The central message of the Surgeon General's recent report on youth violence is that the epidemic of youth violence that began in 1983 and peaked in 1993 is not over. Arrest rates for violent crimes by youth have dropped significantly since 1993, giving cause for hope, but other indicators of violent behavior remain high. The report, released by Surgeon General David Satcher on February 17, also attempts to address the attitude that "nothing works" to prevent violent behavior, insisting that effective prevention programs do exist.

"This is no time to let down our guard on youth violence," Satcher said. "Even so, our success in developing knowledge and tools to prevent serious violence gives us reason for optimism."

The report reviews trends in youth violence over the last 20 years and assesses the state of knowledge concerning the developmental dynamics of youth violence and risk factors associated with youth violence. It also reviews what works and what doesn't work in terms of prevention and intervention, identifying 27 specific programs that have been shown to be effective.

Firearm use declining

The report credits three factors with producing the epidemic of lethal violence from 1983-1993: gangs, drugs and guns. "The combination of increased involvement in gangs, selling drugs on the street, and carrying guns for protection had lethal implications.... It is now clear that the violence epidemic was caused largely by an upsurge in the use of firearms by young people," the report notes.

Current data show arrest rates for violent crimes have been declining since 1994, primarily due to fewer youth using guns. A number of factors are cited as contributing to this reduction in the use of firearms - a decline in youth involvement in the crack cocaine market, police crackdowns on gun carrying, a strong economy, and crime and violence prevention programs - but many other indicators of youth violence remain high. For instance, self-reports of violence have remained at 1993 levels. Therefore, although official statistics like arrest rates have risen and fallen, violent behavior is just as prevalent today as it was during the peak of the youth violence epidemic (see chart).

Correcting myths about youth violence

While the report contains little in the way of concrete policy recommendations, it seeks to dispel certain myths surrounding youth violence. Satcher noted that it is necessary to "correct damaging myths and stereotypes that interfere with the task at hand." The report addresses the following common misconceptions:

• "Most future offenders can be identified in early childhood." In fact, displaying uncontrolled behavior or being diagnosed with a conduct disposer is not necessarily a predictor of violent behavior. Most youth involved in violent behavior during adolescence were nor highly aggressive as children. Likewise, most youth with mental or behavioral disorders are not violent. Nor do physical abuse and neglect inevitably lead to violent behavior later in life. In fact, they are relatively weak predictors of violence.
• "African American and Hispanic youths are more likely to become involved in violence than other racial or ethnic groups." While arrest records show large differences between African American and white youth, data from confidential interviews shows little difference in prevalence rates for serious violent behavior. Racial and ethnic differences in homicide rates increased between 1983 and 1993 and have declined since then. Race has often been considered a risk factor for youth violence, but studies that have controlled for other risk factors have mostly found no independent effect of race on youth violence.
• "Getting tough with juvenile offenders by trying them in adult criminal courts reduces the likelihood that they will commit more crimes." On the country, youth transferred to adult criminal court are significantly more likely to reoffend than youth who remain in the juvenile justice system.
• "Weapons-related injuries in schools have increased dramatically in the last 5 years. "Contrary to public perceptions, schools are relatively safe compared to the homes and neighborhoods in which youth live. The number of schools homicides declined throughout the 1990s and fever students are bringing guns or other weapons to school.

Effective prevention programs do exist

About one-third of the report is devoted to identifying which intervention and prevention strategies are working and which ones are failing. Almost half of the most thoroughly evaluated programs have been shown to be ineffective and a few have even been shown to harm participants.

"[W] e cannot afford to waste resources on ineffective or harmful interventions or strategies - or to further jeopardize the well-being of youth who may be assigned to ineffective programs" Satcher stated.

The report divides prevention and intervention strategies into three classes:

1. Universal - relevant for all youth.
2. Selected - targeted to high-risk youth.
3. Indicated - targeted to youth already involved in violent or seriously delinquent behavior.

Some of these programs address youth violence directly while others target significant risk factors, such as drug use.

Two of the most effective universal strategies are skill development and behavior management. Skills-oriented programs may teach social skills, emotional competence or problem solving. Some programs involve parents - e.g., teaching parenting skills, effective family communication and anger-management. Most behavior management approaches are school-based and include behavior monitoring and reinforcement and the use of behavioral techniques in classroom management. Through these techniques, teachers reinforce pro-social behavior and may work with students to establish rules of behavior.

Successful strategies targeted to at-risk youth and those already involved in violent behavior often combine an orientation on skill development with more active intervention. Successful programs include teaching moral reasoning, social problem solving, social perspective talking, training parents in child management skills and home visitation by a nurse of other professional. Several of the promising programs address multiple contexts affecting risk of violence, including family- and community-based strategies and wraparound services in which comprehensive packages of services are designed for particular individuals.

Some strategies that have received considerable attention appear to be ineffective at reducing violence or associated risk factors. Peer-led programs, including peer meditation, have consistently been shown to be unsuccessful for general prevention. Also, programs that aim at redirecting youth behavior or changing peer group norms have had no effect, or in some cases, have had the negative effect of increasing the cohesiveness of delinquent peer groups. Boot camps, residential programs and waivers to adult court have sometimes had a similar effect of modeling and reinforcing delinquent behavior.

Limiting exposure to violence in the media

For many years, the link between violence and the media has been a matter of public concern and a subject of scientific investigation. On average, children spend over four hours a day watching television or videotapes or using computers and video games. Research has shown that exposure to violence in the media increases physically and verbally aggressive behavior in the short term, but the long-term effects of media violence are still unclear.

The Surgeon General's report asserts that violent behavior is rarely the result of a single cause and media violence is best considered as one of many potential factors that shape violent behavior. Nevertheless, the report concludes that existing evidence is sufficient to justify attempting to limit the effects of media violence on children and youth. The report suggests the following steps that families can take to reduce the amount of media violence that reaches children:

• Adopting V-chip technology for television.
• Using Internet screening.
• Close monitoring of children's use of media.

In support of families, community organizations can teach parents and children how to become more critical consumers of media. Federal agencies can encourage needed research, share research findings with the public, encourage interaction between violence researchers and media researchers, and help create networks to share solutions to social and public health problems.

Looking to the future

One of the main challenges for the future is disseminating programs that have been successful and making sure that they are implemented effectively. According to the report, "Many programs are ineffective not because their strategy is misguided, but because the quality of implementation is poor." Special attention needs to be paid to ensure that programs remain true to their original design when they are replicated on a broad scale.

The report also suggests the following:

• Continue scientific research.
• Accelerate the decline in gun use.
• Help youth into effective intervention programs rather than incarcerating them.
• Provide training for intervention personnel.
• Educate the public about effective intervention strategies.
• Convene a periodic youth violence summit, including youth, families, researches, and private and public organizations.
• Improve practices for reporting crime and violent deaths.

A full copy of Youth Violence: A report of the Surgeon General is available on the Surgeon General's Web site at www.surgeongeneral.gov/library/youthviolence/.

A transcript of the Surgeon General's January 17 interview with CNN can be found online at www.cnn.com/chat/transcripts/2001/01/17/satcher/.