Minnesota Title V MCH Needs Assessment Fact Sheets

Children and Adolescents

Youth Violence/Intentional Injury

September 2004

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Size of the Problem

Youth are disproportionately affected by violence. Between the ages of 12 and 17, they are twice as likely as adults to be victims of serious violent crimes and three times as likely to be victims of simple assault [1].

Homicide is the third leading cause of death for people age 15 to 24 in Minnesota.

The rate of violent crime (including homicide, rape, sexual assault, robbery, and aggravated assault) is higher among people under age 25 than among other age groups (approximately 74 per 1,000) [2].

In 2001, data from the Minnesota Student Survey showed that 38% of 9th grade girls and 59% of 9th grade boys in Minnesota reported that they had been pushed, shoved, or grabbed at school during the past year [3].

Seriousness

Violence surrounds and threatens many young people in their homes, schools and neighborhoods, eroding their sense of safety and stability. Violence takes many forms, and includes verbal, emotional, sexual and physical abuse. In all its forms, violence is most often perpetrated by someone known to the victim, including family members and peers.

Twelve percent of 6th graders and 13% of 9th graders report family violence (a family member has hit someone else in the family so hard as to cause mark or fear) [4].

Whether youth experience violence at home directly, or witness it, violence in the home is harmful. Exposure to violence in the home can also occur through exposure to violent media. Studies indicate that such exposure can increase aggression, and in the case of the Internet, can also increase risk of victimization [5].

Nationally, not going to school because of safety concerns increased significantly between 1993 and 2003 [6].

Youth perceived the following students as the most likely to be victims of school violence: Gay, Lesbian, Bisexual, and Transgender (GLBT) (most likely), overweight students, boys, physically weak students, and trouble makers [7].

The most common violent incidents reported by students were verbal assaults, being pushed, shoved or grabbed, verbal threats, and having something stolen from them [8].

Students reported that school violence makes them feel angry, felt less eager to attend school, feel scared, less inclined to pay attention, and think about changing schools [9].

Forty-four percent of 6th and 9th grade males and approximately 26% of 6th and 9th grade females report having beat up another person in the last 12 months [10].

In a national survey, 25% of teachers see nothing wrong with bullying or putdowns and consequently intervene in only 4% of bullying incidents [11].

The rates (per 100,000 people) of firearm-related homicide (3.7) and nonfatal assaults (14.9) were highest among youth aged 15 to 24 [12].

Youth violence is linked with other risk behaviors. About 65% of all homicides also involved alcohol use by the victim, the perpetrator or both. A similar percentage of stabbings, beating, and domestic violence also involve alcohol [13].

Experiences of victimization are associated with many other health problems, including tobacco, alcohol and other substance use, injuries, early pregnancy, and psychological effects such as Post Traumatic Stress Disorder and depression [14].

Disparities
Analysis of the 2001 Minnesota Student Survey of 6th, 9th, and 12th graders also provided insight into school violence and students with special health care needs [15].

  • Students with special health needs are twice as likely to disagree or strongly disagree with the statement, “I feel safe at school” than their peers.
  • 60% of students with special health needs have been pushed, shoved or grabbed by another student.
  • 52% of students with special health needs have had their property stolen or damaged by another student.

Black youth across all age groups are more likely to be victims of violent crimes than their white counterparts [16]. Black males ages 15 – 19 are murdered at a rate more than seven times that of white males in the same age group [17].

Among African American youth aged 15-24, firearm injury mortality rates are eight times greater than for all other males aged 15-24 in Minnesota. Compared to Whites in Minnesota, African American males in this age group are 25 times more likely to die as a result of firearms [18].

Between 1990-1999, the homicide rate for Latinos was nearly four times higher than for Whites. Homicides from stabbing injuries were over eight times higher and firearm-related homicides were three times higher among Latinos during this same period [19].

The rate (per 100,000 people) of fatal and not-fatal firearm-related injury was three times higher among American Indians as compared to Whites between 1998-2001 [20].

Economic Loss
In 1998, violence cost the United States an estimated $425 billion in direct and indirect costs each year. Of these costs, approximately $90 billion is spent on the criminal justice system, $65 billion on security, $5 billion on the treatment of victims, and $170 billion on lost productivity and quality of life. The annual costs to victims are approximately $178 billion [21].

The most logical way to reduce these costs is to prevent violence altogether. Preventing a single violent crime not only averts the costs of incarceration, it also prevents the short- and long-term costs to victims, including material losses and the costs associated with physical and psychological trauma [22].

Interventions

Violence and intentional injury prevention is most likely to be successful when work occurs at multiple levels simultaneously and when these efforts are connected and integrated. Public health is in a unique position to facilitate and advocate for prevention across these multiple levels.

Promote a safe and supportive home environment. Warm, caring relationships with caregivers and family members have been shown to reduce the risks for violent behavior as well as many other risk behaviors. In order to promote freedom from violence at home, it is important that caregivers have the support and tools they need to parent effectively and model nonviolent behavior. Parent education and support can be very effective in building the capacity of parents.

The parenting education programs, including parent-child development center programs and home visitation by public health nurses to new parents, have demonstrate results in building parenting skills that reduce risk for future violence [23].

The Commission for the Panel on Youth Violence has identified exposure to violent media as a significant contributing factor to youth violence and has recommended increased restrictions and controls in this area [24].

Work with schools to proactively prevent violence. As another environment central to the lives of youth, schools offer further opportunities to promote nonviolence and safety, and to intervene where risk or violence occurs. As a social environment, schools have the capacity to set standards of respect, and to promote warm and supportive relationships within the school community.

Numerous research reviews exist that assess the effectiveness of different school-based violence prevention programs. Efforts that do not comprehensively address violence school-wide and at multiple levels are less likely to be effective. Strategies should also be a permanent component of school environments, rather than temporary programs.

The Olweus Bullying Prevention Program is a program that has been evaluated by the Center of Violence Prevention at the
University of Colorado, and is included in Youth Violence: A Report of the Surgeon General [25]. Full implementation of the program has been found to reduce frequency of bullying reports by up to 50%. This program also found a reduction in vandalism, fighting, theft, and truancy. The social climate of classrooms improved, consistent discipline was established, and students reported positive social relationships and positive attitudes toward schoolwork and school itself.

Bullying programs that concentrate on the high school level are less effective and programs that address only the students exhibiting bullying behavior without a school-wide approach are less likely to show results.

Community involvement in action to prevent youth violence has been included in virtually all major state and national recommendations. Youth development research indicates that youth who have fewer risks and more key protective factors are less likely to engage in violent behavior. The national Commission to Prevent Youth Violence, the National Youth Violence Prevention Resource Center, and others have identified that access to drugs and firearms predicts a greater likelihood of injury-causing violence [26,27].

Community-driven and directed prevention strategies are the most effective way to address the disparity between those enjoying good health and those most effected by injury. Based on evidence to date, an effective strategy would include educational programs on safe storage of and limited access to firearms.

Status

Two of the national healthy objectives for 2010 are to reduce the prevalence of physical fighting among adolescents and to reduce the prevalence of carrying a weapon by adolescents on school property [28]. Minnesota also identified violence as a public health priority with the goal: Promote a violence-free society [29]. Intentional injury is also identified as both a state and federal priority with numerous indicators in Healthy People 2010 and inclusion in Minnesota’s Public Health Improvement Goals [30].

In recent years, youth violence has increasingly been identified as a public health issue. This perspective has brought new opportunities for the synthesis of existing information and ongoing attempts to determine best and promising practices for prevention. At present, prevention approaches and data from many fields, such as education, criminal justice, psychology and public health, are beginning to reflect a growing consensus around key areas for prevention.

Home visiting is offered throughout the state through local public health agencies. Additionally, parent-child development education is offered through Early Childhood Family Education programs statewide. A wide variety of services exist through health plans and local agencies to address violence issues within the home.

In Ramsey County, efforts have taken place through the Initiative for Violence Free Families and Communities to promote successful parenting of teens.

The Jacob Wetterling Foundation offers resources and a speakers' bureau to educate parents and their children about safe use of the internet.

Take a Stand, Lend A Hand, Stop Bullying Now is a national public awareness and prevention campaign through the U.S. Department of Health and Human Services. Launched in 2004, it is the largest bullying prevention campaign designed for 9 to 13 year old youth. It was developed with research-based bullying prevention and intervention strategies.

In 2001, the Minnesota Legislature created the Eliminating Health Disparities Initiative to reduce disparities and improve the health of populations of color and American Indians in the state. The Minnesota Department of Health administers this funding through community and tribal grants. One of the priority health areas is accidental injury and violence.

Youth development approaches have been implemented in many communities in Minnesota, through specific and community-wide programs. Many communities are involved in reducing youth access to alcohol and there are numerous community projects seeking to limit the availability of firearms to youth. Community health service agencies often play an instrumental role in education and other approaches.

References

1. Minnesota Department of Health. (2003). Best practices to prevent youth violence. /injury/best/best.cfm?gcBest=youth. August 20, 2004.
2. Bureau of Justice Statistics. (2000). National Crime Victimization Survey. Washington DC: US Department of Justice.
3. DATA SOURCE: Minnesota Student Survey, 2001.
4. DATA SOURCE: Minnesota Student Survey, 2001.
5. Mann Rinehart, P., Borowsky, I., Stolz, A., Latts, E., Cart, C.U., & Brindis, CD. (1998). Youth violence: Lessons from the experts. Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota & Division of Adolescent Medicine, Department of Pediatrics and Institute for Health Policy Studies, School of Medicine, University of California, San Francisco.
6. CDC. (2004). Violence-related behaviors among high school students – US, 1991-2003. MMWR, 53(29), 651-655.
7. Minnesota Attorney General's Office. 2000 Safe Schools Survey Executive Summary. St. Paul, MN: Author.
8. Minnesota Attorney General's Office. 2000 Safe Schools Survey Executive Summary. St. Paul, MN: Author.
9. Minnesota Attorney General's Office. 2000 Safe Schools Survey Executive Summary. St. Paul, MN: Author.
10. DATA SOURCE: Minnesota Student Survey, 2001.
11. Maternal and Child Health Bureau. Stop Bullying Now Campaign. State Laws Related to Bullying Among Children and Youth. US Health Resources Services Administration
12. Minnesota Department of Health. (2004). Data Brief: Firearm-related injury. /injury/pub/firearm.pdf
13. Adams, P.F., Schoenborn, C.A. & Moss, A.J. (1992). High risk behaviors among our nation’s youth: United States, 1992. (DHHS Pub. No. 95-1520). Hyattsville, Md: National Center for Health Statistics.
14. Peled, E., Jaffe, P.G., & Edleson, J.L. (ed.) (1995). Ending the cycle of domestic violence: Community responses to children of battered women. Thousand Oaks, CA: Sage Publications.
15. DATA SOURCE: Minnesota Student Survey 2001.
16. U.S. Department of Justice, Office of Justice Programs, Victim Characteristics. http://www.ojp.usdoj.gov/bjs/cvict_v.htm. [Attn: Non-MDH Link]
17. U.S. Department of Health and Human Services, National Center for Health Statistics, National Vital Statistics Report, Vol. 49, No. 11, “Deaths: Final Data for 1999”.
18. Minnesota Department of Health. (2004). Eliminating disparities in the health status of African Americans in Minnesota (fact sheet).
19. Minnesota Department of Health. (2004). Eliminating disparities in the health status of Latinos in Minnesota (fact sheet).
20. Minnesota Department of Health. (2004). Eliminating disparities in the health status of Latinos in Minnesota (fact sheet).
21. U.S. Department of Health and Human Services, U.S. Public Health Service. Youth Violence: A report of the Surgeon General.
22. U.S. Department of Health and Human Services, U.S. Public Health Service. Youth Violence: A report of the Surgeon General.
23. U.S. Department of Health and Human Services, U.S. Public Health Service. Youth Violence: A report of the Surgeon General.
24. Commission for the Prevention of Youth Violence. (2000). Youth and violence. Medicine, nursing and public health: Connecting the dots to prevent violence. http://www.ama-assn.org/ama/pub/category/3536.html. [Attn: Non-MDH Link]
25. U.S. Department of Health and Human Services, U.S. Public Health Service. Youth Violence: A report of the Surgeon General. http://surgeongeneral.gov/library/youthviolence/youvioreport.htm. [Attn: Non-MDH Link]
26. Commission for the Prevention of Youth Violence. (2000). Youth and violence. Medicine, nursing and public health: Connecting the dots to prevent violence. http://www.ama-assn.org/ama/pub/category/3536.html. [Attn: Non-MDH Link]
27. National Youth Violence Prevention Resource Center. Youth development as a violence intervention model. http://www.safeyouth.org/topics/dev.htm. [Attn: Non-MDH Link]
28. Healthy People 2010. Accessed 8-4-04. http://www.healthypeople.gov/Document/HTML/Volume1/01Access.htm#_Toc489432807 [Attn: Non-MDH Link]
29. MDH Healthy Minnesotans Public Health Improvement Goals 2004. Accessed 8-4-04. /divs/chs/phg/intro.html
30. Minnesota Department of Health. (1998). Healthy Minnesotans 2004: Public health improvement goals.