdom holds. Race/ethnicity, considered in isolation from other life circumstances, sheds little light on a given child's or adolescent's propensity for engaging in violence.

This chapter describes the scope and focus of the report and explains how the public health approach advances efforts to understand and prevent youth violence. Common myths about youth violence are presented and debunked. Uncorrected, these myths lead to misguided public policies, inefficient use of public and private resources, and loss of traction in efforts to address the problem. Documentation for the facts that counter these myths appears in later chapters. This chapter also lays out the scientific basis of the report—that is, the standards of evidence that research studies had to meet in order to be included in the report and the sources of data cited throughout. Final sections of this chapter preview subsequent chapters and list the report's major conclusions.

SCOPE, FOCUS, AND OVERARCHING THEMES
The mission of the Surgeon General is to protect and improve the public health of the Nation, and this report was developed within the responsibilities and spirit of that mission. The designation of youth violence as a public health concern is a recent development. As discussed below in greater detail, public health offers an approach to youth violence that focuses on prevention rather than consequences. It provides a framework for research and intervention that draws on the insights and strategies of diverse disciplines. Tapping into a rich but often fragmented knowledge base about risk factors, preventive interventions, and public education, the public health perspective calls for examining and reconciling what are frequently contradictory conclusions about youth violence.

Although the public health approach opens up a broad array of considerations, the focus of this initial report is the perpetration by juveniles of interpersonal physical assault that carries a significant risk of injury or death. As restrictive as it may at first appear, this focus draws on a wealth of research into individual, family, school, peer group, and community factors that are associated with serious violence in the second decade of life. This report defines serious violence as aggravated assault, robbery, rape, and homicide; hereafter, it refers simply to "violence" or "violent crime," thus avoiding repetitious use of the terms "serious violence" or "serious violent crime."

The report views violence from a developmental perspective. It examines the interactions of youths' personal characteristics and the social contexts in which they live—as well as the timing of those interactions—to understand why some young people become involved in violence and some do not. This perspective considers a range of risks over the life course, from prenatal factors to factors influencing whether patterns of violent behavior in adolescence will persist into adulthood. The developmental perspective has enabled scientists to identify two general onset trajectories of violence: one in which violent behaviors emerge before puberty, and one in which they appear after puberty. Of the two, the early-onset trajectory provides stronger evidence of a link between early childhood experiences and persistent, even lifelong involvement in violent behavior. The developmental perspective is important because it enables us to time interventions for the particular point or stage of life when they will have the greatest positive effect.

The young people on whom this report focuses are principally children and adolescents from about age 10 through high school. Research reviewed in Chapter 4 shows that although risk factors for violence vary by stage of development, most youth violence emerges during the second decade of life. Appropriate interventions before and—as is increasingly well documented—*during*this period have a good chance of redirecting violent young people toward healthy and constructive adult lives. The window of opportunity for effective interventions opens early and rarely, if ever, closes.

SECONDARY AREAS OF CONCERN
Many legitimate concerns and issues that are indisputably associated with violence by young people are not addressed in depth in this first report. Behavioral patterns marked by aggressiveness, antisocial behavior, verbal abuse, and externalizing (the acting out of feelings) are peripheral to the main focus of the report. These behaviors may include violent physical interactions, such as hitting, slapping, and fist-fighting, that can have significant consequences but generally present little likelihood of serious injury or death. Therefore, such behaviors will be discussed only to the extent that they can be considered risk factors for violence.

Research has shown that victims and offenders share many personal characteristics and that victimization and perpetration of violent behavior are often entwined. Nonetheless, this report does not focus on victims of violence perpetrated by young offenders. Rather, it blends offender-based research with traditional public health concepts of prevention and intervention in an effort to bridge the gap between criminology and the social and developmental sciences, on the one hand, and traditional public health approaches to youth violence, on the other.

The report does not address violence against intimate partners, except when such violence is committed by a young person. The plight of victims, many of whom are children and adolescents, is of the utmost importance, but a key element in helping victims of violence is understanding the perpetrators of violence. Particular categories of crime, such as dating violence and hate crimes (motivated by racist or homophobic attitudes, for example), are important manifestations of violence, including violence committed by youths, and they demand research and targeted interventions. The limited amount of research conducted in this area has focused on victims, so there is little scientific evidence about what distinguishes perpetrators of these specific types of crimes (see reviews by Bergman, 1992; Comstock, 1991; and D'Augelli & Dark, 1984).

Self-directed violence—that is, self-inflicted injury and suicide—is not covered either. In collaboration with other Federal health agencies, the Office of the Surgeon General developed a National Strategy for the Prevention of Suicide (U.S. Public Health Service, 1999). In directing national attention to suicide as a major, yet largely preventable public health problem, the Surgeon General is bringing together health professional organizations, educators, health care executives, and managed care clinical directors to discuss gaps in scientific knowledge that impede efforts to decrease the incidence of suicide among Americans of all ages. The vast majority of youth suicides occur in the context of mental disorders (Brent et al., 1988; Shaffer et al., 1996), a topic that was reviewed in depth in the Surgeon General's report on mental health (U.S. DHHS, 1999).

Finally, the report does not propose public policy to reduce or prevent youth violence. The purpose of this report, like others from U.S. Surgeons General, is to review and describe existing knowledge in order to provide a basis for action at all levels of society. The last chapter identifies potential courses of action, including specific areas in which research is needed, but suggesting whether and how such action will lend itself to policy development is beyond the purview of this report.

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